Dyspnea management in advanced cancer: ASCO Guideline
USA: The American Society of Clinical Oncology (ASCO) has released guideline on clinical management of dyspnea in adult patients with advanced cancer. The guideline is published in the Journal of Clinical Oncology.
ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020.
Screening and Assessment
- Clinicians should perform systematic assessment of dyspnea at every inpatient and outpatient encounter in patients with advanced cancer using validated patient-reported outcome measures.
- For patients who are unable to self-report, clinicians should use a validated observation measure.
- Whenever possible, patients with dyspnea should undergo a comprehensive evaluation for the severity, chronicity, potential causes, triggers, and associated symptoms, as well as emotional and functional impact.
Treatment of Underlying Causes
- Patients with potentially reversible, common etiologies of dyspnea such as pleural effusion, pneumonia, airway obstruction, anemia, asthma, chronic obstructive pulmonary disease (COPD) exacerbation, pulmonary embolism, or treatment-induced pneumonitis should be given goal-concordant treatment(s) consistent with their wishes, prognosis, and overall health status.
- Patients with dyspnea because of underlying malignancy (eg, lymphangitic carcinomatosis, atelectasis because of large pulmonary mass, malignant pleural effusion) may benefit from cancer-directed treatments if consistent with their wishes, prognosis, and overall health status.
- Patients with underlying comorbidities such as COPD or heart failure should have the management of these conditions optimized.
Referral to Palliative Care
- Patients with advanced cancer and dyspnea should be referred to an interprofessional palliative care team where available.
- Airflow interventions such as directing a fan at the cheek (trigeminal nerve distribution) should be offered.
- Standard supplemental oxygen should be available for patients with hypoxemia who are experiencing dyspnea (ie, SpO2 ≤ 90% on room air).
- Supplemental oxygen is not recommended when SpO2 > 90%.
- A time-limited therapeutic trial of high-flow nasal cannula oxygen therapy, if available, may be offered to patients who have significant dyspnea and hypoxemia despite standard supplemental oxygen.
- A time-limited therapeutic trial of noninvasive ventilation, if available, may be offered to patients who have significant dyspnea despite standard measures and do not have contraindications.
- Other nonpharmacologic measures such as breathing techniques, posture, relaxation, distraction, meditation, self-management, physical therapy, and music therapy may be offered.
- Acupressure or reflexology, if available, may be offered.
- Evidence remains insufficient for a recommendation for or against pulmonary rehabilitation in patients with advanced cancer and dyspnea.
Source : Journal of Clinical Oncology