Dexamethasone for Dyspnea in Cancer Patients: A Pilot Double-Blind, Randomized, Controlled Trial

Abstract

ContextDexamethasone is often used to treat dyspnea in cancer patients, but evidence is lacking. ObjectivesWe determined the feasibility of conducting a randomized trial of dexamethasone in cancer patients and estimated the efficacy of dexamethasone in the treatment of dyspnea. MethodsIn this double-blind, randomized, controlled trial, patients with dyspnea ≥4 were randomized to receive either dexamethasone 8 mg twice daily × four days then 4 mg twice daily × three days or placebo for seven days, followed by an open-label phase for seven days. We documented the changes in dyspnea (0–10 numeric rating scale), spirometry measures, quality of life, and toxicities. ResultsA total of 41 patients were randomized and 35 (85%) completed the blinded phase. Dexamethasone was associated with a significant reduction in dyspnea numeric rating scale of −1.9 (95% CI −3.3 to −0.5, P = 0.01) by Day 4 and −1.8 (95% CI −3.2 to −0.3, P = 0.02) by Day 7. In contrast, placebo was associated with a reduction of −0.7 (95% CI −2.1 to 0.6, P = 0.38) by Day 4 and −1.3 (95% CI −2.4 to −0.2, P = 0.03) by Day 7. The between-arm difference was not statistically significant. Drowsiness improved with dexamethasone. Dexamethasone was well tolerated with no significant toxicities. ConclusionA double-blind, randomized, controlled trial of dexamethasone was feasible with a low attrition rate. Our preliminary data suggest that dexamethasone may be associated with rapid improvement in dyspnea and was well tolerated. Further studies are needed to confirm our findings. Trial RegistrationClinicalTrials.govNCT01670097.