Vol. 56 No.

4 October 2018 Journal of Pain and Symptom Management 493

Original Article

Fan Therapy Is Effective in Relieving Dyspnea in Patients

With Terminally Ill Cancer: A Parallel-Arm, Randomized
Controlled Trial
Jun Kako, MHSc, RN, OCNS, Tatsuya Morita, MD, Takuhiro Yamaguchi, PhD,
Masamitsu Kobayashi, MSN, RN, OCNS, Asuko Sekimoto, MSN, RN, Hiroya Kinoshita, MD,
Asao Ogawa, MD, PhD, Sadamoto Zenda, MD, PhD, Yosuke Uchitomi, MD, PhD, Hironobu Inoguchi, MA, and
Eisuke Matsushima, MD, PhD
Section of Liaison Psychiatry and Palliative Medicine (J.K., E.M.), Tokyo Medical and Dental University Graduate School of Medical and
Dental Sciences, Tokyo; Division of Nursing Science (J.K.), Graduate School of Biomedical and Health Sciences, Hiroshima University,
Hiroshima; Department of Nursing (J.K., M.K., A.S.), National Cancer Center Hospital East, Kashiwa, Chiba; Palliative and Supportive
Care Division (T.M.), Seirei Mikatahara Hospital, Hamamatsu, Shizuoka; Biostatistics Division (T.Y.), Tohoku University Graduate School
of Medicine, Sendai, Miyagi; Community Health Nursing (M.K.), Ministry of Defense National Defense Medical College, Saitama; Palliative
Care Division (H.K.), Tokatsu Hospital, Nagareyama, Chiba; Psycho-Oncology Division (A.O.), Exploratory Oncology Research and Clinical
Trial Center, National Cancer Center Hospital East, Kashiwa, Chiba; Department of Radiation Oncology (S.Z.), National Cancer Center
Hospital East, Kashiwa, Chiba; Innovation Center for Supportive, Palliative and Psychosocial Care (Y.U.), National Cancer Center
Hospital, Tokyo; Division of Health Care Research (Y.U.), Center for Public Health Sciences, National Cancer Center, Tokyo; and Department
of Psycho-oncology (H.I.), National Cancer Center Hospital, Tokyo, Japan

Abstract
Context. Dyspnea is a common distressing symptom among patients with advanced cancer.
Objective. The objective of this study was to determine the effect of fan therapy on dyspnea in patients with terminally ill cancer.
Methods. This parallel-arm, randomized controlled trial included 40 patients with advanced cancer from a palliative care
unit at the National Cancer Center Hospital in Japan. All patients experienced dyspnea at rest with a score of at least three
points on a subjective 0- to 10-point Numerical Rating Scale (NRS), showed peripheral oxygen saturation levels of $90%, had
an Eastern Cooperative Oncology Group grade of 3 or 4, and were aged 20 years or more. In one group, a fan was directed to
blow air on the patient’s face for five minutes. This group was compared to a control group wherein air was blown to the
patient’s legs. Patients were randomly assigned to each group. The main outcome measure was the difference in dyspnea NRS
scores between fan-to-face and fan-to-legs groups.
Results. No significant differences were seen in baseline dyspnea NRS between groups (mean score, 5.3 vs. 5.1, P ¼ 0.665).
Mean dyspnea changed by 1.35 points (95% CI, 1.86 to 0.84) in patients assigned to receive fan-to-face and by 0.1
points (0.53 to 0.33) in patients assigned to receive fan-to-legs (P < 0.001). The proportion of patients with a one-point
reduction in dyspnea NRS was significantly higher in the fan-to-face arm than in the fan-to-legs arm (80% [n ¼ 16] vs. 25%
[n ¼ 5], P ¼ 0.001).
Conclusion. Fan-to-face is effective in alleviating dyspnea in patients with terminally ill cancer. J Pain Symptom Manage
2018;56:493e500. Ó 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Key Words
Dyspnea, neoplasms, palliative care, randomized controlled trial, nursing

Address correspondence to: Jun Kako, MHSc, RN, OCNS, Divi- Minami-ku, Hiroshima, 734-8533, Japan. E-mail: jkako-tky@
sion of Nursing Science, Graduate School of Biomedical umin.ac.jp
and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Accepted for publication: July 2, 2018.

