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Efficacy of a two-dimensional intervention model combining breathing training and psychological support for dyspnea
Longmei Fang1, Yaling Tan2, Zhuona Li1
1Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China.
Background:
Dyspnea affects 50%-70% of patients with advanced cancer. Current management typically addresses physiological or psychological aspects in isolation. This trial evaluated a two-dimensional intervention targeting both breathing mechanics and psychological distress simultaneously.
Methods:
This four-arm randomized controlled trial enrolled 160 patients with advanced cancer and moderate-to-severe dyspnea, allocated to Control (standard care), Breathing Training (BT), Psychological Support (PS), or Combined intervention (n = 40 per arm). Primary endpoints included dyspnea severity [Visual Analog Scale (VAS), Medical Research Council Dyspnea Scale] and psychological distress [Hospital Anxiety and Depression Scale [HADS)]. Secondary outcomes comprised quality of life (EORTC QLQ-C30) and physiological parameters. Assessments occurred at baseline and weeks 2, 4, 6, and 8.
Results:
The Combined intervention produced significantly greater VAS improvement vs. Control (-0.93 vs -0.21, p < 0.001; Cohen's d = 0.91). Effect sizes for the Combined group were large across all outcomes: anxiety (d = 1.17), depression (d = 1.28), and quality of life (d = 1.32). The additive effect index of 0.65 indicated sub-additive rather than synergistic component interaction. Number needed to treat for 30% dyspnea response was 3 for Combined intervention. Subgroup analysis revealed attenuated benefits in ECOG performance status 3 patients.
Conclusions:
The two-dimensional intervention demonstrates comprehensive efficacy for cancer-related dyspnea across physical and psychological domains, achieving the largest effect sizes despite additive rather than synergistic effects.
Clinical Trial Registration:
This trial was not registered in a public clinical trials registry. The absence of prospective registration is acknowledged as a limitation of the study (see Discussion).
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