High Flow Oxygen and Bilevel Airway Pressure for Persistent Dyspnea in Patients With Advanced Cancer

Inclusion Criteria:

1. History of advanced cancer, defined as locally advanced, recurrent or metastatic disease
2. Patients with persistent dyspnea, defined in this study as dyspnea at rest with an average intensity level \>/=3 out of a Numeric Rating Scale from 0 to 10 for at least 2 week and just prior to study initiation, despite supplemental oxygen of up to 21 L/min to keep oxygen saturation \>/=90%
3. Dyspnea is judged clinical to be predominantly due to underlying malignancy, with or without obstructive lung disease
4. Inpatient at MD Anderson Cancer Center
5. Patients with cancer treatment related dyspnea are eligible for this study if they meet the eligibility criteria above.
6. Able to communicate in English
7. Expected life expectancy \>1 week
8. Patients with a diagnosis of pneumonia are also eligible for this study if they meet the eligibility criteria above, with dyspnea \>=2 weeks prior to the diagnosis of pneumonia.
9. Age 18 or greater

Exclusion Criteria:

1. Patients who remain hypoxic (i.e. O2 saturation \<90% despite maximal oxygen delivery (21 L/min) are not included in this study because they are considered to have severe life-threatening respiratory failure and are too unstable for study inclusion.
2. Hemodynamic instability (Heart Rate (HR) \>140, systolic blood pressure (SBP) \<80) within 24 hours of study initiation (as per Clinic Station)
3. Acute respiratory distress requiring intubation
4. Delirium as indicated by a Memorial Delirium Assessment Scale (MDAS) of 13 or higher
5. Glasglow coma scale \<8
6. Excessive airway secretions interfering with BIPAP administration
7. History of facial trauma within 1 month of enrollment
8. Upper GI bleed within 2 weeks of enrollment or esophageal rupture
9. Partial or complete small bowel obstruction or severe nausea/vomiting (ESAS nausea \>7/10) within 48 hours of enrollment
10. Hemoglobin \<8 g/dL at the time of enrollment (blood draw within last 2 weeks)
11. Acute exacerbation of COPD or CHF within 2 weeks of enrollment by history or physical
12. Unwilling to provide informed consent
13. Diagnosis of non-cancer related dyspnea (e.g. Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) or any chronic respiratory disease) requiring supplemental home oxygen prior to hospitalization.