Ó 2018 American Academy of Hospice and Palliative Medicine. 0885-3924/$ - see front matter
Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jpainsymman.2018.07.001
494 Kako et al.
Introduction
Dyspnea, a common and distressing symptom
among patients with advanced cancer, is defined as
an unpleasant or uncomfortable sensation during
breathing.1,2 This symptom has negative physical,
emotional, and psychosocial effects. The prevalence
of dyspnea increases as patients approach death,3,4
and its alleviation is, therefore, critically important
to improve the quality of life in such patients. Manage-
ment of dyspnea includes treatment of the underlying
causes with various combinations of pharmacological
therapy and nonpharmacological approaches.5e7
Fan therapy, often used to palliate dyspnea, uses a
fan to blow air in the direction of the patient’s face.
The mechanism by which fan therapy provides relief
from symptoms of dyspnea is not yet clear; however,
direct stimulation of the face, nasal mucosa, or phar-
ynx, as well as changes in facial temperature by cool-
ing due to the airflow, may affect the ventilation
patterns.8e10
Although fan therapy is recommended by various
clinical guidelines,11e13 there is limited empirical ev-
idence to support its effectiveness.14,15 A randomized
trial conducted by Galbraith et al. reported that fan
therapy was effective in reducing dyspnea, but the
subjects studied were patients with different primary
advanced diseases, and included 11 patients with pri-
mary or secondary lung cancer.16 Galbraith et al. con-
ducted a second single-arm study targeting a similar
population (n ¼ 31) and reported that half of the
participants showed reduced intensity of dyspnea
with fan therapy.17 Other randomized controlled tri-
als targeting patients with cancer have involved small
sample sizes (n ¼ 21) with varying performance sta-
tus.18 Wong et al.19 in a randomized controlled trial
(RCT) of patients with terminally ill cancer reported
on the effectiveness of fan therapy. However, this
study had neither an adequate sample power analysis
nor a clear definition of the target population. Allevi-
ating dyspnea in patients with terminally ill cancer is
a crucial issue; therefore, it is important to evaluate
the effectiveness of fan therapy in these patients.
However, adequately powered RCTs have not been
conducted to examine the efficacy of fan therapy
for dyspnea in such patients. Given the minimal po-
tential side effects, low cost, practical convenience,
and immediate responses, a well-designed clinical
trial evaluating the effectiveness of fan therapy will
be of great value.
The primary aim of this study was, therefore, to eval-
uate the effectiveness of fan therapy for dyspnea in pa-
tients with terminally ill cancer. In addition, we aimed
to investigate the changes in patients’ facial surface
temperature and physiological parameters, after fan
therapy.
Vol. 56 No. 4 October 2018
Methods
Study Design
We conducted a parallel-arm RCT (Japanese Clin-
ical Trials Register UMIN000023345; https://upload.
umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno¼R
000026902) and recruited patients between
September 28, 2016, and August 25, 2017. We adopted
a parallel control design because in our pilot study,
the washout period for fan therapy that may affect
the study outcome needed to be more than one
hour, which indicated that a crossover design was inap-
propriate.17,20 Fig. 1 shows the CONSORT flowchart
for patient selection.
Participants and Settings
Participants were recruited from a palliative care
unit of the National Cancer Center Hospital East, Chi-
ba, Japan. Patients were required to meet the
following inclusion criteria: 1) metastatic or locally
advanced cancer, 2) not undergoing current or
further anticancer treatment, 3) dyspnea while sitting
or lying at rest with a score of at least three points on a
0- to 10-point Numerical Rating Scale (NRS) (0 ¼ no
breathlessness; 10 ¼ worst possible breathlessness); 4)
peripheral oxygen saturation levels $90%; 5) Eastern
Cooperative Oncology Group grade of 3 or 4; 6)
aged $ 20 years; and 7) no cognitive impairment
and able to communicate in Japanese. Owing to the
lack of an established definition, we defined our target
