{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:11:41Z","timestamp":1790143901162,"version":"4.0.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dyspnea affects 50%\u221270% of patients with advanced cancer. Current management typically addresses physiological or psychological aspects in isolation. This trial evaluated a two-dimensional intervention targeting both breathing mechanics and psychological distress simultaneously.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This four-arm randomized controlled trial enrolled 160 patients with advanced cancer and moderate-to-severe dyspnea, allocated to Control (standard care), Breathing Training (BT), Psychological Support (PS), or Combined intervention (\n                      <jats:italic>n<\/jats:italic>\n                      = 40 per arm). Primary endpoints included dyspnea severity [Visual Analog Scale (VAS), Medical Research Council Dyspnea Scale] and psychological distress [Hospital Anxiety and Depression Scale [HADS)]. Secondary outcomes comprised quality of life (EORTC QLQ-C30) and physiological parameters. Assessments occurred at baseline and weeks 2, 4, 6, and 8.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The Combined intervention produced significantly greater VAS improvement vs. Control (\u22120.93 vs \u22120.21,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001; Cohen's d = 0.91). Effect sizes for the Combined group were large across all outcomes: anxiety (d = 1.17), depression (d = 1.28), and quality of life (d = 1.32). The additive effect index of 0.65 indicated sub-additive rather than synergistic component interaction. Number needed to treat for 30% dyspnea response was 3 for Combined intervention. Subgroup analysis revealed attenuated benefits in ECOG performance status 3 patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The two-dimensional intervention demonstrates comprehensive efficacy for cancer-related dyspnea across physical and psychological domains, achieving the largest effect sizes despite additive rather than synergistic effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>This trial was not registered in a public clinical trials registry. The absence of prospective registration is acknowledged as a limitation of the study (see Discussion).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1881099","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:53:21Z","timestamp":1790142801000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of a two-dimensional intervention model combining breathing training and psychological support for dyspnea management in patients with advanced cancer: a randomized controlled trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Longmei","family":"Fang","sequence":"first","affiliation":[{"name":"Department of Radiotherapy, Hangzhou Cancer Hospital","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaling","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Oncology, Hangzhou Cancer Hospital","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuona","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Hangzhou Cancer Hospital","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1016\/j.jpainsymman.2009.09.017","article-title":"Do the trajectories of dyspnea differ in prevalence and intensity by diagnosis at the end of life?","volume":"39","author":"Currow","year":"2010","journal-title":"J Pain Symptom Manage."},{"key":"B2","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.jpainsymman.2005.06.007","article-title":"A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease","volume":"31","author":"Solano","year":"2006","journal-title":"J Pain Symptom Manage."},{"key":"B3","doi-asserted-by":"publisher","first-page":"103908","DOI":"10.1016\/j.critrevonc.2022.103870","article-title":"Systematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients","volume":"182","author":"Shin","year":"2023","journal-title":"Crit Rev Oncol Hematol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1164\/rccm.201111-2042ST","article-title":"An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea","volume":"185","author":"Parshall","year":"2012","journal-title":"Am J Respir Crit Care Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"v169","DOI":"10.1093\/annonc\/mdv306","article-title":"Treatment of dyspnoea in advanced cancer patients: ESMO Clinical Practice Guidelines","volume":"26","author":"Kloke","year":"2015","journal-title":"Ann Oncol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1200\/JCO.20.03465","article-title":"Management of dyspnea in advanced cancer: ASCO guideline","volume":"39","author":"Hui","year":"2021","journal-title":"J Clin Oncol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1056\/NEJMoa1000678","article-title":"Early palliative care for patients with metastatic non-small-cell lung cancer","volume":"363","author":"Temel","year":"2010","journal-title":"N Engl J Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1186\/PREACCEPT-1197669166131735","article-title":"Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? 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