Know Your Guidelines 2022 Series: The ASCO Management of Dyspnea in Advanced Cancer Guideline Review

Authors: Christopher D. Jackson, MD, Alana J. Schilthuis, MD, Kenneth C. Guice, DO, Katie S. Payne, MD, Tracey D. Dabal, MD


Dyspnea is a subjective, yet complex experience of breathlessness, even in the absence of overt hypoxia. Although the pathophysiology of dyspnea is not fully understood, abnormalities of sensation in the brainstem, chest wall, and lungs play a role. Because of the limits of objective findings, many clinicians easily overlook this vital symptom.1 Air hunger can severely affect the quality of life of patients with advanced cancer. Estimates suggest that 70% of this patient population experiences dyspnea.2
Posted in: Medical Oncology44

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1. Meriggi F. Dyspnea in cancer patients: a well-known and neglected symptom. Rev Recent Clin Trials 2018;13:84–88.
2. McKenzie E, Hwang MK, Chan S, et al. Predictors of dyspnea in patients with advanced cancer. Ann Palliat Med 2018;7:427–436.
3. Dudgeon DJ, Kristjanson L, Sloan JA, et al. Dyspnea in cancer patients: prevalence and associated factors. J Pain Symptom Manage 2001;21: 95–102.
4. Maltoni M, Caraceni A, Brunelli C, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 2005;23:6240–6248.
5. Hui D, Bohlke K, Bao T, et al. Management of dyspnea in advanced cancer: ASCO guideline. J Clin Oncol 2021;39:1389–1411.
6. Higginson IJ, Bausewein C, Reilly CC, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. Lancet Respir Med 2014;2: 979–987.
7. Kako J, Morita T, Yamaguchi T, et al. Fan therapy is effective in relieving dyspnea in patients with terminally ill cancer: a parallel-arm, randomized controlled trial. J Pain Symptom Manage 2018;56:493–500.
8. Wong SL, Leong SM, Chan CM, et al. The effect of using an electric fan on dyspnea in Chinese patients with terminal cancer. Am J Hosp Palliat Care 2017;34:42–46.
9. Luckett T, Phillips J, Johnson MJ, et al. Contributions of a handheld fan to self-management of chronic breathlessness. Eur Respir J 2017;50:1700262.
10. Galbraith S, Fagan P, Perkins P, et al. Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. J Pain Symptom Manage 2010;39:831–838.
11. Tan S-B, Liam C-K, Pang Y-K, et al. The effect of 20-minute mindful breathing on the rapid reduction of dyspnea at rest in patients with lung diseases: a randomized controlled trial. J Pain Symptom Manage 2019;57: 802–808.
12. Moore S, Corner J, Haviland J, et al. Nurse led follow-up and conventional medical follow up in management of patients with lung cancer: randomised trial. BMJ 2002;325:1145.
13. Bredin M, Corner J, Krishnasamy M, et al. Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. BMJ 1999;318:901–904.
14. Barnes H, McDonald J, Smallwood N, et al. Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database Syst Rev 2016;3:CD011008.
15. Ekstrom M, Bajwah S, Bland JM, et al. One evidence base; three stories: do opioids relieve chronic breathlessness? Thorax 2018;73:88–90.
16. Luo N, Tan S, Li X, et al. Efficacy and safety of opioids in treating cancer-related dyspnea: a systematic review and met