Wiener Medizinische Wochenschrift

, Volume 168, Issue 13–14, pp 333–343 | Cite as

Symptomatic treatment of dyspnea in advanced cancer patients

A narrative review of the current literature
  • Matthäus Strieder
  • Martin Pecherstorfer
  • Gudrun KreyeEmail author



Dyspnea is a common, very distressing symptom in advanced cancer patients that challenges them, their relatives, and healthcare professionals. This narrative review summarizes important literature dealing with the evidence for opioids, benzodiazepines, oxygen, and steroids for treating dyspnea in advanced cancer patients.


A selective literature search was undertaken in PubMed, Embase, and the Cochrane Library and extended with literature from the reference lists of included studies up to April 2016. Inclusion criteria were that patients were suffering from advanced cancer and were receiving either opioids, benzodiazepines, corticosteroids, or oxygen. The outcome of interest was the reduction of dyspnea measured via a visual analogue scale (VAS), a numerical rating scale (NRS), or a Borg scale. This narrative review describes in detail the findings of 13 studies.


Nine studies deal with the effectiveness of opioids for reducing dyspnea in advanced cancer patients. Five of these found a significant benefit to the use of opioids compared to a placebo. Three found no significant improvements, and two favored combinations of opioids and benzodiazepines. Few high-quality studies were available that used benzodiazepines (n = 3, no difference, significant improvement with midazolam + morphine, significant difference for midazolam) or oxygen (n = 2, both without significant difference). Only one study examined treating dyspnea with steroids in patients with advanced cancer, and that study indicated a benefit of steroids compared to a placebo.


Opioids are the drug of choice for treating refractory dyspnea in advanced cancer patients. Neither benzodiazepines nor oxygen showed significant benefit. In addition, there is insufficient literature available to draw a conclusion about the effectiveness of steroids for treating persistent dyspnea in advanced cancer patients.


Dyspnea Advanced cancer Opioids Benzodiazepines Steroids 



Chronic obstructive pulmonary disease


Cancer-related fatigue


Edmonton Symptom Assessment Scale


European Society for Medical Oncology


Nebulized hydromorphone


Numeric rating scale


Nebulized saline


Randomized controlled trials


Visual analog scale


Conflict of interest

M. Strieder, M. Pecherstorfer, and G. Kreye declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Matthäus Strieder
    • 1
  • Martin Pecherstorfer
    • 1
  • Gudrun Kreye
    • 1
    Email author
  1. 1.Department of Internal Medicine 2, Division for Palliative CareUniversity Hospital KremsKremsAustria

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