population (patients with terminally ill cancer) using
the criteria of disease (metastatic or locally advanced),
treatment (no anticancer treatment), and perfor-
mance status. The exclusion criteria were fever
>38 C in the preceding 24 hours, a hemoglobin level
#6 g/dL, and diseases or treatments affecting the tri-
geminal nerve.
Interventions and Procedures
Fan therapy constituted of directing a fan to blow
air for five minutes across the region innervated by
the second/third trigeminal nerve branches. The fan
(model PJ-B3CLL [SHARP, Sakai-ku, Sakai, Japan];
five blades; size, 37  35.6  84 cm) was directed to-
ward one side of the face. The rationale for using
five minutes of directed airflow was based on previous
findings that this protocol achieved symptom pallia-
tion.16,17,20 As in previous studies,16 the distance, loca-
tion, side of the face, strength, and swing of the fan
were determined as per the patient’s prefer-
ences.16,18,20 A standing fan placed on the floor was
applied at the lowest speed initially and was gradually
adjusted to increase the speed and strength of the fan
breeze. In the control arm, airflow was directed onto
the legs with the patient’s skin exposed for
five minutes using the same model of fan as that
Vol. 56 No. 4 October 2018 Fan Therapy for Dyspnea in Patients With Cancer
Fig. 1. CONSORT 2010 flow diagram.
used in the intervention arm. We adopted the fan-to-
legs method as the control treatment based on the
study by Galbraith et al.16
We applied a washout time based on the NCCN
guidelines before initiating therapy so as to avoid
the effects of prior opioid treatment on the study
outcome.21
Outcomes
The primary outcome was change in dyspnea NRS.
The severity of dyspnea was recorded at baseline and
immediately after treatment, using a Japanese version
of the Edmonton Symptom Assessment Systemerevised
(ESAS-r).22 The ESAS-r measures nine symptoms that
include pain, tiredness, drowsiness, nausea, lack of appe-
tite, depression, anxiety, dyspnea, and well-being.23 The
ESAS-r rates these symptoms on an 11-point Likert scale
from 0 (no symptoms) to 10 (most severe symptoms). For
sensitivity analyses, we conducted an exploratory
responder analysis based on the proportion of patients
in both the study groups who experienced a $1 point/
$2 point reduction, and $10%/25% reduction in the
dyspnea NRS. The clinical benefit for dyspnea measured
495
as a minimal clinically important difference was defined
as a one-point reduction in the NRS score.24e27
The secondary outcomes included changes in pa-
tients’ facial surface temperature, measured using a
FLIRÒ TG165 IR thermometer (FLIR Systems Inc.,
Wilsonville, OR) and other physiological parameters
such as the respiratory rate, peripheral oxygen satura-
tion level, and pulse rate. Ambient room temperature
and humidity were also measured. These data were re-
corded at baseline and immediately after the treat-
ment. We did not conduct the arterial blood gas and
respiratory function test due to the patient burden
this test imposes. The investigator monitored adverse
events by directly questioning the patient if adverse
events had been experienced. Such information was
reported to the concerned palliative care specialists.
Baseline characteristics such as primary tumor sites,
comorbidities, underlying etiologies of dyspnea,
Eastern Cooperative Oncology Group grade, Karnof-
sky Performance Status score, Palliative Prognostic
Score, Palliative Prognostic Index, and prescriptions
for opioids, steroids, and oxygen were obtained from
patient medical records.28,29 Comorbidities and
496 Kako et al.
underlying etiologies were determined based on clin-
ical judgments made by the palliative care specialists
primarily responsible for the patient’s care.
Sample Size
We estimated that >16 patients per group would
allow for detection of a mean difference of 1.0 (SD
1), with a P-value of <0.05 at a power of 80%, using
the dyspnea NRS. The SD value was decided based
on the results of our pilot study.20 To allow for a con-
servative estimated attrition of 20%, we planned to re-
cruit at least 40 patients.
Randomization
Participants who met all the eligibility criteria and
