Advertisement

High Flow Nasal Cannula in Patients With Cancer at the End of Life

      Abstract

      Context

      High flow nasal cannula (HFNC) is frequently used to manage dyspnea in patients with cancer near the end of life. Because HFNC is restricted to the in-patient setting, patients on HFNC need to be liberated from it to be discharged from the hospital.

      Objectives

      The purpose of this study is to assess the rate of successful liberation from HFNC in a palliative and supportive care unit (PSCU).

      Methods

      The study is a retrospective chart review of all 374 adult patients with cancer on HFNC admitted to a palliative and supportive care unit at a tertiary medical center from January 1, 2018 to December 31, 2020. We determined the proportion of patients who were liberated from HFNC (by day three and overall) and the proportion of patients discharged alive.

      Results

      The mean age of the patients was 64, 54% were male and 73% were white. Only 16% (95% CI: 13–20) of the patients were discharged alive. Liberation from HFNC by day three and overall was accomplished in 23% and 25% of the patients respectively. Comparing the patients who could be liberated from HFNC vs. those who could not by day three, 38% vs. 9% were discharged alive respectively; and overall, 62% vs. 1% respectively (P < 0.001 in both cases).

      Conclusion

      Only a minority of patients with cancer at the end of life can be liberated from HFNC, and only a minority are discharged alive. This information is important when discussing goals of care with patients and their families before initiating HFNC.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hui D
        • Hernandez F
        • Urbauer D
        • et al.
        High-flow oxygen and high-flow air for dyspnea in hospitalized patients with cancer: a pilot crossover randomized clinical trial.
        Oncologist. 2021; 26: e883-e892
        • Cuervo Pinna MA
        • Mota Vargas R
        • Redondo Moralo MJ
        • Sanchez Correas MA
        • Pera Blanco G
        Dyspnea–a bad prognosis symptom at the end of life.
        Am J Hosp Palliat Care. 2009; 26: 89-97
        • Reuben DB
        • Mor V
        Dyspnea in terminally ill cancer patients.
        Chest. 1986; 89: 234-236
        • Bruera E
        • de Stoutz N
        • Velasco-Leiva A
        • Schoeller T
        • Hanson J
        Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients.
        Lancet. 1993; 342: 13-14
        • Jennings AL
        • Davies AN
        • Higgins JP
        • Gibbs JS
        • Broadley KE
        A systematic review of the use of opioids in the management of dyspnoea.
        Thorax. 2002; 57: 939-944
        • Mercadante S
        • Adile C
        • Ferrera P
        • Giuliana F
        • Grassi Y
        High-flow nasal OXYGEN therapy.
        BMJ Support Palliat Care. 2022; (bmjspcare-2022-003606.)
        • Mercadante S
        • Giuliana F
        High flow nasal therapy in the management of hypoxemic dyspnea at the end of life.
        Support Care Cancer. 2021; 29: 6179-6181
        • Hui D
        • Bohlke K
        • Bao T
        • et al.
        Management of dyspnea in advanced cancer: ASCO guideline.
        J Clin Oncol. 2021; 39: 1389-1411
        • Lemyze M
        • Dupre C
        [High flow oxygen via nasal cannula: palliative care and ethical considerations].
        Rev Mal Respir. 2022; 39: 367-375
        • Hui D
        • Mahler DA
        • Larsson L
        • et al.
        High-flow nasal cannula therapy for exertional dyspnea in patients with cancer: a pilot randomized clinical trial.
        Oncologist. 2021; 26: e1470-e1479
        • Díaz-Lobato S
        • Carratalá Perales JM
        • Alonso Iñigo JM
        • et al.
        Things to keep in mind in high flow therapy: as usual the devil is in the detail.
        Int J Crit Care Emerg Med. 2018; 4: 048
        • Bode S
        • Grove G
        Use of humidified high flow nasal oxygen in community palliative care: a case report.
        Palliat Med Rep. 2020; 1: 179-182
        • Oken MM
        • Creech RH
        • Tormey DC
        • et al.
        Toxicity and response criteria of the Eastern Cooperative Oncology Group.
        Am J Clin Oncol. 1982; 5: 649-655
        • Bruera E
        • Kuehn N
        • Miller MJ
        • Selmser P
        • Macmillan K
        The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients.
        J Palliat Care. 1991; 7: 6-9
        • Breitbart W
        • Rosenfeld B
        • Roth A
        • et al.
        The memorial delirium assessment scale.
        J Pain Symptom Manage. 1997; 13: 128-137
        • Peters SG
        • Holets SR
        • Gay PC
        High-flow nasal cannula therapy in do-not-intubate patients with hypoxemic respiratory distress.
        Respir Care. 2013; 58: 597-600
        • Shah N
        • Chuang E
        High flow nasal cannula and hospice and palliatice care (HI-HOPEs).
        Chest. 2019; 156: A1600
        • Brackett H
        • Forman A
        • Foster LA
        • Fischer SM
        Compassionate removal of heated high-flow nasal cannula for end of life: case series and protocol development.
        J Hosp Palliat Nurs. 2021; 23: 360-366
        • Shibata H
        • Takeda N
        • Suzuki Y
        • et al.
        Editors' Choice Effects of high-flow nasal cannula oxygen therapy on oral intake of do-not-intubate patients with respiratory diseases.
        Nagoya J Med Sci. 2021; 83: 509-522
        • Shah N
        • Mehta Z
        • Mehta Y
        High-flow nasal cannula oxygen therapy in palliative care #330.
        J Palliat Med. 2017; 20: 679-680
        • Quill TE
        • Holloway R
        Time-limited trials near the end of life.
        JAMA. 2011; 306: 1483-1484
        • Goda K
        • Kenzaka T
        • Kuriyama K
        • Hoshijima M
        • Akita H
        End-of-life home care of an interstitial pneumonia patient supported by high-flow nasal cannula therapy: a case report.
        World J Clin Cases. 2020; 8: 4853-4857
        • Nagata K
        • Horie T
        • Chohnabayashi N
        • et al.
        Home high-flow nasal cannula oxygen therapy for stable hypercapnic COPD: a randomized trial.
        Am J Respir Crit Care Med. 2022;
        • Nagata K
        • Kikuchi T
        • Horie T
        • et al.
        Domiciliary high-flow nasal cannula oxygen therapy for patients with stable hypercapnic chronic obstructive pulmonary disease. a multicenter randomized crossover trial.
        Ann Am Thorac Soc. 2018; 15: 432-439
        • Sorensen SS
        • Storgaard LH
        • Weinreich UM
        Cost-effectiveness of domiciliary high flow nasal cannula treatment in COPD patients with chronic respiratory failure.
        Clinicoecon Outcomes Res. 2021; 13: 553-564
        • Annunziata A
        • Coppola A
        • Carannante N
        • et al.
        Home management of patients with moderate or severe respiratory failure secondary to COVID-19, using remote monitoring and oxygen with or without HFNC.
        Pathogens. 2021; 10: 413
        • Kim MC
        • Lee YJ
        • Park JS
        • et al.
        Simultaneous reduction of flow and fraction of inspired oxygen (FiO2) versus reduction of flow first or FiO2 first in patients ready to be weaned from high-flow nasal cannula oxygen therapy: study protocol for a randomized controlled trial (SLOWH trial).
        Trials. 2020; 21: 81