Fan Therapy Helps Relieve Breathlessness Associated With Advanced Cancers

Fan therapy and bi-level ventilation helped relieve breathlessness lasting for a few minutes to a few hours for patients with advanced cancers admitted to the hospital.

In advanced cancer patients experiencing breathlessness, blowing air from a fan into their face may offer symptom relief, revealed new research published in JAMA Oncology and directed by Johns Hopkins Kimmel Cancer Center investigators.

Opioid medications had a limited impact on improving breathlessness in advanced cancer patients.

Dyspnea / Shortness of Breath
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‘Fan therapy and bi-level ventilation helped relieve breathlessness lasting for a few minutes to a few hours for patients with advanced cancers admitted to the hospital.’

Researchers found several nonpharmacological interventions, including fan therapy and bi-level ventilation, were linked to improved breathlessness in a systematic review of 29 randomized clinical trials of breathlessness in 2,423 adults with advanced cancer. Bi-level ventilation is the air pressure delivered through a face mask covering the mouth and nose).

A more comprehensive companion report, including results from both nonpharmacological and pharmacological interventions for breathlessness, was published the same day by the Agency for Healthcare Research and Quality (AHRQ), which sponsored this study along with the American Society of Clinical Oncology (ASCO) and the Patient-Centered Outcomes Research Institute.

These findings inform an upcoming ASCO Clinical Practice Guideline on managing breathlessness in patients with advanced cancer.

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"Breathlessness, or dyspnea, is a common and distressing symptom in patients with advanced cancer," says lead author of the JAMA Oncology article, Arjun Gupta, M.D., chief medical oncology fellow at the Johns Hopkins Kimmel Cancer Center.

"Breathlessness can be associated with and made worse by accompanying anxiety, and can severely impact quality of life and exercise capacity. In patients with advanced cancer, treating the underlying cause of breathlessness (such as the cancer itself) may provide incomplete symptom relief or may not be feasible. In these scenarios, treating the symptom of breathlessness may be indicated. However, patients in this situation are often vulnerable with limited time to recover, and a question that comes up for clinicians is, are the potential benefits of this intervention likely to outweigh the harms?"

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Medications such as opioids and benzodiazepines are often used to treat breathlessness in patients with advanced cancer. However, researchers couldn't understand how well they worked on these patients.

These drugs can also cause side effects such as drowsiness and constipation. Therefore, researchers performed a comprehensive review of interventions (both nonpharmacological and pharmacological) to improve breathlessness.

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On the outpatient side, acupressure, reflexology, and multicomponent interventions (combining activity and rehabilitation with behavioral, psychosocial, and integrative medicine), brought relief lasting for a few weeks to months.

Risks associated with nonpharmacological interventions were minimal.

Opioids in Treating Breathlessness

In the accompanying AHRQ report of 50 studies, the authors found that opioids were not more effective than placebo or anti-anxiety medications for improving breathlessness.

There were no differences in effectiveness between different doses or routes of administration. Anti-anxiety drugs were not more effective than placebo for improving breathlessness.

"We believe these data should catalyze a shift in how we approach and treat breathlessness, away from a medicalized approach using drugs, to a more comprehensive assessment and attempting nonpharmacologic interventions, such as fan therapy, first," Gupta says. "Clinical guidelines and practice should evolve to represent these novel findings."

Source-Medindia