Structured Personalized Oxygen and Supportive Therapies for Dyspnea in Oncology

Primary Objectives:

• To determine the effect of SPOT-ON and Enhanced Usual Care on the change in intensity of dyspnea (NRS) between baseline and 24 h in hypoxemic hospitalized patients with cancer.
• To determine the effect of SPOT-ON and Enhanced Usual Care on the change in intensity of dyspnea (NRS) between baseline and 24 h in non-hypoxemic hospitalized patients with cancer.

Secondary Objectives:

• To determine the effect of SPOT-ON and Enhanced Usual Care on patient outcomes over 72 h, including intensity of dyspnea (NRS), unpleasantness of dyspnea (NRS), dyspnea response, ital signs, symptom burden, health-related quality of life (EQ-5D-5L), adverse events, patterns of device use, and hospital outcomes.
• To identify factors associated with dyspnea response in the SPOT-ON intervention, including patient demographics, preferences, and level of usage of oxygen delivery modalities.
• To identify patient factors associated with their preferences (after Phase II and Phase III) for each of the oxygen delivery modalities in the SPOT-ON intervention, such as patient demographics and dyspnea characteristics.

Inclusion criteria

• Diagnosis of cancer
• Age 18 or older.
• Admitted to a medical floor.
• Dyspnea intensity at rest of at least 4 on a 0-10-point NRS (where 0 = none, 10 = worst).
• Speak English or Spanish.

Exclusion criteria

• Hemodynamic instability requiring active Merit Team or ICU team involvement.
• Delirium as per clinical team's assessment in the Electronic Health Record (EHR).
• Severe hypoxemia (SpO2 < 90% despite supplemental oxygen of up to 6 L/min).
• Continuous positive airway pressure (CPAP) use for obstructive sleep apnea, actively using >10 hours a day.
• Respiratory failure necessitating mechanical ventilation (i.e., HFNC or NIV), and planned thoracentesis within 72 hours of enrollment.
• Patients with known pregnancy.