What are the ONS treatment guidelines for dyspnea in palliative cancer care?

Updated: Aug 13, 2018
  • Author: Winston W Tan, MD, FACP; more...
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Answer

Answer

The only treatment for dyspnea recommended in the Oncology Nursing Society (ONS) guidelines is parenteral or oral immediate-release opioids. For patients with a life expectancy of years to months to weeks, the ONS deemed the following interventions “likely to be effective“ [11] :

  • Temporary ventilator support for severe, reversible conditions
  • Oxygen therapy
  • Benzodiazepines for anxiety
  • Increasing ambient airflow directed at the face or nose
  • Providing cooler temperatures
  • Promoting relaxation and stress reduction
  • Providing educational, emotional, and psychosocial support for patients and family caregivers, and referring to other disciplines as appropriate

For patients with a life expectancy of weeks to days, the ONS recommendations are as follows:

  • Reduce excessive secretions with scopolamine, hyoscyamine, or atropine
  • Implement oxygen therapy, if the patient reports subjective relief with it
  • Institute sedation as needed
  • Discontinue fluid support; consider low‐dose diuretics if fluid overload may be a contributing factor

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