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Background: The efficacy and tolerability of high-flow nasal cannula (HFNC) for relieving dyspnea in advanced cancer patients with limited prognosis requires elucidation. Methods: Patients with advanced cancer who had dyspnea at rest (numeric rating scale, NRS≥3) and respiratory failure were enrolled. They were treated with HFNC for five days. Primary endpoint was change of mean modified Borg scale at 24 hours. Key secondary endpoints consisted of change in modified Borg scale during the study period and feasibility (Trial Identifier, UMIN000035738). Results: Between February 2019 and February 2022, 25 patients were enrolled and 21 were analyzed. Twenty patients used inspired oxygen and the mean fraction of inspired oxygen (FiO2) was 0.34 (range, 0.21–1.0). At baseline, mean NRS (dyspnea) was 5.9 (range, 3–10). Median survival time was 19 days (range, 3–657). The change of mean modified Borg scale was 1.4 (80% confidence interval [CI]: 0.8–1.9) at 24 hours, 11 patients showed 1.5 points improvement of modified Borg scale. Within 1 hour, nine patients showed 1.5 points improvement of modified Borg scale and such early responders were likely to maintain dyspnea improvement for 24 hours.­ Nineteen patients could continue HFNC for 24 hours and 11 patients completed five days of HFNC. Conclusion: To our knowledge, this trial is the first prospective study to show the efficacy and tolerability of HFNC regarding dyspnea for five days in patients under palliative care. HFNC can be a palliative treatment option in advanced cancer patients with dyspnea.

No large-scale studies have reported on the clinical course of acute exacerbation of fibrosing interstitial lung disease (AE-FILD). We aimed to elucidate the clinical course of AE-FILD. We retrospectively included patients admitted with AE-FILD diagnosis. The clinical courses of AE-FILD were classified as consistent improvement after response to treatment (responder group); no response to treatment (non-responder group); improvement after treatment followed by worsening respiratory status not attributable to AE-FILD (complication group); and improvement after treatment followed by worsening respiratory status attributable to AE-FILD relapse (second-attack group). Among 340 patients, 123 died within 90 days, 265 responded, and 75 were refractory to initial treatment. Among patients who responded to treatment, 191, 26, 46, and 2 belonged to the responder, complication, second-attack, and unknown groups, respectively. Multivariate analysis revealed that high lactate dehydrogenase, high C-reactive protein, and low PaO2/FiO2 were associated with 90-day mortality (odds ratio [OR] 2.27, p = 0.002; OR 2.01, p = 0.008; and OR 1.70, p = 0.042, respectively). Of patients who responded to treatment, a second attack was strongly associated with 90-day mortality (OR 18.54, p