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The management of dyspnea in cancer patients: a systematic review

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Abstract

Goals of work

The goal of the study is to evaluate the effectiveness of four drug classes (opioids, phenothiazines, benzodiazepines, and systemic corticosteroids) for relieving dyspnea experienced by advanced cancer patients.

Materials and methods

A systematic literature review was conducted to July 2006. Search sources included MEDLINE, EMBASE, HealthSTAR, CINAHL, and the Cochrane Library. Four reviewers selected evidence using predefined criteria: controlled trials not limited to cancer and involving the specified drug classes for dyspnea treatment.

Main results

Three systematic reviews, one with meta-analysis, two practice guidelines, and 28 controlled trials were identified. Most examined the effect of opioids, generally morphine, on dyspnea. Although the results of individual trials were mixed, the systematic review with meta-analysis detected a significant benefit for dyspnea with systemic opioids; two small placebo-controlled trials in cancer patients found systemic morphine reduced dyspnea, and dihydrocodeine also significantly reduced dyspnea in four placebo-controlled trials. Nebulized morphine was not effective in controlling dyspnea in any study or the meta-analysis. No controlled trials examined systemic corticosteroids in the treatment of cancer patients, and of the other non-opioid drugs examined, only oral promethazine, a phenothiazine, showed some benefit in the relief of dyspnea. Studies varied in methodological quality.

Conclusions

Systemic opioids, administered orally or parenterally, can be used to manage dyspnea in cancer patients. Oral promethazine may also be used, as a second-line agent if systemic opioids cannot be used or in addition to systemic opioids. Nebulized morphine, prochlorperazine, and benzodiazepines are not recommended for the treatment of dyspnea, and promethazine must not be used parenterally.

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Acknowledgements

The Program in Evidence-Based Care is supported by, but editorially independent of, Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care. No potential conflicts of interest with regard to this review were declared by the authors.

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Authors and Affiliations

  1. Palliative Care Medicine Program, Queen’s University, 34 Barrie Street, Kingston, Ontario, K7L 3J7, Canada

    Raymond Viola

  2. Credit Valley Hospital, 2200 Eglinton Avenue West, Mississauga, Ontario, L5M 2N1, Canada

    Cathy Kiteley

  3. McMaster University/Cancer Care Ontario Program in Evidence-Based Care, 1280 Main Street West, Downtown Centre, 3rd Floor, Hamilton, L8S 4L8, Ontario, Canada

    Nancy S. Lloyd, Jean A. Mackay & Julie Wilson

  4. Department of Radiation Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Rebecca K. S. Wong

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  1. Raymond Viola
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Supportive Care Guidelines Group of the Cancer Care Ontario Program in Evidence-Based Care

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Correspondence to Raymond Viola.

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A complete list of Supportive Care Guidelines Group members is available at: http://www.cancercare.on.ca/.

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Viola, R., Kiteley, C., Lloyd, N.S. et al. The management of dyspnea in cancer patients: a systematic review. Support Care Cancer 16, 329–337 (2008). https://doi.org/10.1007/s00520-007-0389-6

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  • DOI: https://doi.org/10.1007/s00520-007-0389-6

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