Greer, J.A., MacDonald, J.J., Vaughn, J., Viscosi, E., Traeger, L., McDonnell, T., . . . Temel, J.S. (2015). Pilot study of a brief behavioral intervention for dyspnea in patients with advanced lung cancer. Journal of Pain and Symptom Management, 50, 854–860.

To determine the feasibility and usefulness of providing brief behavioral interventions to manage dyspnea in patients with advanced lung cancer

Participants received two 30-minute intervention sessions by the same nurse practioner, the second session provided within four weeks of the first. Two nurse practioners were trained in psychoeducation, behavioral techniques, and relaxation. The first session consisted of the nurse practioner explaining cognitive behavioral therapy and the effects of breathlessness, triggers, physiological factors, and behavioral responses on patients. Patients were taught pursed lip breathing, how to use a battery-operated fan, postural techniques, relaxation exercises, diaphragmatic breathing, and meditation. Participants were provided MP3 players with a recording of the guided breathing exercises to practice at home. The second intervention session consisted of reviewing and reinforcing the above instruction, answering questions, and identifying problems or obstacles.

• N = 32   
• AGE = 63.34 years
• MALES: 43.7%, FEMALES: 56.3%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Advanced lung cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Eastern Cooperative Oncology Group (ECOG) performance status of 0–2, ongoing outpatient oncology treatment, English language literacy, and Modified Medical Research Council Dyspnea Scale (MMRCDS) score of less than or equal to 2 

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Scheduled visits in an outpatient infusion suit and a follow-up appointment or telephone call

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Palliative care 

• Pre/post design

Participants completed three measurements: the MMRCDS, the Functional Assessment of Cancer Therapy–Lung Trial Outcome Index (FACT-L TOI), and the Hospital Anxiety and Depression Scale (HADS) at baseline and again postassessment (six weeks after enrollment). Also used was the enrollment rate/study completion rate to examine feasibility.

Fifty-seven patients were referred to the study with 32 patients enrolled. Four patients could not complete it and one withdrew, leaving 27 participants completing all study procedures (84%). First intervention sessions were provided in the infusion suite, and half of the second sessions were provided in the infusion suite and half over the phone. Participants reported reduction in dyspnea (MMRCDS) over time and improvement in quality of life (QOL) (FACT–L TOI) and depression (HADS), but no significant differences in anxiety. Results were unchanged for all outcomes when adjusting for primary and secondary analyses for the line of chemotherapy.

This study demonstrates the feasibility and possible benefit of providing brief behavioral interventions to patients with advanced lung cancer to decrease breathlessness, improve QOL, and decrease depression. The study showed that a potential barrier may be the availability of resources and time for staff in cancer centers to provide education and training to patients. With a small sample size and pre/post design, larger randomized controlled studies are needed to determine intervention effectiveness.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (sample characteristics)
• Unintended interventions or applicable interventions not described that would influence results
• Findings not generalizable
• Patients may have simultaneously responded to chemotherapy resulting in decreased breathlessness.
• Recruitment limited to clinician referral
• Homogenous sample limited the generalizability of results.
• The racial makeup was 93% Caucasian, and 63% were college graduates.
• Participants consisted of only patients with lung cancer.

Dyspnea, which impairs QOL, is a common symptom in patients with advanced lung cancer. Oncology nurses are in unique position to assess dyspnea and how it relates to patient distress and overall QOL. Nurses trained in strategies and interventions to decrease dyspnea are also in a unique position to provide this education to their patients.