Comparative effectiveness of pharmacological and non-pharmacological interventions for dyspnea management in advanced cancer: A systematic review and network meta-analysis

IF 2.4 3区医学 Q1 NURSING

Asia-Pacific Journal of Oncology Nursing Pub Date : 2025-02-18 DOI:10.1016/j.apjon.2025.100671

An Thuy Vo , Kim-Ngan Thi Ta , Kai-Jen Chuang

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引用次数: 0

Abstract

Objective

This study aimed to evaluate and rank the effectiveness of pharmacological and non-pharmacological interventions for managing dyspnea severity, anxiety, exercise capacity, and health-related quality of life (HRQoL) in patients with advanced cancer.

Methods

A comprehensive search of PUBMED, HINARI, CENTRAL, and ResearchGate was conducted to identify randomized controlled trials (RCTs) published up to March 2024. Network meta-analysis was performed to compare interventions, calculating mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI). P-scores were used to rank the interventions. Risk of bias was assessed using the Cochrane tool, and the quality of evidence (QOE) was evaluated using the GRADE framework.

Results

A total of 42 RCTs, encompassing 3,832 patients, were included in the analysis. Among the evaluated interventions, high-flow nasal cannula (HFNC) demonstrated the most significant improvement in dyspnea relief (SMD = −1.91; 95% CI: −3.32 to −0.49; QOE: moderate), followed by acupressure/reflexology (SMD = −1.04; 95% CI: −2.02 to −0.06; QOE: very low). Activity rehabilitation was the only intervention that significantly reduced anxiety compared to the control group (SMD = −0.64; 95% CI: −0.97 to −0.32; QOE: very low). While all interventions showed trends of improving exercise capacity, none reached statistical significance. Notably, acupressure/reflexology significantly enhanced HRQoL (SMD = 1.55; 95% CI: 0.22 to 2.88; QOE: moderate).

Conclusions

Non-pharmacological interventions, particularly HFNC and acupressure/reflexology, were more effective than pharmacological approaches in improving dyspnea relief and HRQoL. However, the low quality of evidence underscores the need for high-quality, large-scale trials to confirm these findings and refine treatment strategies for dyspnea management in advanced cancer patients.

Systematic review registration

PROSPERO CRD42023479041.

查看原文本刊更多论文

方法对PUBMED、HINARI、CENTRAL和ResearchGate进行了全面检索，以确定截至2024年3月发表的随机对照试验（RCT）。通过网络荟萃分析对干预措施进行比较，计算平均差异（MD）和标准化平均差异（SMD）以及 95% 置信区间（CI）。P值用于对干预措施进行排序。使用 Cochrane 工具评估了偏倚风险，并使用 GRADE 框架评估了证据质量（QOE）。在接受评估的干预措施中，高流量鼻插管（HFNC）在缓解呼吸困难方面的改善最为显著（SMD = -1.91; 95% CI: -3.32 to -0.49；QOE：中度），其次是穴位按摩/反射疗法（SMD = -1.04; 95% CI: -2.02 to -0.06；QOE：极低）。与对照组相比，活动康复是唯一能显著降低焦虑的干预措施（SMD = -0.64；95% CI：-0.97 至 -0.32；QOE：非常低）。虽然所有干预措施都显示出提高运动能力的趋势，但都没有达到统计学意义。值得注意的是，穴位按摩/反射疗法显著提高了 HRQoL（SMD = 1.55；95% CI：0.22 至 2.88；QOE：中等）。结论在改善呼吸困难缓解和 HRQoL 方面，非药物干预，尤其是高频核磁和穴位按摩/反射疗法，比药物疗法更有效。然而，由于证据质量较低，因此需要进行高质量的大规模试验来证实这些发现，并完善晚期癌症患者呼吸困难管理的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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