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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.

Keywords

dyspnea terminal cancer palliative care meta-analysis nursing fan therapy

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References

Parshall

Schwartzstein

Adams

, et al. An official American thoracic society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435–452.

Bruera

Schmitz

Pither

Neumann

Hanson

. The frequency and correlates of dyspnea in patients with advanced cancer. J Pain Symptom Manage. 2000;19(5):357–362.

Chang

Curtis

Patrick

Raghu

. Assessment of health-related quality of life in patients with interstitial lung disease. Chest. 1999;116(5):1175–1182.

Nordgren

Sörensen

. Symptoms experienced in the last six months of life in patients with end-stage heart failure. Eur J Cardiovasc Nurs. 2003;2(3):213–217.

Skilbeck

Mott

Page

Smith

Hjelmeland-Ahmedzai

Clark

. Palliative care in chronic obstructive airways disease: a needs assessment. Palliat Med. 1998;12(4):245–254.

Solano

Gomes

Higginson

. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage. 2006;31(1):58–69.

Bausewein

Booth

Gysels

Higginson

. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev. 2008;16(2):CD005623.

Currow

Smith

Davidson

Newton

Agar

Abernethy

. Do the trajectories of dyspnea differ in prevalence and intensity by diagnosis at the end of life? A consecutive cohort study. J Pain Symptom Manage. 2010;39(4):680–690.

Reuben

Mor

. Dyspnea in terminally ill cancer patients. Chest. 1986;89(2):234–236.

10.

Booth

Silvester

Todd

. Breathlessness in cancer and chronic obstructive pulmonary disease: using a qualitative approach to describe the experience of patients and carers. Palliat Support Care. 2003;1(4):337–344.

11.

Simon

Basner

Weinberger

Fencl

Weiss

Schwartzstein

. Oral mucosal stimulation modulates intensity of breathlessness induced in normal subjects. Am Rev Respir Dis. 1991;144(2):419–422.

12.

Schwartzstein

Lahive

Pope

Weinberger

Weiss

. Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis. 1987;136(1):58–61.

13.

Burgess

Whitelaw

. Effects of nasal cold receptors on pattern of breathing. J Appl Physiol (1985). 1988;64(1):371–376.

14.

Oncology Nursing Society. Symptom interventions. Dyspnea. https://www.ons.org/pep/dyspnea. Updated April 27, 2017. Accessed March 28, 2019.

15.

NCCN Clinical Practice Guidelines in Oncology. Palliative care (version 2. 2019) https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf. Updated February 8, 2019. Accessed April 1, 2019.

16.

Kvale

Selecky

Prakash

; American College of Chest Physicians. Palliative care in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(suppl 3):368S–403S.

17.

Swan

Booth

. The role of airflow for the relief of chronic refractory breathlessness. Curr Opin Support Palliat Care. 2015;9(3):206–211.

18.

Booth

Farquhar

Gysels

Bausewein

Higginson

. The impact of a breathlessness intervention service (BIS) on the lives of patients with intractable dyspnea: a qualitative phase 1 study. Palliat Support Care. 2006;4(3):287–293.

19.

Farquhar

Higginson

Fagan

Booth

. The feasibility of a single-blinded fast-track pragmatic randomised controlled trial of a complex intervention for breathlessness in advanced disease. BMC Palliat Care. 2009;8(1):9.

20.

Farquhar

Prevost

McCrone

, et al. Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial. BMC Med. 2014;12(1):194.

21.

Johnson

Booth

Currow

Lam

Phillips

. A mixed-methods, randomized, controlled feasibility trial to inform the design of a phase III trial to test the effect of the handheld fan on physical activity and carer anxiety in patients with refractory breathlessness. J Pain Symptom Manage. 2016;51(5):807–815.

22.

Qian

Rozman de Moraes

, et al. Fan therapy for the treatment of dyspnea in adults: a systematic review. J Pain Symptom Manage. 2019;S0885–3924(19)30179–4. doi:10.1016/j.jpainsymman.2019.04.011.

23.

Swan

Newey

Bland

, et al. Airflow relieves chronic breathlessness in people with advanced disease: an exploratory systematic review and meta-analyses. Palliat Med. 2019;33(6):618–633.

24.

Moher

Liberati

Tetzlaff

Altman

; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med. 2009;6(7):e1000097.

25.

Higgins

JPT

Green

, eds. Cochrane Handbook for Systematic Reviews of Interventions Ver 5.1.0 (updated March 2011). British, England: Wiley-Blackwell; 2011.

26.

Galbraith

Fagan

Perkins

Lynch

Booth

. Does the use of a handheld fan improve chronic dyspnea? a randomized, controlled, crossover trial. J Pain Symptom Manage. 2010;39(5):831–838.

27.

Wong

Leong

Chan

Kan

Cheng

. The effect of using an electric fan on dyspnea in Chinese patients with terminal cancer: a randomized controlled trial. Am J Hosp Palliat Care. 2017;34(1):42–46.

28.

Kako

Morita

Yamaguchi

, et al. Fan therapy is effective in relieving dyspnea in in patients with terminally ill cancer: a parallel-arm, randomized controlled trial. J Pain Symptom Manage. 2018;56(4):493–500.

29.

Abernethy

McDonald

Frith

, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376(9743):784–793.

30.

Johnson

Bland

Oxberry

Abernethy

Currow

. Clinically important differences in the intensity of chronic refractory breathlessness. J Pain Symptom Manage. 2013;46(6):957–963.

31.

Hui

Shamieh

Paiva

, et al. Minimal clinically important difference in the physical, emotional, and total symptom distress scores of the Edmonton symptom assessment system. J Pain Symptom Manage. 2016;51(2):262–269.

32.

Hui

Kilgore

Frisbee-Hume

, et al. Dexamethasone for dyspnea in cancer patients: a pilot double-blind, randomized, controlled trial. J Pain Symptom Manage. 2016;52(1):8–16 e11.

33.

Booth

Galbraith

Ryan

Parker

Johnson

. The importance of the feasibility study: lessons from a study of the hand-held fan used to relieve dyspnea in people who are breathless at rest. Palliat Med. 2016;30(5):504–509.

34.

Kako

Morita

Yamaguchi

, et al. Evaluation of the appropriate washout period following fan therapy for dyspnea in patients with advanced cancer: a Pilot Study. Am J Hosp Palliat Care. 2018;35(2):293–296.

35.

Egger

Davey Smith

Schneider

Minder

. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–634.

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

Abstract

Background:

Aim:

Design:

Data sources:

Results:

Conclusions:

Keywords

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References

Supplementary Material