provided written informed consent were randomly as-
signed in a 1:1 ratio to the intervention (fan therapy:
fan-to-face) or to the control group (fan-to-legs). Par-
ticipants were stratified based on baseline dyspnea
NRS levels (#7) and randomized using a software
application available (via https://epocdatabase.epoc-
ncc.net/) through the clinical support system at the
National Cancer Center.
Statistical Analysis
All randomized patients who completed a baseline
assessment were included in the primary analysis.
We analyzed the descriptive statistics for patient char-
acteristics. Continuous variables were compared using
the Student’s t-test, and categorical variables were
compared using the c2 test or the Fisher’s exact
test, as appropriate. For the primary outcome, the dif-
ference in dyspnea NRS between fan-to-face and
fan-to-legs was assessed using the Student’s t-test. For
secondary analyses, we defined a P-value <0.05 as sta-
tistically significant, due to expletory nature of these
outcomes.
Statistical analyses were performed using the EZR
statistical software (Saitama Medical Center, Jichi Med-
ical University, Saitama, Japan) and R (The R Founda-
tion for Statistical Computing, Vienna, Austria).30
Results
Between September 28, 2016, and August 25, 2017,
we screened 429 eligible patients. Of 429 enrolled pa-
tients, 389 declined to participate in the RCT. Except
for one patient who was not interested, the rest of the
patients did not meet inclusion criteria. A total of 40
patients were included and were randomly assigned
to the two groups: 20 patients to the fan-to-face and
20 to the fan-to-legs groups (Fig. 1). All participants
completed the study.
Vol. 56 No. 4 October 2018
Patient Characteristics and Baseline Symptoms
Patient characteristics were generally similar be-
tween the intervention and control arms (Table 1).
The average age was 69 years, and 22 of 40 (55%) pa-
tients were men. Approximately two-thirds of the par-
ticipants had primary or secondary lung cancer. The
average hemoglobin level was 10.9 g/dL. Types of
opioids used included morphine, oxycodone, and
fentanyl, with a mean daily oral morphine dose of
30.3 mg/d (SD 31.9, range 0e119 mg/day). About
80% of the participants had a Karnofsky Perfor-
mance Status score of 40 or less indicating a disability
for self-care. While 52.5% (n ¼ 21) had a Palliative
Prognostic Score of 9 or more, 70% (n ¼ 28) had a
Palliative Prognostic Index score of 6.5 or more.
Half of the participants were on supplemental oxy-
gen at the time of enrollment, with a median of
2 L/minute and an average oxygen saturation of
96% (SD 2).
Table 2 shows the intensity of the baseline symptoms
measured by the ESAS-r. No significant differences
were seen in the baseline dyspnea NRS between the
intervention and the control groups (mean score,
5.3 vs. 5.1, P ¼ 0.665).
Changes in Dyspnea and Other Symptom Intensities
Table 3 summarizes the changes in dyspnea inten-
sity. The mean scores changed by 1.35 points (95%
CI, 1.86 to 0.84) in the fan-to-face group versus
by 0.1 points (CI, 0.53 to 0.33) in the fan-to-legs
group (P < 0.001). The proportion of patients with
$1-point and $2-point reductions in dyspnea NRS
scores was significantly higher in the fan-to-face group
than in the fan-to-legs group: 80% versus 25%,
P ¼ 0.001; 35% versus 5.0%, P ¼ 0.043 (Table 3). Simi-
larly, the proportion of patients with $10% reduction
was significantly higher in the fan-to-face group than
in the fan-to-legs group: 80% versus 25%, P ¼ 0.001
(Table 3).
The change in the drowsiness score was significantly
higher in the fan-to-face group than in the fan-to-legs
group (absolute difference: þ0.40) (Table 4). The
other symptoms were not different between the
groups (Table 4).
No adverse effects were reported to the palliative
care specialists primarily responsible for patient care.
Changes in Facial Surface Temperature and
Physiological Parameters
Facial surface temperatures at baseline were not
significantly different between the two groups (fan-
to-face group vs. fan-to-legs group: 33.2 [SD 1.5]
vs. 33.2 [SD 1.8], P ¼ 0.95). However, the fan-to-
face group showed a drop in temperature (by
Vol. 56 No. 4 October 2018 Fan Therapy for Dyspnea in Patients With Cancer 497

