For patients with end-stage lung cancer, noninvasive ventilation (NIV) may be more effective at reducing breathing difficulty than standard oxygen therapy, and has the added advantage of reducing patients' reliance on morphine, thus improving lucidity in their final days, according to research presented at the American Thoracic Society's 2008 International Conference in Toronto on Tuesday, May 20. For patients at this stage, even small comforts can be the difference between a peaceful or an agonizing death.
"With oxygen therapy you might improve oxygenation of the whole body with a small cannula inserted into the nose," explained Stefano Nava, M.D., chief of the respiratory critical care unit at Istituto Scientifico di Pavia in Italy, who led the research. "NIV implies the application of a face mask connected to ventilator. The main advantage over oxygen is that NIV not only improve oxygenation, but also the work of breathing."
This is the first research to compare the two therapies, and the first randomized controlled study to investigate the relief of respiratory distress in end-stage cancer patients. "It is surprising that in the literature there is nothing about the relief of respiratory distress in these end-stage cancer patients," said Dr. Nava. "The usual practice is giving standard oxygen therapy and/or morphine, but there is no evidence that these interventions work. This study may have important implications for both those patients and their families in the final, critical moments of their lives."
Dr. Nava and colleagues enrolled 92 patients who met the criteria and agreed to be randomized to receive either oxygen therapy or NIV. Three-month mortality for the groups were 89 and 87 percent respectively, and was not significantly different between the groups. Roughly a third of each patient group was discharged alive after an average of two weeks.
But while outcomes did not vary significantly, there were other striking differences: the researchers found that standard oxygen therapy took three hours to become effective, whereas NIV was able to relieve symptoms more quickly-- and after three hours, it remained as effective as standard therapy. Furthermore, the average use of morphine on the first 24 hours was significantly lower in the patients who received NIV.
"By using NIV, the need of morphine was reduced, and thus its side effects," explained Dr. Nava. "This means in addition to important physical benefits to the patients, there are also great potential benefits in the communication with caregivers and relatives."
"Keeping in mind that the patient should decide which treatment he or she would like, NIV may be proposed as an alternative treatment," he concluded. "In the subset of patients who could tolerate the treatment, NIV therapy may be an effective and more rapid treatment for improving dyspnea than standard oxygen therapy in end-stage cancer patients."
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