Kako, J., Morita, T., Yamaguchi, T., Kobayashi, M., Sekimoto, A., Kinoshita, H., ... Matsushima, E. (2018). Fan therapy is effective in relieving dyspnea in patients with terminally ill cancer: A parallel-arm, randomized controlled trial. Journal of Pain and Symptom Management, 56, 493–500.

To determine the effect of fan therapy on dyspnea in patients with terminally ill cancer.

Fan therapy consisted of directing a fan to blow air for five minutes across the region innervated by the second/third trigeminal nerve branches. Control was directing a fan to blow air for five minutes to legs. Intervention delivered after a washout period for opioids.

• N = 40   
• AGE: Average age = 69 years
• MALES: 55%  
• FEMALES: 45%
• CURRENT TREATMENT: Had to be getting no cancer treatment
• KEY DISEASE CHARACTERISTICS: Metastatic or locally advanced cancer, ECOG score of 3 or 4
• OTHER KEY SAMPLE CHARACTERISTICS: Dyspnea while sitting or laying at rest, O₂ saturation of 90% or greater

• SITE: Single site
• SETTING TYPE: Inpatient palliative care unit    
• LOCATION: Hospital in Chiba, Japan

• PHASE OF CARE: End of life
• APPLICATIONS: Palliative care

Randomized controlled trial

ESAS-r (ESAS-revised): used NRS for dyspnea (0-10 scale) (primary measure),  facial temperature, respiratory rate, peripheral O₂ saturation, and heart rate (secondary measures)

Improvement in dyspnea for the treatment arm was seen with mean NRS scores that changed by -1.35 in the treatment arm versus a change of -0.1 in the control arm (p < 0.001) and the number of patients who experienced a greater than one or two-point reduction on their NRS was greater (80%) when compared to the control group (25%). There was also a reduction noted in drowsiness in the treatment group. Significant secondary outcomes included that the mean change in drowsiness on NRS was 0.4 for the treatment group versus -0.45 for control (p = 0.01) and facial temperature was significantly lower after the intervention for the treatment group (reduction of 1.43 degrees C) versus control (reduction of 0.01) (p = 0.003)

The authors conclude that the study presents evidence that fan therapy is effective for the treatment of dyspnea in terminally ill patients with cancer.

• Small sample (< 100)

This study has significant implications for nursing as it provides an intervention for dyspnea that could be wholly within the ability of nurses to deliver and could be taught to families. It is also an intervention with little risk and could offer patients some control.