People with advanced cancer who experience breathlessness may benefit more from non-pharmacological interventions, such as handheld fan use, than from medications, researchers at Johns Hopkins University in Baltimore report in the journal JAMA Oncology.

Breathlessness is a common symptom of advanced metastatic cancer. As the body weakens, respiration becomes progressively more difficult, causing considerable anxiety and negatively affecting quality of life. Oncologists have historically prescribed medications such as opioids and benzodiazepines, but their ability to provide relief is not strongly supported by available evidence.

The researchers reviewed 29 studies of non-pharmacological interventions in 2,423 adults with advanced cancer. The strongest evidence, supported by nine studies, was for respiratory interventions such as fan therapy and bilevel ventilation. Fan therapy entails a fan, often handheld, blowing air (room-temperature or cold) toward the mouth and nose of the person experiencing breathlessness. Bilevel ventilation refers to breathing on one’s own while simultaneously being supported by a ventilator. Other studies found benefits from acupressure and reflexology in an outpatient setting.

“Guidelines and clinical practice should evolve to incorporate non-pharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness,” the authors write.