Table 1
Patient Characteristics (n ¼ 40)
Variable Fan-to-Face (n ¼ 20) Fan-to-Legs (n ¼ 20) P-value

Age (yrs), mean (SD) 71.5 (8.2) 67.0 (11.9) 0.171

Sex (male) 12 (60.0) 10 (50.0) 0.751
Primary tumor sites, n (%)
Lung 11 (55.0) 4 (20.0) 0.048
Colon/rectum 1 (5.0) 2 (10.0) 1
Breast 1 (5.0) 2 (10.0) 1
Stomach 1 (5.0) 1 (5.0) 1
Esophagus 1 (5.0) 1 (5.0) 1
Gallbladder/bile duct 1 (5.0) 1 (5.0) 1
Liver 1 (5.0) 0 (0.0) 1
Uterus/ovary 1 (5.0) 0 (0.0) 1
Skin 1 (5.0) 0 (0.0) 1
Unknown 1 (5.0) 0 (0.0) 1
Pancreas 0 (0.0) 4 (20.0) 0.106
Head and neck 0 (0.0) 3 (15.0) 0.231
Prostate 0 (0.0) 2 (10.0) 0.487
Comorbidities, n (%)
Chronic obstructive pulmonary disease 4 (20.0) 2 (10.0) 0.661
Interstitial lung disease 2 (10.0) 1 (5.0) 1
Chronic heart failure 2 (10.0) 1 (5.0) 1
Hepatic cirrhosis 2 (10.0) 0 (0.0) 0.487
Chronic renal failure 0 (0.0) 0 (0.0) 1
Underlying etiologies of dyspnea, n (%)
Primary or secondary lung cancer 14 (70.0) 11 (55.0) 0.514
Pleural effusion 12 (60.0) 13 (65.0) 1
Respiratory muscle weakness 9 (45.0) 8 (40.0) 1
Ascites/liver enlargement 7 (35.0) 10 (50.0) 0.523
Respiratory infection 5 (25.0) 4 (20.0) 1
Major airway obstruction 5 (25.0) 2 (10.0) 0.407
Lymphangiosis 1 (5.0) 1 (5.0) 1
Superior vena cava syndrome 1 (5.0) 1 (5.0) 1
Use of medications, n (%)
Opioids 14 (70.0) 15 (75.0) 1
Daily oral morphine equivalent, mg/day, mean (SD) 21.2 (26.5) 39.4 (34.8) 0.071
Corticosteroids 9 (45.0) 8 (40.0) 1
Benzodiazepines 1 (5.0) 4 (20.0) 0.342
Oxygen, n (%) 9 (45.0) 11 (55.0) 0.752
Performance status, n (%)
Karnofsky performance status, mean (SD) 42.5 (10.7) 43.0 (7.3) 0.864
ECOG performance status
3 16 (80.0) 15 (75.0) 1
4 4 (20.0) 5 (25.0) 1
ECOG ¼ Eastern Cooperative Oncology Group.

1.43 C) after the intervention (95% CI, 2.30 to Changes in physiological parameters including
0.56), which was significantly different from the pulse rate, respiratory rates, and SpO2 showed no
change in the fan-to-legs group (0.01-point significant differences between the two groups
decrease; 95% CI, 0.36 to 0.34; P ¼ 0.003). (Table 5).

