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Buspirone for management of dyspnea in cancer patients receiving chemotherapy: a randomized placebo-controlled URCC CCOP study

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Abstract

Purpose

Cancer-related dyspnea is a common, distressing, and difficult-to-manage symptom in cancer patients, resulting in diminished quality of life and poor prognosis. Buspirone, a non-benzodiazepine anxiolytic which does not suppress respiration and has proven efficacy in the treatment of generalized anxiety disorder, has been suggested to relieve the sensation of dyspnea in patients with COPD. The main objective of our study was to evaluate whether buspirone alleviates dyspnea in cancer patients.

Methods

We report on a randomized, placebo-controlled trial of 432 patients (mean age 64, female 51 %, lung cancer 62 %) from 16 participating Community Clinical Oncology Program (CCOP) sites with grade 2 or higher dyspnea, as assessed by the Modified Medical Research Council Dyspnea Scale. Dyspnea was assessed by the Oxygen Cost Diagram (OCD; higher scores are better) and anxiety by the state subscale of the State‐Trait Anxiety Inventory (STAI-S; lower scores are better) at baseline and after the 4-week intervention (post-intervention).

Results

Mean scores from baseline to post-intervention for buspirone were OCD 8.7 to 9.0 and STAI-S 40.5 to 40.1 and for placebo were OCD 8.4 to 9.3 and STAI-S 40.9 to 38.6 with raw improvements over time on both measures being greater in the placebo group. Analysis of covariance (ANCOVA) controlling for baseline scores showed no statistically significant difference between groups for OCD (P = 0.052) or STAI-S (P = 0.062).

Conclusion

Buspirone did not result in significant improvement in dyspnea or anxiety in cancer patients. Thus, buspirone should not be recommended as a pharmacological option for dyspnea in cancer patients.

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References

  1. Bruera E, Ripamonti C (1998) Dyspnea in patients with advanced cancer. In: Berger A, Portenoy R, Weissman D (eds) Principles and practice of supportive oncology. Lippencott-Raven Publishers, Philadelphia, pp 295–308

    Google Scholar 

  2. Booth S, Moosavi SH, Higginson IJ (2008) The etiology and management of intractable breathlessness in patients with advanced cancer: a systematic review of pharmacological therapy. Nat Clin Pract Oncol 5(2):90–100. doi:10.1038/ncponc1034

    Article  CAS  PubMed  Google Scholar 

  3. American Thoracic Society (1999) Dyspnea: mechanisms, assessment, and management. A consensus statement. Am J Respir Crit Care Med 159:321–340

    Article  Google Scholar 

  4. Muers MF, Round CE (1993) Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation Thoracic Group. Thorax 48:339–343. doi:10.1136/thx.48.4.339

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Ripamonti C, Fusco F (2002) Respiratory problems in advanced cancer. Support Care Cancer 10(3):204–216. doi:10.1007/s005200100296

    Article  PubMed  Google Scholar 

  6. Dudgeon D, Christiansen L, Sloan J, Lertzman M, Clement K (2001) Dyspnoea in cancer patients: prevalence and associated factors. J Pain Symptom Manag 21(2):95–102. doi:10.1016/S0885-3924(00)00258-X

    Article  CAS  Google Scholar 

  7. Sarna L, Evangelista L, Tashkin D, Padilla G, Holmes C, Brecht ML, Grannis F (2004) Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. CHEST 125(2):439–445

    Article  PubMed  Google Scholar 

  8. Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Vigano A, Larkin P, De Conno F, Hanks G, Kaasa S (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23(25):6240–6248. doi:10.1200/JCO.2005.06.866

    Article  PubMed  Google Scholar 

  9. Wickham R (2002) Dyspnea: recognizing and managing an invisible problem. Oncol Nurs Forum 29(6):925–933. doi:10.1188/02.ONF.925-933

    Article  PubMed  Google Scholar 

  10. Dudgeon DJ, Rosenthal S (1996) Management of dyspnea and cough in patients with cancer. Hematol Oncol Clin North Am 10(1):157–171

    Article  CAS  PubMed  Google Scholar 

  11. Lanken PN, Terry PB, Delisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE, Levy M, Mularski RA, Osborne ML, Prendergast TJ, Rocker G, Sibbald WJ, Wilfond B, Yankaskas JR (2008) An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 177(8):912–927. doi:10.1164/rccm.200605-587ST 177/8/912

    Article  PubMed  Google Scholar 

  12. Marciniuk DD, Goodridge D, Hernandez P, Rocker G, Balter M, Bailey P, Ford G, Bourbeau J, O’Donnell DE, Maltais F, Mularski RA, Cave AJ, Mayers I, Kennedy V, Oliver TK, Brown C (2011) Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society clinical practice guideline. Can Respir J 18(2):69–78

