Abstract
Objectives: To evaluate the efficacy of a brief tailored non-pharmacological intervention comprising breathing retraining and psychosocial support for managing dyspnea in cancer patients.Design: Multicenter, single blinded, parallel group, randomized controlled trial.Setting: Four major public hospitals, Brisbane, Australia.Participants: One hundred and forty four cancer patients, including 81 who received an 8-week tailored intervention and 63 who received standard care.Inclusion Criteria: Diagnosis of small or non-small cell lung cancer, mesothelioma or lung metastases; completed first line therapy for the disease; average dyspnea rating >2 on (0–10) rating scale in past week; anticipated life expectancy ≥3 months.Outcomes: The primary outcome measure was change in “worst” dyspnea at 8 weeks compared to baseline. Secondary outcomes were change in: dyspnea “at best” and “on average”; distress; perceived control over dyspnea; functional status, psychological distress; and use of non-pharmacological interventions to manage dyspnea at 8 weeks relative to baseline.Results: The mean age of participants was 67.9 (SD = 9.6) years. Compared to the control group, the intervention group demonstrated a statistically significant: (i) improvement in average dyspnea from T1(M = 4.5, SE = 0.22) to T3 (M = 3.6, SE = 0.24) vs. (M = 3.8, SE = 0.24) to (M = 4.1, SE = 0.26); (ii) greater control over dyspnea from T1 (M = 5.7, SE = 0.28) to T3 (M = 7.5, SE = 0.31) vs. (M = 6.8, SE = 0.32) to (M = 6.6, SE = 0.33); and (iii) greater reduction in anxiety from T1 (M = 5.4, SE = 0.43) to T3 (M = 4.5, SE = 0.45) vs. (M = 4.2, SE = 0.49) to (M = 4.6, SE = 0.50). This study found no intervention effect for best and worst dyspnea, distress from breathlessness, functional status, and depression over time.Conclusions: This study demonstrates efficacy of tailored non-pharmacological interventions in improving dyspnea on average, control over dyspnea, and anxiety for cancer patients.Clinical Trial Registration: The trial is registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au). The registration number is ACTRN12607000087459.
Highlights
Dyspnea is a common and distressing symptom experienced by many people with advanced cancer
This study found no intervention effect for best and worst dyspnea, distress from breathlessness, functional status, and depression over time
This study demonstrates efficacy of tailored non-pharmacological interventions in improving dyspnea on average, control over dyspnea, and anxiety for cancer patients
Summary
Dyspnea is a common and distressing symptom experienced by many people with advanced cancer. Compared to other cancer types, dyspnea is most common and most severe in primary lung cancer patients, affecting 90% of this patient group [2]. Causes of dyspnea in advanced disease are complex and multifactorial, including obstructions or restrictions directly related to lung or pleural involvement or its treatments, factors indirectly related to the disease such as infections, anemia, or respiratory muscle weakness from cachexia, and from comorbid conditions that may be unrelated to the primary presenting problem, such as underlying chronic obstructive pulmonary disease or heart failure [3, 4]. Dyspnea is an especially complex symptom to assess and treat in practice, as the threshold of perception varies widely, with the severity of disease not always directly related to the intensity of breathing discomfort [8]
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