Immediate Effect of Fan Therapy in Terminal Cancer With Dyspnea at Rest: A Meta-Analysis

Abstract

Background: Dyspnea is a common distressing symptom in patients with malignant and nonmalignant diseases. Fan therapy, which uses a fan to blow air toward the patient’s face, can alleviate dyspnea; however, its efficacy remains unclear. Aim: To examine the immediate efficacy of fan therapy for alleviation of dyspnea at rest. Design: Meta-analysis. Data sources: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and Scopus from January 1, 1987, to August 21, 2018 (PROSPERO-CRD42018108610). In addition, we hand-searched studies and used the similar articles feature on PubMed to search for articles. Randomized controlled trials comparing the effects of fan therapy with placebo or other interventions to alleviate dyspnea at rest, in which patients were aged ≥18 years, were eligible for inclusion in the review. We excluded articles on long-term intervention involving fan therapy and complex intervention (including fan therapy). The risk of bias assessment was conducted using the Cochrane tool, and the meta-analysis was performed using RevMan version 5.3. Results: We identified a total of 218 studies; 2 met our criteria for inclusion in the meta-analysis. Fan therapy significantly improved dyspnea at rest in terminally ill patients with cancer compared to control groups (mean difference: −1.31, 95% confidence interval: −1.79 to −0.83, P < .001). There were no studies that met the inclusion criteria regarding fan therapy for patients with nonmalignant disease. Conclusions: This meta-analysis demonstrated that fan therapy may be an effective intervention for dyspnea at rest in patients with terminal cancer.

Fan-on-Face Therapy in Relieving Dyspnea of Adult Terminally Ill Cancer Patients: A Meta-Analysis

“…[16][17][18] In contrast to the other recently published meta-analysis, which only looked into the effect of fan-on-face therapy on improvement in dyspnea score, this updated review attempted to look into potential physiologic improvements by fan-on-face therapy with the inclusion of mean change in RR as surrogate outcome. 9 The present pooled analysis has shown significant improvement in mean change in RR. Admittedly, change in RR is potentially confounded by factors other than fan-on-face therapy such as the effect of opioids, which are commonly given in the palliative care of cancer patients.…”

“…8 Finally, four full-text journals were eligible for inclusion. For the missing data of the study by Kako et al, 9 the corresponding author was contacted and the raw data for pre-and post-intervention values of RR were provided. The flow of literature search is shown in ►Fig.…”

“…7,8 Here we present the results of an updated systematic review and meta-analysis of clinical trial data on the use of fan-on-face therapy as an adjunct to standard therapy to relieve dyspnea in terminally ill adult cancer patients. 9 The mean change in self-reported dyspnea score was used to measure its clinical impact. Mean change in respiratory rate (RR), an objective parameter of improved breathing and adequate ventilation, was also taken into consideration as a surrogate for fan-on-face therapy's potential physiologic benefits.…”

Unanswered questions and future direction in the management of terminal breathlessness in patients with cancer

“…In a recent parallel-arm RCT that evaluated the effect of fan therapy on breathlessness in 40 terminally ill patients with cancer compared with a fan-to-legs group, the mean breathlessness scores decreased more significantly in the intervention group 66. A recent meta-analysis also demonstrated the immediate benefit of fan therapy on breathlessness at rest compared with a control group 64. As evidence is limited, it is unclear whether non-pharmacological management other than fan therapy is effective for terminal breathlessness.…”

“…Recent systematic reviews on non-pharmacological interventions for breathlessness relief in patients with advanced diseases showed the effectiveness of fan therapy, neuroelectrical muscle stimulation, chest wall vibration, walking aids, breathing training and holistic services 62–65. Among these, fan therapy may be readily available for patients with cancer with terminal breathlessness.…”