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

Ann Am Thorac Soc. 2025 Aug 7. doi: 10.1513/AnnalsATS.202406-580OC. Online ahead of print.

ABSTRACT

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 5 one-hour, weekly, individual sessions employing exposure-based interventions paired with pulse oximetry biofeedback, psychoeducation, and behavioral skills (e.g., pursed lip breathing). Robust mixed-effects modeling tested group x time interactions.

MEASUREMENTS: The Client Satisfaction Questionnaire-8 measured acceptability. Accrual, treatment retention, and homework completion measured feasibility. Primary outcomes were the ATS Dyspnea Scale (dyspnea-related functioning) and Cancer Dyspnea Scale (dyspnea-related effort, discomfort, and anxiety). Secondary outcomes included depression (PHQ-9), health-related quality of life (SF-12), physical activity (IPAQ-SF), and functional status (KPS). Measurements occurred at baseline, mid-treatment (3 weeks), post-treatment (6 weeks), and 1-month follow-up.

RESULTS: TAB was ≥”mostly satisfactory” for 75% of participants. The accrual was 25.6%, with 60% completing all sessions and an 88.7% homework completion rate. Intent-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 (p’s<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 registration available at www.

CLINICALTRIALS: gov, ID: NCT05304793.

PMID:40772929 | DOI:10.1513/AnnalsATS.202406-580OC