Dyspnea management in advanced cancer: ASCO Guideline
Pharmacologic Interventions
- Systemic opioids should be offered to patients with dyspnea when nonpharmacologic interventions are insufficient to provide dyspnea relief.
- Short-acting benzodiazepines may be offered to patients who experience dyspnea-related anxiety and continue to experience dyspnea despite opioids and other nonpharmacologic measures.
- Systemic corticosteroids may be offered to select patients with airway obstruction or when inflammation is likely a key contributor of dyspnea.
- Bronchodilators should be used for palliation of dyspnea when patients have established obstructive pulmonary disorders or evidence of bronchospasm.
- Evidence remains insufficient for a recommendation for or against the use of antidepressants, neuroleptics, or inhaled furosemide for dyspnea.
- 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.
"Given the high prevalence of this symptom in patients with advanced cancer, its distressing nature, and functional impact, more high-quality research is needed to develop novel interventions to support patients and informal caregivers. Funding agencies need to prioritize dyspnea interventions to catalyze research in this area. Collaboration among investigators would allow sharing of expertise to optimize study designs, facilitate multicenter recruitment to increase sample size, and maximize generalizability and knowledge translation," wrote the authors.
The guideline titled, "Management of Dyspnea in Advanced Cancer: ASCO Guideline," is published in the Journal of Clinical Oncology.
DOI: https://ascopubs.org/doi/full/10.1200/JCO.20.03465
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