    PubMed Central  PubMed  Google Scholar 

  13. Jennings AL (2002) A systematic review of the use of opioids in the management of dyspnoea. Thorax 57:939–944

    Article  PubMed Central  PubMed  Google Scholar 

  14. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, Glaser SE, Vallejo R (2008) Opioid complications and side effects. Pain Physician 11(2 Suppl):S105–120

    PubMed  Google Scholar 

  15. Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA, Morton SC, Hughes RG, Hilton LK, Maglione M, Rhodes SL, Rolon C, Sun VC, Shekelle PG (2008) Evidence for improving palliative care at the end of life: a systematic review. Ann Intern Med 148(2):147–159

    Article  PubMed  Google Scholar 

  16. Neuman A, Gunnbjornsdottir M, Tunsater A, Nystrom L, Franklin KA, Norrman E, Janson C (2006) Dyspnea in relation to symptoms of anxiety and depression: a prospective population study. Respir Med 100(10):1843–1849. doi:10.1016/j.rmed.2006.01.016

    Article  PubMed  Google Scholar 

  17. Navigante AH (2006) Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manag 31:38–47

    Article  CAS  Google Scholar 

  18. Booth S, Dudgeon D (2006) Dyspnoea in advanced disease: a guide to clinical management, 1st edn. Oxford University Press, Oxford

    Google Scholar 

  19. Simon ST, Higginson IJ, Booth S, Harding R, Bausewein C (2010) Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev 1:CD007354. doi:10.1002/14651858.CD007354.pub2

    PubMed  Google Scholar 

  20. Hardman J, Limbird L (2005) Goodman & Gilman’s the pharmacological basis of therapeutics, 11th edn. McGraw-Hill, New York

    Google Scholar 

  21. Janssens JP, de Muralt B, Titelion V (2000) Management of dyspnea in severe chronic obstructive pulmonary disease. J Pain Symptom Manag 19(5):378–392

    Article  CAS  Google Scholar 

  22. Rickels K (1990) Buspirone in clinical practice. J Clin Psychiatry 51(Suppl):51–54

    PubMed  Google Scholar 

  23. Goa KL, Ward A (1986) Buspirone. A preliminary review of its pharmacological properties and therapeutic efficacy as an anxiolytic. Drugs 32(2):114–129

    Article  CAS  PubMed  Google Scholar 

  24. Baldessarini RJ (1996) Drugs and the treatment of psychiatric disorders: psychosis and anxiety. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Gilman AG (eds) Goodman & Gilman’s the pharmacological basis of therapeutics. McGraw-Hill, New York

    Google Scholar 

  25. Mahler DA, Wells CK (1988) Evaluation of clinical methods for rating dyspnea. CHEST 93(3):580–586

    Article  CAS  PubMed  Google Scholar 

  26. Wedzicha JA, Bestall JC, Garrod R, Garnham R, Paul EA, Jones PW (1998) Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale. Eur Respir J 12(2):363–369

    Article  CAS  PubMed  Google Scholar 

  27. McGavin CR, Artvinli M, Naoe H, McHardy GJ (1978) Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease. Br Med J 2(6132):241–243

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Spielberger CD (1983) Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto. Consulting Psychologists Press, CA

  29. Endler NS, Kocovski NL (2001) State and trait anxiety revisited. J Anxiety Disord 15(3):231–245

    Article  CAS  PubMed  Google Scholar 

  30. Little RJA, Rubin DB (2002) Statistical analysis with missing data. John Wiley & Sons, Hoboken

    Book  Google Scholar 

  31. van Buuren S (2007) Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 16:219–242

    Article  PubMed  Google Scholar 

  32. Singh NP, Despars JA, Stansbury DW, Avalos K, Light RW (1993) Effects of buspirone on anxiety levels and exercise tolerance in patients with chronic airflow obstruction and mild anxiety. Chest 103(3):800–804

    Article  CAS  PubMed  Google Scholar 

  33. Argyropoulou P, Patakas D, Koukou A, Vasiliadis P, Georgopoulos D (1993) Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease. Respiration 60(4):216–220

    Article  CAS  PubMed  Google Scholar 

  34. Fulton B, Brogden RN (1997) Buspirone—an updated review of its clinical pharmacology and therapeutic applications. Cns Drugs 7(1):68–88

    Article  CAS  Google Scholar 

  35. Bandelow B, Boerner RJ, Kasper S, Linden M, Wittchen H-W, Möller H-J (2013) The diagnosis and treatment of generalized anxiety disorder. Dtsch Arztebl Int 110(17):300–310

    PubMed Central  PubMed  Google Scholar 

  36. Bohm C, Robinson DS, Gammans RE, Shrotriya RC, Alms DR, Leroy A, Placchi M (1990) Buspirone therapy in anxious elderly patients: a controlled clinical trial. J Clin Psychopharmacol 10(3 Suppl):47S–51S

