Effect of dexamethasone on dyspnoea in patients with cancer (ABCD): a parallel-group, double-blind, randomised, controlled trial

Hui, David; Puac, Veronica; Shelal, Zeena; Dev, Rony; Hanneman, Sandra K.; Jennings, Kristofer; Ma, Huaxian; Urbauer, Diana L.; Shete, Sanjay; Fossella, Frank V.; Liao, Zhongxing; Blumenschein, George R.; Chang, Joe Y.; O’Reilly, Michael; Gandhi, Saumil; Tsao, Anne S.; Mahler, Donald A.; Bruera, Éduardo

doi:10.1016/s1470-2045(22)00508-3

Cited by 15 publications

(8 citation statements)

References 30 publications

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“…1 In a recently reported randomized trial, high-dose dexamethasone did not improve dyspnea in patients with cancer more effectively than a placebo, but was associated with a higher frequency of adverse events. 14 Given these circumstances, construction of evidence of the ways to relieve dyspnea, especially those under palliative care, is urgent.…”

Section: Discussionmentioning

confidence: 99%

A phase II study of High-Flow Nasal Cannula for relieving dyspnea in advanced cancer patients.

Takase

Akamatsu

Teraoka

et al. 2023

Preprint

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Background: The efficacy and tolerability of high-flow nasal cannula (HFNC) for relieving dyspnea in advanced cancer patients with limited prognosis requires elucidation. Methods: Patients with advanced cancer who had dyspnea at rest (numeric rating scale, NRS≥3) and respiratory failure were enrolled. They were treated with HFNC for five days. Primary endpoint was change of mean modified Borg scale at 24 hours. Key secondary endpoints consisted of change in modified Borg scale during the study period and feasibility (Trial Identifier, UMIN000035738). Results: Between 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 change of mean modified Borg scale was 1.4 (80% confidence interval [CI]: 0.8–1.9) at 24 hours, 11 patients showed 1.5 points improvement of modified Borg scale. Within 1 hour, nine patients showed 1.5 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. Conclusion: To our knowledge, this trial is the first prospective study to show the efficacy and tolerability of HFNC regarding dyspnea for five days in patients under palliative care. HFNC can be a palliative treatment option in advanced cancer patients with dyspnea.

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Section: Discussionmentioning

confidence: 99%

A phase II study of High-Flow Nasal Cannula for relieving dyspnea in advanced cancer patients.

Takase

Akamatsu

Teraoka

et al. 2023

Preprint

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“…Importantly, patients in the dexamethasone group had a higher incidence of Grade 3+ adverse effects than placebo ( n =45 vs. 7), with insomnia (Grades 1–4 39%; Grade 3+ 8%), dyspepsia (Grades 1–4 23%; Grade 3+ 2%), infections (Grades 1–4 22%; Grade 3+ 10%), neuropsychiatric symptoms (Grades 1–4 15%; Grade 3+ 3%), and edema (Grades 1–4 18%; Grade 3+ 0%) being particularly common 24▪▪ . In addition, 28% of patients in the dexamethasone group were hospitalized for serious adverse events compared to 7% in the placebo group.…”

Section: Clinical Trialsmentioning

confidence: 94%

“…Building on the findings of this pilot trial, we conducted a larger double-blind, randomized clinical trial to assess the efficacy and safety of high-dose dexamethasone for dyspnea in cancer patients (Fig. 1B) 24▪▪ . Patients were assigned in 2:1 ratio to 2 weeks of dexamethasone or placebo.…”

Section: Clinical Trialsmentioning

confidence: 99%

“…Design of double-bind randomized clinical trials of high-dose dexamethasone for dyspnea in cancer patients. (A) Pilot trial 23 ; (B) confirmatory trial 24▪▪ . PO, oral.…”

Section: Clinical Trialsmentioning

confidence: 99%

“…The authors stated that no conclusions could be drawn due to insufficient evidence. It should be noted that these systematic reviews were both published prior to the most recent negative trial 24▪▪ .…”

Section: Systematic Reviewsmentioning

confidence: 99%

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The role of corticosteroids in the palliation of dyspnea in cancer patients: an evidence-based review

Hui,

Yennurajalingam

2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review To provide an evidence-based review on the use of corticosteroids for dyspnea in cancer patients. Recent findings Corticosteroids are commonly used for palliation of dyspnea; however, there is wide variation in how they are prescribed due to the paucity of high-quality evidence. Some clinicians would offer corticosteroids routinely regardless of the causes of dyspnea, while others would only prescribe corticosteroids selectively for specific indications, such as lymphangitic carcinomatosis, upper airway obstruction, superior vena cava obstruction, and cancer treatment-induced pneumonitis. Few mechanistic studies have been conducted to support the use of corticosteroids in cancer patients. Two double-blind, placebo-controlled randomized trials have examined the routine use of high-dose dexamethasone for dyspnea in cancer patients. A pilot study suggested some benefits, but the larger confirmatory trial revealed no improvement compared to the placebo and significantly more adverse events. The selective use of corticosteroids use is only based on observational studies such as case series. Summary The unfavorable risk:benefit ratio of high-dose dexamethasone suggests that it should not be routinely prescribed for dyspnea in cancer patients. More research is needed to assess the selective use of corticosteroids and identify patients most likely be benefit from corticosteroid use.

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Current Management Options for Dyspnea in Cancer Patients

Mori

Miwa

Ikari

et al. 2023

Curr. Treat. Options in Oncol.

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Effect of dexamethasone on dyspnoea in patients with cancer (ABCD): a parallel-group, double-blind, randomised, controlled trial

Cited by 15 publications

References 30 publications

A phase II study of High-Flow Nasal Cannula for relieving dyspnea in advanced cancer patients.

A phase II study of High-Flow Nasal Cannula for relieving dyspnea in advanced cancer patients.

The role of corticosteroids in the palliation of dyspnea in cancer patients: an evidence-based review

Current Management Options for Dyspnea in Cancer Patients

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