High-flow nasal oxygen for the relief of persistent dyspnea in adult patients with cancer: A systematic review and meta-analysis.

Abstract

Dyspnea is a frequent and distressing symptom in people with cancer. High-flow nasal oxygen has been shown to relieve dyspnea and could offer several advantages over conventional oxygen delivery devices. To assess the effectiveness of high-flow nasal oxygen compared with other medical oxygen or air delivery devices on dyspnea in people with cancer. This study was designed as a systematic review and meta-analysis and was registered prospectively with PROSPERO (CRD42021265395). EMBASE, MEDLINE and Web of Science electronic databases were searched from inception to February 23, 2025. Randomized controlled trials and controlled clinical trials evaluating the effectiveness of high-flow nasal oxygen in adults with cancer were screened, and data were independently extracted by three authors. The primary outcome was the mean change in dyspnea scores. Seven trials (374 patients) met the inclusion criteria. Six trials (272 patients) were included in the meta-analysis. Most trials were at a high risk of bias or had some concerns. The meta-analysis showed that high-flow nasal oxygen significantly improved dyspnea compared to other medical oxygen or air delivery devices (SMD: -0.60; 95% CI: -1.02 to -0.17; <i>I</i>² = 65%, <i>p</i> < 0.014). Sub-group analysis showed that the improvement was only visible in hypoxemic patients (SMD: -0.87; 95% CI -1.33 to -0.40; <i>I</i>² = 58.7%, <i>p</i> = 0.089). High-flow nasal oxygen could be an additional therapeutic option for alleviating dyspnea in hospitalized people with advanced cancer.