Management of Dyspnea in Advanced Cancer
Publication Date: January 31, 2021
Last Updated: March 14, 2022
Recommendations
Screening and assessment
1.1. Clinicians should perform systematic assessment of dyspnea at every inpatient and outpatient encounter in patients with advanced cancer using validated patient-reported outcome measures.
(good practice statement)
6539
1.2. For patients who are unable to self-report, clinicians should use a validated observation measure.
(good practice statement)
6539
1.3. Whenever possible, patients with dyspnea should undergo a comprehensive evaluation for the severity, chronicity, potential causes, triggers, and associated symptoms, as well as emotional and functional impact.
(good practice statement)
6539
Treatment of underlying causes
2.1. Patients with potentially reversible, common etiologies of dyspnea such as pleural effusion, pneumonia, airway obstruction, anemia, asthma, chronic obstructive pulmonary disease (COPD) exacerbation, pulmonary embolism, or treatment-induced pneumonitis should be given goal-concordant treatment(s) consistent with their wishes, prognosis, and overall health status.
(good practice statement)
6539
2.2. Patients with dyspnea because of underlying malignancy (eg, lymphangitic carcinomatosis, atelectasis because of large pulmonary mass, malignant pleural effusion) may benefit from cancer-directed treatments if consistent with their wishes, prognosis, and overall health status.
(good practice statement)
6539
2.3. Patients with underlying comorbidities such as COPD or heart failure should have the management of these conditions optimized.
(good practice statement)
6539
Referral to palliative care
3.1. Patients with advanced cancer and dyspnea should be referred to an interprofessional palliative care team where available.
6539
Nonpharmacologic interventions
4.1. Airflow interventions such as directing a fan at the cheek (trigeminal nerve distribution) should be offered.
6539
4.2. Standard supplemental oxygen should be available for patients with hypoxemia who are experiencing dyspnea (ie, SpO2 ≤ 90% on room air).
6539
4.3. Supplemental oxygen is not recommended when SpO2 > 90%.
6539
4.4. A time-limited therapeutic trial of high-flow nasal cannula oxygen therapy, if available, may be offered to patients who have significant dyspnea and hypoxemia despite standard supplemental oxygen.
6539
4.5. A time-limited therapeutic trial of noninvasive ventilation, if available, may be offered to patients who have significant dyspnea despite standard measures and do not have contraindications.
6539
4.6. Other nonpharmacologic measures such as breathing techniques, posture, relaxation, distraction, meditation, self-management, physical therapy, and music therapy may be offered.
6539
4.7. Acupressure or reflexology, if available, may be offered.
6539
4.8. Evidence remains insufficient for a recommendation for or against pulmonary rehabilitation in patients with advanced cancer and dyspnea.
6539
Pharmacologic interventions
5.1. Systemic opioids should be offered to patients with dyspnea when nonpharmacologic interventions are insufficient to provide dyspnea relief.
6539
5.2. Short-acting benzodiazepines may be offered to patients who experience dyspnea-related anxiety and continue to experience dyspnea despite opioids and other nonpharmacologic measures.
6539
5.3. Systemic corticosteroids may be offered to select patients with airway obstruction or when inflammation is likely a key contributor of dyspnea.
6539
5.4. Bronchodilators should be used for palliation of dyspnea when patients have established obstructive pulmonary disorders or evidence of bronchospasm.
6539
5.5. Evidence remains insufficient for a recommendation for or against the use of antidepressants, neuroleptics, or inhaled furosemide for dyspnea.
6539
5.6. Continuous palliative sedation should be offered to patients with dyspnea that is refractory to all standard treatment options and all applicable palliative options, and who have an expected life expectancy of days.
6539
Recommendation Grading
Overview
Title
Management of Dyspnea in Advanced Cancer
Authoring Organization
American Society of Clinical Oncology
Publication Month/Year
January 31, 2021
Last Updated Month/Year
November 1, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer.
Target Patient Population
Adult patients with advanced cancer and dyspnea.
Target Provider Population
Clinicians who provide care to adult patients with cancer
PICO Questions
How should dyspnea be assessed in patients with advanced cancer?
What underlying conditions cause or contribute to dyspnea and warrant specific management?
What is the role of palliative care in the management of dyspnea?
What nonpharmacologic interventions provide palliation of dyspnea?
What pharmacologic interventions provide palliation of dyspnea?
Inclusion Criteria
Male, Female, Adult
Health Care Settings
Ambulatory, Home health, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant, social worker
Scope
Management
Diseases/Conditions (MeSH)
D004417 - Dyspnea
Keywords
dyspnea, Clinical Guideline, Advanced cancer, air hunger
Source Citation
Hui D, et al. J Clin Oncol. 2021 Feb 22. doi: 10.1200/JCO.20.03465