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Prophylaxis and treatment of cancer-related dyspnea with pharmacologic agents: A systematic review and network meta-analysis

Published online by Cambridge University Press:  14 October 2021

Ronald Chow Open the ORCID record for Ronald Chow [Opens in a new window] ,
David Hui ,
Saverio Caini ,
Charles B. Simone II ,
Elizabeth Prsic ,
Gabriel Boldt  and
Michael Lock
Ronald Chow*
Affiliation:
New York Proton Center, Memorial Sloan Kettering Cancer Center, New York, NY London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, ON, Canada
David Hui
Affiliation:
MD Anderson Cancer Center University of Texas, Houston, TX
Saverio Caini
Affiliation:
Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
Charles B. Simone II
Affiliation:
New York Proton Center, Memorial Sloan Kettering Cancer Center, New York, NY
Elizabeth Prsic
Affiliation:
Yale New Haven Hospital, Yale University, New Haven, CT
Gabriel Boldt
Affiliation:
London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, ON, Canada
Michael Lock
Affiliation:
London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, ON, Canada
*
Author for correspondence: Ronald Chow, New York Proton Center, Memorial Sloan Kettering Cancer Center, New York, NY. E-mail: [email protected]
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Abstract

Introduction

Cancer-related dyspnea is a common symptom in patients with cancer. It has also been reported to be a predictor of poorer prognosis, which can then change clinical treatment and advance care planning. Currently, no definitive recommendation for pharmacologic agents for cancer-related dyspnea exists. The aim of this systematic review and network meta-analysis is to compare pharmacologic agents for the prophylaxis and treatment of cancer-related dyspnea.

Methods

A search was conducted in the databases of PubMed, Embase, and Cochrane CENTRAL through May 2021. Standardized mean differences (SMDs), as reported by studies or calculated from baseline and follow-up dyspnea scores, were amalgamated into a summary SMD and 95% confidence interval (CI) using a restricted maximum likelihood multivariate network meta-analysis.

Results

Twelve studies were included in this review; six reported on prophylaxis of exertional dyspnea, five on treatment of everyday dyspnea, and one on treatment of episodic dyspnea. Morphine sulfate was better at controlling everyday dyspnea than placebo (SMD 1.210; 95% CI: 0.415–2.005). Heterogeneity in study design and comparisons, however, led to some concerns with the underlying consistency assumption in network meta-analysis design.

Conclusion

Optimal pharmacologic interventions for cancer-related dyspnea could not be determined based on this analysis. Further trials are needed to report on the efficacy of pharmacologic interventions for the prophylaxis and treatment of cancer-related dyspnea.

Keywords

Cancer-related dyspneaMeta-analysisPalliative carePharmacologic interventionsSystematic review
Type
Review Article
Information
Palliative & Supportive Care , Volume 20 , Issue 5 , October 2022 , pp. 744 - 751
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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