Palliative Oxygen Therapy

Background Information

Long-term home oxygen therapy (LTOT) is an established therapeutic intervention able to improve survival in patients with chronic severe hypoxemia most commonly due to end-stage COPD (1). Eligibility criteria for LTOT are based on the partial pressure of the arterial oxygen (PaO2) without considering the patient’s symptoms, dominated by breathlessness.

Oxygen therapy is often given in clinical practice with the aim to increase physical function through alleviating exertional breathlessness (palliative oxygen) in patients with milder levels of hypoxemia due various end-stage cardiorespiratory diseases and cancer. Palliative oxygen in these situations is not given with the main aim to improve survival, but to improve the quality of life and comfort most often in the end-of-life phase.

Currently palliative oxygen therapy is only recognized in some countries due to the fact that there is no standardized definition, the target populations are not clearly defined, and it is not clear how to best measure its effectiveness (2). Guidelines of oxygen therapy pertain to LTOT (to improve survival) and ambulatory oxygen in respiratory conditions (Jacobs), but international clinical guidelines for palliative oxygen therapy are lacking.

The Task Force is chaired by Professor Antoniu Sabina Antonela, University of Medicine and Pharmacy Grigore T Popa Iasi, Romania, and Associate Professor Magnus Ekström, Lund University, Sweden.

Therefore the EAPC Task Force on palliative oxygen therapy aims to fill in these gaps by elaborating evidence-based clinical guidelines and by identifying potential research gaps.

References:

Ekström M. Clinical Usefulness of Long-Term Oxygen Therapy in Adults. New England Journal of Medicine 2016; 375: 1683-1684.
Antoniu SA et al. Outcome measures for palliative oxygen therapy: relevance and practical utility. Expert Rev Pharmacoecon Outcomes Res 2014;14(3):417-23
Abernethy AP, Currow DC, Frith P, Fazekas B. Prescribing palliative oxygen: a clinician survey of expected benefit and patterns of use. Palliat Med 2005;19(2): 168-70.
Jacobs S, Krishnan JA, Lederer DJ, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. AJRCCM 2020; 202: e121-e141.

Aim

To define palliative oxygen therapy and inform best management in clinical practice using an evidence-based approach.

Objetives

1. Standardization of palliative oxygen therapy definition through a modified Delphi process 2. Standardization of palliative oxygen therapy indications and target patient groups 3. Identification of outcome measures for palliative oxygen therapy effectiveness and safety 4. Provide evidence-based recommendations on the use of palliative oxygen in clinical practice through a systematic review and meta-analysis