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. 2021 Apr 20;39(12):1389-1411.
doi: 10.1200/JCO.20.03465. Epub 2021 Feb 22.

Management of Dyspnea in Advanced Cancer: ASCO Guideline

David Hui  1 , Kari Bohlke  2 , Ting Bao  3 , Toby C Campbell  4 , Patrick J Coyne  5 , David C Currow  6 , Arjun Gupta  7 , Aliza L Leiser  8 , Masanori Mori  9 , Stefano Nava  10 , Lynn F Reinke  11 , Eric J Roeland  12 , Carole Seigel  13 , Declan Walsh  14 , Margaret L Campbell  15
Affiliations

Management of Dyspnea in Advanced Cancer: ASCO Guideline

David Hui et al. J Clin Oncol. .

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.Additional information is available at www.asco.org/supportive-care-guidelines.

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Conflict of interest statement

Reprint Requests: 2318 Mill Road, Suite 800, Alexandria, VA 22314; guidelines@asco.org David HuiResearch Funding: Helsinn Healthcare Toby C. CampbellConsulting or Advisory Role: HeronOther Relationship: Agrace Hospice & Palliative Care David C. CurrowConsulting or Advisory Role: Mayne Pharma, Specialised Therapeutics, Helsinn HealthcarePatents, Royalties, Other Intellectual Property: Intellectual Property—Mayne PharmaTravel, Accommodations, Expenses: Helsinn Therapeutics Masanori MoriHonoraria: Shionogi, Chugai Pharma, Kyowa Hakko Kirin, Daiichi Sankyo, Lilly Japan Stefano NavaConsulting or Advisory Role: Breas Eric J. RoelandConsulting or Advisory Role: Napo Pharmaceuticals, AIM Specialty Health, Oragenics, BASF, Vector Oncology, Asahi Kasei, Heron, Pfizer/EMD Serono, Astellas Pharma, Helsinn TherapeuticsExpert Testimony: Regents of the University of California Declan WalshLeadership: NualtraStock and Other Ownership Interests: NualtraHonoraria: Helsinn TherapeuticsConsulting or Advisory Role: Helsinn TherapeuticsResearch Funding: NualtraNo other potential conflicts of interest were reported.

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