Management of Dyspnea in Advanced Cancer: ASCO Guideline.

Hui, D; Bohlke, K; Bao, T; Campbell, TC; Coyne, PJ; Currow, DC; Gupta, A; Leiser, AL; Mori, M; Nava, S; Reinke, LF; Roeland, EJ; Seigel, C; Walsh, D; Campbell, ML

Management of Dyspnea in Advanced Cancer: ASCO Guideline.

Hui, D Bohlke, K Bao, T Campbell, TC Coyne, PJ Currow, DC Gupta, A Leiser, AL Mori, M Nava, S Reinke, LF Roeland, EJ Seigel, C Walsh, D Campbell, ML

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Publisher:: American Society of Clinical Oncology
Publication Type:: Journal Article
Citation:: Journal of Clinical Oncology, 2021, 39, (12), pp. 1389-1411
Issue Date:: 2021-04

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Field	Value	Language
dc.contributor.author	Hui, D
dc.contributor.author	Bohlke, K
dc.contributor.author	Bao, T
dc.contributor.author	Campbell, TC
dc.contributor.author	Coyne, PJ
dc.contributor.author	Currow, DC
dc.contributor.author	Gupta, A
dc.contributor.author	Leiser, AL
dc.contributor.author	Mori, M
dc.contributor.author	Nava, S
dc.contributor.author	Reinke, LF
dc.contributor.author	Roeland, EJ
dc.contributor.author	Seigel, C
dc.contributor.author	Walsh, D
dc.contributor.author	Campbell, ML
dc.date.accessioned	2021-11-11T04:38:07Z
dc.date.available	2021-11-11T04:38:07Z
dc.date.issued	2021-04
dc.identifier.citation	Journal of Clinical Oncology, 2021, 39, (12), pp. 1389-1411
dc.identifier.issn	0732-183X
dc.identifier.issn	1527-7755
dc.identifier.uri	http://hdl.handle.net/10453/151511
dc.description.abstract	PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS 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. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A meta-analysis of specialty breathlessness services reported improvements in distress because of dyspnea. RECOMMENDATIONS A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	American Society of Clinical Oncology
dc.relation.ispartof	Journal of Clinical Oncology
dc.relation.isbasedon	10.1200/jco.20.03465
dc.rights	info:eu-repo/semantics/embargoedAccess
dc.subject	1103 Clinical Sciences, 1112 Oncology and Carcinogenesis
dc.subject.classification	Oncology & Carcinogenesis
dc.subject.mesh	Dyspnea
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Practice Guidelines as Topic
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Dyspnea
dc.subject.mesh	Practice Guidelines as Topic
dc.subject.mesh	Dyspnea
dc.subject.mesh	Humans
dc.subject.mesh	Neoplasms
dc.subject.mesh	Practice Guidelines as Topic
dc.title	Management of Dyspnea in Advanced Cancer: ASCO Guideline.
dc.type	Journal Article
utslib.citation.volume	39
utslib.location.activity	United States
utslib.for	1103 Clinical Sciences
utslib.for	1112 Oncology and Carcinogenesis
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
utslib.copyright.embargo	2021-12-01T00:00:00+1000Z
dc.date.updated	2021-11-11T04:38:06Z
pubs.issue	12
pubs.publication-status	Published
pubs.volume	39
utslib.citation.issue	12

Abstract:

PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS 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. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A meta-analysis of specialty breathlessness services reported improvements in distress because of dyspnea. RECOMMENDATIONS A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed.

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http://hdl.handle.net/10453/151511