Building the Palliative Care Evidence Base: Lessons From a Randomized Controlled Trial of Oxygen vs Room Air for Refractory Dyspnea

Abstract

Palliative Care is increasingly seen as a standard component of high-quality comprehensive cancer care. However, there remain several challenges to its widespread integration into clinical oncology practice, including workforce problems, reimbursement concerns, and a fledgling evidence base. Here we discuss issues around evidence base development in palliative cancer care, using the example of a recently-published randomized controlled trial of oxygen vs. room air. The Oxygen Trial randomized patients with refractory dyspnea and adequate PaO2 to oxygen or room air, administered via nasal cannula. Both groups experienced improvements in self-rated dyspnea scores, but there were no statistical differences between intervention arms. These results suggest that supplementary oxygen is often unnecessary in the palliative setting, and that room air is similarly efficacious. This example highlights the importance and need for ongoing development of the evidence base in palliative medicine. The Palliative Care Research Cooperative Group (PCRC) is a novel National Institute of Nursing Research-funded research infrastructure that seeks to expand the palliative care evidence base. Its first multi-site trial was recently completed, assessing the pragmatic question of whether statin medications can be safely discontinued in end-of-life settings. The PCRC will be a vehicle through which a high-quality evidence base will continue to expand and develop. Such ongoing research efforts are needed to inform and improve palliative care practice.

Palliative Care and Symptom Management in Older Patients with Cancer

“…Oxygen delivered by a nasal cannula provides no additional symptomatic benefit for relief of refractory dyspnea in patients with life-limiting illness compared with room air. (50)…”

Dying With Dyspnea in the Hospital

“…Further study should document nonpharmacologic management of dyspnea in addition to opioid use (ie, positioning, air versus oxygen, fans, and noninvasive ventilation) for hospitalized patients at end of life as we examine our routine practices and develop evidence to improve care. 13,14 Despite these limitations, our study does reflect findings of earlier studies and indicates the continued need for a standardized approach to assessing, documenting, and treating dyspnea in the hospitalized patient near the end of life. Collaboration with palliative care clinicians may provide patient care, education, or assistance to develop protocols at hospitals to improve care of individuals dying in the hospital.…”

Control of Pain and Dyspnea in Non-Pharmacological Interventions: Patients with Oncologic Disease in Acute Care

“…Non-pharmacological strategies aimed at functional and respiratory rehabilitation, cold application, adoption of healthy lifestyles, education for self-management/counseling, psycho-emotional support and relaxation/ visualization exercises in anxiety control and referral to others health professionals/ services allow better control of dyspnea (ONS, 2011) [23][24][25][26][27].…”