Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

Abstract

As there is a high propensity for patients with advanced malignancy to experience refractory dyspnea, it is necessary for physicians to be well-versed in the management of these patients’ dyspneic symptoms. For symptomatic treatment of cancer patients with dyspnea, both pharmacologic and non-pharmacologic methods should be considered. The main source of pharmacologic symptom management for dyspnea is oral and parenteral opioids; benzodiazepines and corticosteroids may serve as helpful adjuncts alongside opioid treatments. However, oxygen administration and nebulized loop diuretics have not been shown to clinically benefit dyspneic cancer patients. Applying non-pharmacologic dyspnea management methods may be valuable palliative therapies for advanced cancer patients, as they provide benefit with negligible harm to the patient. Advantageous and minimally harmful non-pharmacologic dyspnea therapies include facial airflow, acupuncture and/or acupressure, breathing exercises, cognitive behavioral therapy, music therapy, and spiritual interventions. Thus, it is vital that physicians are prepared to provide symptomatic care for dyspnea in advanced cancer patients as to minimize suffering in this patient population during definitive cancer treatments or hospice care.

Opioids for the management of dyspnea in cancer patients: a systematic review and meta-analysis

“…It is also important to consider adjustments in activities of daily living and the environment. When treatment for the cause is difficult or no more effective, pharmacological and non-pharmacological palliative therapies are used to alleviate symptoms [ 7 , 8 ].…”

“…Opioids are widely used as pharmacological therapy to relieve dyspnea in cancer patients and are recommended as first-line pharmacological therapy by several guidelines [ 7 , 9 , 10 ]. Among them, the usefulness of systemic morphine for dyspnea in cancer patients has been widely reported, and in recent years, the usefulness of other opioids such as fentanyl and oxycodone has also been reported in some non-randomized studies [ 8 ]. However, currently available studies employ multiple rating scales, and their sample sizes are small and follow-up periods are relatively short.…”