We conducted a systematic review of randomized controlled trials assessing all pharmacologic and nonpharmacologic interventions for
dyspnea palliation in
cancer patients, and searched the Cochrane Library, MEDLINE, conference proceedings, and references. Two reviewers independently appraised the quality of trials and extracted data.
RESULTS: Our search yielded 18 trials. Fourteen evaluated pharmacologic interventions: seven assessing
opioids (a total of 256 patients), five assessing
oxygen (137 patients), one assessing
helium-enriched air, and one assessing
furosemide. Four trials evaluated nonpharmacologic interventions (403 patients). The administration of subcutaneous
morphine resulted in a significant reduction in
dyspnea Visual Analog Scale (VAS) compared with placebo. No difference was observed in
dyspnea VAS score when nebulized
morphine was compared with subcutaneous
morphine, although patients preferred the nebulized route. The addition of
benzodiazepines to
morphine was significantly more effective than
morphine alone, without additional adverse effects.
Oxygen was not superior to air for alleviating
dyspnea, except for patients with
hypoxemia. Nursing-led interventions improved
breathlessness. Acupuncture was not beneficial.
CONCLUSION: Our review supports the use of
opioids for
dyspnea relief in
cancer patients. The use of supplemental
oxygen to alleviate
dyspnea can be recommended only in patients with
hypoxemia. Nursing-led nonpharmacologic interventions seem valuable. Only a few studies addressing this question were performed. Thus, further studies evaluating interventions for alleviating
dyspnea are warranted.