Abstract 1271P
Background
High-Flow Nasal Cannula (HFNC) has shown benefits in patients with acute respiratory failure. However, efficacy and tolerability of HFNC in advanced cancer patients under palliative care setting has not been fully investigated.
Methods
Advanced cancer patients who had dyspnea at rest (numeric rating scale: NRS ≥ 3) and respiratory failure were enrolled. Patients were treated with HFNC for 5 days and patient-reported dyspnea was assessed using modified Borg scale and NRS. Primary endpoint was change of mean modified Borg scale at 24 hours. Key secondary endpoints consisted of change in modified Borg scale during study period and feasibility. Based on the hypothesis that change of HFNC will improve modified Borg scale from 1.5 to 2.5 (0.10 of one-sided α and power of 0.80), 21 patients are required (Trial Identifier, UMIN000035738).
Results
Between Feb 2019 and Feb 2022, 25 patients were enrolled and 21 were analyzed. Mean age was 72 (range, 48-92); male/female 17/4; ECOG PS 3/4 17/4. Twenty patients used inspired oxygen and mean fraction of inspired oxygen (FiO2) was 0.34 (range, 0.21-1.0). At baseline, mean modified Borg scale (dyspnea) was 5.2 (range, 2-10), and mean NRS (dyspnea) was 5.9 (range, 3-10). Median survival time was 19 days (range, 3-657). After starting HFNC, 90% (19 patients) could continue HFNC for 24 hours and 52% (11 patients) completed 5 days of HFNC. The change of mean modified Borg scale was 1.4 (80%CI: 0.8-1.9) at 24 hours, which did not reach the primary endpoint, while 52% (11 patients) showed 1.5 points improvement of modified Borg scale. Change of mean modified Borg scale at each timepoint was 1.3 (1 hour), 1.5 (2 hours), 1.4 (24 hours), 0.82 (day 3), 1.8 (day 4), and 2.3 (day 5), respectively. Within 1 hour, 42% (9 patients) showed 1.5 points improvement of modified Borg scale and such early responders were likely to maintain dyspnea improvement for 24 hours.
Conclusions
Although our study did not accomplish prespecified threshold, almost half had clinically meaningful improvement in dyspnea. HFNC can be a palliative treatment option in advanced cancer patients with dyspnea.
Clinical trial identification
UMIN000035738.
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
H. Akamatsu: Financial Interests, Personal, Invited Speaker: AstraZeneca K.K., Boehringer Ingelheim Japan Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd., Eli Lilly Japan K.K., MSD K.K., Novartis Pharma K.K., Ono Pharmaceutical Co. Ltd., Pfizer Inc, Taiho Pharmaceutical Co. Ltd; Financial Interests, Personal, Research Grant: AMGEN Inc, Chugai Pharmaceutical Co. Ltd., MSD K.K.. S. Teraoka: Financial Interests, Personal, Advisory Board: Pfizer R&D Japan G.K.; Financial Interests, Personal, Invited Speaker: AstraZeneca K.K., Chugai Pharmaceutical Co. Ltd. Eli Lilly Japan K.K., Novartis Pharma K.K., Taiho Pharmaceutical Co. Ltd., Boehringer Ingelheim Japan Inc., Eli Lilly Japan K.K., Ono Pharmaceutical Co. Ltd.. K. Furuta: Financial Interests, Personal, Invited Speaker: Nippon Boehringer Ingelheim Co. D. Fujimoto: Financial Interests, Personal, Research Grant: AstraZeneca KK, BoehringerIngelheim Japan Inc; Financial Interests, Personal, Invited Speaker: AstraZeneca KK, Ono Pharmaceutical Co Ltd Honoraria, Bristol-Myers Squibb Co Ltd, Taiho Pharmaceutical Co Ltd, Chugai Pharmaceutical Co Ltd, Merck Sharp & Dohme KK Honoraria, BoehringerIngelheim Japan Inc, Eli Lilly Japan KK, Novartis Pharma K.K, Kyowa Kirin Co. Ltd Honoraria, Janssen Pharmaceutical KK; Financial Interests, Personal, Advisory Board: AstraZeneca KK, Chugai Pharmaceutical Co Ltd. N. Tokudome: Financial Interests, Personal, Invited Speaker: Chugai Pharmaceutical Co., Ltd., Boehringer Ingelheim. Y. Ozawa: Financial Interests, Personal, Invited Speaker: AstraZeneca K.K., Chugai Pharmaceutical Co. Ltd., Taiho Pharmaceutical Co. Ltd., Novartis Pharma K.K., Nippon Kayaku, Msd K.K., Ono Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd. N. Yamamoto: Financial Interests, Personal, Invited Speaker: MSD K.K., Chugai Pharmaceutical CO., LTD., Ono Pharmaceutical Co., Ltd., AstraZeneca, Takeda Pharmaceutical CO., LTD., Eli Lilly Japan K.K., Novartis, Pfizer Inc., Janssen, Taiho, Daiichisankyo, Amgen Inc., Eisai Co., Ltd., Toppan Printing Co., Ltd., Boehringer-Ingelheim. All other authors have declared no conflicts of interest.