Cognitive-Behavioral Treatment for Breathlessness in Lung Cancer: A Randomized Controlled Trial.

Rationale: Dyspnea (breathlessness) commonly impacts patients with lung cancer, worsening depression, anxiety, quality of life, and functioning. Current treatments are limited.

Objectives

To test the acceptability, feasibility, and preliminary efficacy of "Take a Breath" (TAB), a novel cognitive-behavioral treatment for dyspnea.

Methods

A randomized controlled trial compared TAB with standard of care (SOC) in patients with lung cancer reporting at least moderate dyspnea (N = 45). TAB consisted of five 1-hour weekly individual sessions employing exposure-based interventions paired with pulse oximetry biofeedback, psychoeducation, and behavioral skills (e.g., pursed lip breathing). The Client Satisfaction Questionnaire-8 measured acceptability. Accrual, treatment retention, and homework completion measured feasibility. Primary outcomes were the American Thoracic Society Dyspnea Scale (dyspnea-related functioning) and Cancer Dyspnea Scale (dyspnea-related effort, discomfort, and anxiety). Secondary outcomes included depression (Patient Health Questionnaire-9), health-related quality of life (12-item Short Form Health Survey), physical activity (International Physical Activity Questionnaire Short Form), and functional status (Karnofsky performance status). Measurements occurred at baseline, midtreatment (3 wk), post-treatment (6 wk), and 1-month follow-up. Robust mixed-effects modeling tested group × time interactions.

Results

TAB was at least "mostly satisfactory" for 75% of participants. The accrual was 25.6%, with 60% completing all sessions and an 88.7% homework completion rate. Intention-to-treat analysis revealed greater improvements in TAB than SOC for dyspnea-related functioning (Cohen's d = 0.82; P = 0.03) and anxiety (Cohen's d = 0.87; P < 0.01) at post-treatment and follow-up. TAB outperformed SOC in improving depressive symptoms, health-related quality of life, sedentary time, and performance status over time (all P < 0.05).

Conclusions

TAB yielded symptom, psychological, and functional improvements, establishing its readiness for further testing as the first comprehensive cognitive-behavioral treatment for dyspnea and related sequelae. Clinical trial registered with www.clinicaltrials.gov (NCT05304793).