High Flow Nasal Cannula in patients with cancer at the end of life



      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.


      The purpose of this study is to assess the rate of successful liberation from HFNC in a Palliative and Supportive Care Unit (PSCU).


      The study is a retrospective chart review of all 374 adult patients with cancer on HFNC admitted to a PSCU at a tertiary medical center from January 1st 2018 to December 31st 2020. We determined the proportion of patients who were liberated from HFNC (by day 3 and overall) and the proportion of patients discharged alive.


      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 3 and overall was accomplished in 23 and 25% of the patients respectively. Comparing the patients who could be liberated from HFNC versus those who could not by day 3, 38% versus 9% were discharged alive respectively; and overall, 62% versus 1% respectively (P< 0.001 in both cases).


      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.


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