Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis.
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The aim of this study was to determine the efficacy of palliative oxygen for relief of dyspnoea in cancer patients. MEDLINE and EMBASE were searched for randomised controlled trials, comparing oxygen and medical air in cancer patients not qualifying for home oxygen therapy. Abstracts were reviewed and studies were selected using Cochrane methodology. The included studies provided oxygen at rest or during a 6-min walk. The primary outcome was dyspnoea. Standardised mean differences (SMDs) were used to combine scores. Five studies were identified; one was excluded from meta-analysis due to data presentation. Individual patient data were obtained from the authors of the three of the four remaining studies (one each from England, Australia, and the United States). A total of 134 patients were included in the meta-analysis. Oxygen failed to improve dyspnoea in mildly- or non-hypoxaemic cancer patients (SMD=-0.09, 95% confidence interval -0.22 to 0.04; P=0.16). Results were stable to a sensitivity analysis, excluding studies requiring the use of imputed quantities. In this small meta-analysis, oxygen did not provide symptomatic benefit for cancer patients with refractory dyspnoea, who would not normally qualify for home oxygen therapy. Further study of the use of oxygen in this population is warranted given its widespread use.
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Uronis, HE, DC Currow, DC McCrory, GP Samsa and AP Abernethy (2008). Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis. Br J Cancer, 98(2). pp. 294–299. 10.1038/sj.bjc.6604161 Retrieved from https://hdl.handle.net/10161/13711.
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Scholars@Duke
Hope Elizabeth Uronis
Douglas Charles McCrory
Dr. McCrory's research interests include systematic reviews and synthesis of existing evidence and clinical practice guideline development. Dr. McCrory is currently co-director of the AHRQ-designated Evidence-based Practice Center (EPC) at Duke University, which was recently renewed for a second 5-year award. EPC projects have included systematic reviews on a variety of clinical topics including cervical cytologic screening, management of acute exacerbation of COPD, pulmonary complications of cervical spinal cord injury, uterine fibroids, postterm pregnancy, and allergic rhinitis. What has tied these projects together is a rigorous , comprehensive methodical systematic review and synthesis, using state-of-the-art methods when necessary, such as meta-analyses, decision modelling and cost-effectiveness modelling. The EPC developed from similar previous experience an AHCPR-sponsored project on chronic headache management and the Stroke Prevention Patient Outcomes Research Team (PORT).
Dr. McCrory has also worked in health care policy development, working with professional and other organizations translate evidence into clinical recommendations. Such projects include the RAND carotid endarterectomy appropriateness project, the American College of Physicians' Clinical Efficacy Assessment Project recommendations for medical treatment for stroke prevention and a joint ACP-ASIM/ACCP guideline development on management of acute exacerbation of COPD.
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