• Eri Takase, Hiroaki Akamatsu, Shunsuke Teraoka, Keita Nakaguchi, Masanori Tanaka, Takahiro Kaki, Katsuyuki Furuta, Koichi Sato, Eriko Murakami, Takeya Sugimoto, Ryota Shibaki, Daichi Fujimoto, Atsushi Hayata, Nahomi Tokudome, Yuichi Ozawa, Yasuhiro Koh, Masanori Nakanishi, Kuninobu Kanai, Toshio Shimokawa, and Nobuyuki Yamamoto.
• Internal Medicine III (E.T., H.A., S.T., K.N., M.T., T.K., K.F., K.S., E.M., T.S., R.S., D.F., A.H., N.T., Y.O., Y.K., M.N., N.Y.), Wakayama Medical University, Wakayama, Japan.
• J Pain Symptom Manage. 2024 Mar 1; 67 (3): 204211.e1204-211.e1.

ContextThe efficacy and tolerability of high-flow nasal cannula (HFNC) for relieving dyspnea in advanced cancer patients with limited prognosis requires elucidation.ObjectivesThe primary aim of this trial was to assess the efficacy and tolerability of HFNC regarding dyspnea including severe as well as moderate for longer durations in patients under palliative care.MethodsIn this prospective study, hospitalized patients with advanced cancer who had dyspnea at rest (numeric rating scale, NRS≥3) and hypoxemia were enrolled. They were treated with HFNC for five days in the respiratory unit. Primary endpoint was mean change of modified Borg scale at 24 hours. Key secondary endpoints consisted of mean changes in modified Borg scale during the study period and feasibility (Trial Identifier, UMIN000035738).ResultsBetween February 2019 and February 2022, 25 patients were enrolled and 21 were analyzed. Twenty patients used inspired oxygen and the mean fraction of inspired oxygen (FiO2) was 0.34 (range, 0.21-1.0). At baseline, mean NRS (dyspnea) was 5.9 (range, 3-10). Median survival time was 19 days (range, 3-657). The mean change of modified Borg scale was 1.4 (80% confidence interval [CI]: 0.8-1.9) at 24 hours, 12 patients (57%) showed 1.0 points improvement of modified Borg scale. Within two hours, 15 patients showed 1.0 points improvement of modified Borg scale and such early responders were likely to maintain dyspnea improvement for 24 hours. Nineteen patients could continue HFNC for 24 hours and 11 patients completed five days of HFNC.ConclusionTo our knowledge, this trial is the first prospective study to assess the five-day efficacy and tolerability of HFNC for dyspnea in patients under palliative care. Although this did not reach the prespecified endpoint, about half of the patients showed 1.0 point improvement, a minimally clinically important difference (MCID) in the chronic lung disease. HFNC can be a palliative treatment option in advanced cancer patients with dyspnea.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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