Table 2
Baseline Symptom Intensity Measured by the Edmonton Symptom Assessment SystemeRevised
Symptom Fan-to-Face Group (n ¼ 20) Fan-to-Legs Group (n ¼ 20) P-value

Dyspnea 5.30 (1.38) 5.10 (1.52) 0.665

Well-being 5.70 (1.89) 5.70 (2.08) 1
Tiredness 5.05 (2.42) 4.70 (2.27) 0.640
Lack of appetite 5.00 (3.70) 3.80 (3.07) 0.271
Drowsiness 4.55 (2.11) 4.25 (2.63) 0.693
Abdominal distention 4.10 (3.28) 4.10 (3.01) 1
Pain 3.95 (2.31) 3.50 (2.21) 0.533
Anxiety 3.90 (3.18) 3.45 (2.72) 0.633
Depression 3.70 (2.90) 3.05 (2.28) 0.436
Nausea 2.05 (2.42) 1.25 (2.12) 0.273
Means (SD) are presented.
498 Kako et al. Vol. 56 No. 4 October 2018

Table 3
Changes in Dyspnea Intensity
Dyspnea Score Fan-to-Face Group (n ¼ 20) Fan-to-Legs Group (n ¼ 20) P-value

Absolute change (95% CI) 1.35 (1.86 to 0.84) 0.10 (0.53 to 0.33) <0.001
One-point reduction, n (%) 16 (80.0) 5 (25.0) 0.001
Two-point reduction or more, n (%) 7 (35.0) 1 (5.0) 0.043
Relative change (%) 27.7% 1.7% 0.002
$10% reduction, n (%) 16 (80.0) 5 (25.0) 0.001
$25% reduction, n (%) 8 (40.0) 2 (10.0) 0.065

Discussion therapy may be able to increase self-efficacy35 as it

This study presents evidence that fan therapy is
effective in ameliorating dyspnea in terminally ill can-
cer patients. Several previous studies have reported
the effectiveness of fan therapy on refractory dyspnea
but have targeted patients with different primary dis-
eases.16,17 Our results in patients with terminal cancer
confirm the observations by Wong et al. who conduct-
ed a study with similar participants as in our study;
however, in the study by Wong et al., the sample size
was smaller and the performance status was not
defined.19 The absolute dyspnea NRS score in our
study changed by 1.35 (95% CI, 1.86 to 0.84),
which was higher than the minimal clinically impor-
tant difference (1.0) for dyspnea.24 An empirical study
has suggested that differences of 11.3 mm for mod-
erate effects and 18.2 mm for large effects on a Vi-
sual Analogue Scale were clinically important in
dyspnea treatment.24 Moreover, in our study, 80% of
the participants receiving fan therapy showed a reduc-
tion of $1 point while 35% showed a reduction of $2
points. Based on these findings, we believe that fan
therapy is beneficial in alleviating dyspnea in patients
with terminally ill cancer.
Fan therapy has multiple advantages over pharma-
cological or medical treatment.31 Patients often have
a psychological resistance to opioids due to miscon-
ceptions such as notions that opioids shorten life,
cause addiction, or cause brain toxicity.32e34 Fan ther-
apy, on the other hand, causes no changes in physio-
logical parameters and theoretically and empirically
has no adverse effects. In addition, it is inexpensive,
convenient, and available in all care settings. Fan
can be initiated anywhere at any time without the
help of clinical staff. Based on our findings, we
strongly recommend fan therapy for dyspnea in pa-
tients with terminally ill cancer.
Another important finding in this study is the
decrease in the patients’ facial temperature in the
intervention group. Literature evidence suggests that
directing cold air at the patient’s face alleviates dys-
pnea.9,10 Taken together, it may be postulated that
the control of facial surface temperature may be a
mechanism that underlies alleviation of dyspnea by
fan therapy.
The strength of this study includes the randomized
controlled trial design with adequate sample size
calculation, and clarification of the target population
using objective criteria.
This study nonetheless has several limitations. First,
this study was a single-center trial. A previous meta-
epidemiologic study has concluded that single-center
RCTs tend to show larger treatment effects than do
multicenter studies.36 Thus, a multicenter study is
needed to confirm our findings. Second, owing to
the nature of the intervention, blinding of patients
was not possible. Third, we did not assess the arterial
blood gas and respiratory functions. However, because
the results of these tests do not necessarily correlate
with the subjective intensity of dyspnea,37,38 we assume
this limitation has minimal effect on data interpreta-
tion. In addition, we were not able to identify physio-
logical causes of dyspnea (e.g., increased effort while
breathing due to airway resistance, decreased compli-
ance of the lung or chest wall, or stimulation of

