High-flow nasal oxygen for the relief of persistent dyspnea in adult patients with cancer: A systematic review and meta-analysis

Background: Dyspnea is a frequent and distressing symptom in people with cancer. High-flow nasal oxygen has been shown to relieve dyspnea and could offer several advantages over conventional oxygen delivery devices. Aim: To assess the effectiveness of high-flow nasal oxygen compared with other medical oxygen or air delivery devices on dyspnea in people with cancer. Design: This study was designed as a systematic review and meta-analysis and was registered prospectively with PROSPERO (CRD42021265395). Data sources: EMBASE, MEDLINE and Web of Science electronic databases were searched from inception to February 23, 2025. Randomized controlled trials and controlled clinical trials evaluating the effectiveness of high-flow nasal oxygen in adults with cancer were screened, and data were independently extracted by three authors. The primary outcome was the mean change in dyspnea scores. Results: Seven trials (374 patients) met the inclusion criteria. Six trials (272 patients) were included in the meta-analysis. Most trials were at a high risk of bias or had some concerns. The meta-analysis showed that high-flow nasal oxygen significantly improved dyspnea compared to other medical oxygen or air delivery devices (SMD: −0.60; 95% CI: −1.02 to −0.17; I 2 = 65%, p < 0.014). Sub-group analysis showed that the improvement was only visible in hypoxemic patients (SMD: –0.87; 95% CI —1.33 to —0.40; I 2 = 58.7%, p = 0.089). Conclusion: High-flow nasal oxygen could be an additional therapeutic option for alleviating dyspnea in hospitalized people with advanced cancer.