    Article  CAS  PubMed  Google Scholar 

  37. Bohm C, Placchi M, Stallone F, Gammans RE, Alms DR, Shrotriya RC, Robinson DS (1990) A double-blind comparison of buspirone, clobazam, and placebo in patients with anxiety treated in a general practice setting. J Clin Psychopharmacol 10(3 Suppl):38S–42S

    Article  CAS  PubMed  Google Scholar 

  38. Gammans RE, Mayol RF, Labudde JA (1986) Metabolism and disposition of buspirone. Am J Med 80(3B):41–51. doi:10.1016/0002-9343(86)90331-1

    Article  CAS  PubMed  Google Scholar 

  39. Sramek JJ, Frackiewicz EJ, Cutler NR (1997) Efficacy and safety of two dosing regimens of buspirone in the treatment of outpatients with persistent anxiety. Clin Ther 19(3):498–506

    Article  CAS  PubMed  Google Scholar 

  40. Petracca A, Nisita C, McNair D, Melis G, Guerani G, Cassano GB (1990) Treatment of generalized anxiety disorder: preliminary clinical experience with buspirone. J Clin Psychiatry 51(Suppl):31–39

    PubMed  Google Scholar 

  41. Knight RG, Waal-Manning HJ, Spears GF (1983) Some norms and reliability data for the State-Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J Clin Psychol 22(Pt 4):245–249

    Article  PubMed  Google Scholar 

  42. Addolorato G, Ancona C, Capristo E, Graziosetto R, Di Rienzo L, Maurizi M, Gasbarrini G (1999) State and trait anxiety in women affected by allergic and vasomotor rhinitis. J Psychosom Res 46(3):283–289

    Article  CAS  PubMed  Google Scholar 

  43. Kvaal K, Ulstein I, Nordhus IH, Engedal K (2005) The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients. Int J Geriatr Psychiatry 20(7):629–634. doi:10.1002/gps.1330

    Article  PubMed  Google Scholar 

  44. Crisafulli E, Clini EM (2010) Measures of dyspnea in pulmonary rehabilitation. Multidiscip Respir Med 5(3):202–210. doi:10.1186/2049-6958-5-3-202

    Article  PubMed Central  PubMed  Google Scholar 

  45. Chhabra SK, Gupta AK, Khuma MZ (2009) Evaluation of three scales of dyspnea in chronic obstructive pulmonary disease. Ann Thorac Med 4(3):128–132. doi:10.4103/1817-1737.53351

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank the clinicians, patients, clinical staff, and data managers who made this study possible.

Funding

This study was funded by the NCI grants U10 CA37420 and R25CA10618.

Conflict of interest

The authors declare that they have no competing interests. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Author information

Authors and Affiliations

  1. University of Rochester Cancer Center Community Clinical Oncology Program Research Base, Behavioral Medicine Unit, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642, USA

    Anita R. Peoples, Charles E. Heckler, Joseph A. Roscoe, Luke L. Peppone, Marie A. Flannery & Gary R. Morrow

  2. Lipson Cancer Center, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, USA

    Peter W. Bushunow

  3. Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA

    Sheila N. Garland

  4. Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA

    Sheila N. Garland

  5. Palliative Care Medicine, Department of Internal Medicine, Queen’s University, Kingston, ON, Canada

    Deborah J. Dudgeon

  6. HOACNY CCOP, 5008 Brittonfield Parkway, Suite #700, PO Box 2050, East Syracuse, NY, 13057, USA

    Jeffrey J. Kirshner

  7. Marshfield CCOP, Marshfield Clinic, 1000 N. Oak Avenue, 2R-1 Lawton Center, Marshfield, WI, 54449, USA

    Tarit K. Banerjee

  8. Southeast Cancer Control consortium, 2150 Country Club Road, Suite 200, Winston-Salem, NC, 27104, USA

    Judith O. Hopkins

  9. Wichita CCOP, 929 North St. Frances, Wichita, KS, 67214, USA

    Shaker R. Dakhil

Authors
  1. Anita R. Peoples
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  2. Peter W. Bushunow
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  3. Sheila N. Garland
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  4. Charles E. Heckler
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  5. Joseph A. Roscoe
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  6. Luke L. Peppone
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  7. Deborah J. Dudgeon
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  8. Jeffrey J. Kirshner
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  10. Judith O. Hopkins
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  13. Gary R. Morrow
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Corresponding author

Correspondence to Anita R. Peoples.

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Peoples, A.R., Bushunow, P.W., Garland, S.N. et al. Buspirone for management of dyspnea in cancer patients receiving chemotherapy: a randomized placebo-controlled URCC CCOP study. Support Care Cancer 24, 1339–1347 (2016). https://doi.org/10.1007/s00520-015-2903-6

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  • DOI: https://doi.org/10.1007/s00520-015-2903-6

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