Table 4
Changes in the Intensity of Symptoms Other Than Dyspnea
Symptom Fan-to-Face Group (n ¼ 20) Fan-to-Legs Group (n ¼ 20) P-value

Absolute change (95% CI)

Well-being 0.15 (0.72 to 0.43) 0.25 (0.62 to 0.12) 0.760
Tiredness 0.55 (1.19 to 0.09) 0.45 (0.89 to 0.01) 0.788
Drowsiness 0.4 (0.01 to 0.81) 0.45 (0.97 to 0.07) 0.010
Lack of appetite 0.05 (0.05 to 0.15) 0.0 (0.15 to 0.15) 0.574
Abdominal distention 0.55 (1.04 to 0.06) 0.65 (1.28 to 0.02) 0.795
Pain 0.6 (1.38 to 0.18) 0.15 (0.50 to 0.20) 0.277
Anxiety 0.25 (0.45 to 0.04) 0.15 (0.66 to 0.36) 0.706
Depression 0.1 (0.31 to 0.11) 0.40 (0.78 to 0.02) 0.159
Nausea 0.1 (0.31 to 0.11) 0.2 (0.53 to 0.13) 0.592
Vol. 56 No. 4 October 2018 Fan Therapy for Dyspnea in Patients With Cancer
Table 5
Changes in Physiological Parameters
Fan-to-Face Group (n ¼ 20)
Variable Before After
Pulse rate 93.9 (17.4) 88.0 (25.3)
Respiratory rate 17.8 (4.8) 17.6 (4.6)
SpO2 95.7 (2.0) 95.7 (2.1)
SpO2 ¼ peripheral oxygen saturation levels.
Means (SDs) are presented.
deflation receptors due to atelectasis with large effu-
sion). This information may be helpful in creating hy-
potheses about why some patients responded better
than did others. However, obtaining this information
can be a burden on patients with terminal cancer.
Finally, the format of control treatment is a significant
issue. In our pilot study, none of the participants expe-
rienced a clinical benefit from ‘‘no fan’’ and ‘‘fan-to-
legs’’.20 Therefore, even if we had set ‘‘no fan’’ as the
control treatment, the result might not have been
different.
In conclusion, fan therapy is a clinically effective
treatment for dyspnea in patients with terminally ill
cancer. Considering its safety, convenience, and low
cost, fan therapy should be regarded as a highly valu-
able intervention for the terminally ill cancer patients
with dyspnea.
Disclosures and Acknowledgments
The authors thank the patients who participated in
this RCT and the registered nurses of the Palliative
Care Unit at the National Cancer Center Hospital
East. Special thanks to Yoshihisa Matsumoto, MD (Na-
tional Cancer Center Hospital East), Tomofumi
Miura, MD (National Cancer Center Hospital East),
and Keita Tagami, MD (Tohoku University Hospital).
The authors also thank Editage (www.editage.jp) for
editing the article.
This work was supported by JSPS KAKENHI grant
number 15K20723. The funder had no involvement
in the study design, collection, analysis, and interpre-
tation of data; writing of the report; and decision to
submit the article for publication.
The authors have no conflicts of interest to declare.
Ethical approval: This study was conducted in accor-
dance with the amended Declaration of Helsinki, was
approved by the Ethical Committee of the National
Cancer Center, Japan (2015-144, approval no.:
2015e144), and was registered before the first partic-
ipant was enrolled (University Hospital Medical Infor-
mation Network, Japan [UMIN000023345]). All
participants provided written informed consent. The
full protocol for the trial is available from the corre-
sponding author.
499
Fan-to-Legs Group (n ¼ 20)
P Before After P
0.114 94.3 (17.3) 92.4 (17.3) 0.125
0.522 14.6 (4.2) 14.7 (4.2) 0.716
0.858 96.7 (2.0) 96.9 (1.8) 0.408
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