TY - JOUR
T1 - Do Types of Opioids Matter for Terminal Cancer Dyspnea? A Preliminary Multicenter Cohort Study
AU - Japanese Dyspnea Relief Investigators
AU - Mori, Masanori
AU - Yamaguchi, Takashi
AU - Suzuki, Kozue
AU - Matsuda, Yoshinobu
AU - Matsunuma, Ryo
AU - Watanabe, Hiroaki
AU - Ikari, Tomoo
AU - Matsumoto, Yoshihisa
AU - Imai, Kengo
AU - Yokomichi, Naosuke
AU - Miwa, Satoru
AU - Yamauchi, Toshihiro
AU - Okamoto, Soichiro
AU - Inoue, Satoshi
AU - Inoue, Akira
AU - Hui, David
AU - Morita, Tatsuya
AU - Satomi, Eriko
N1 - Funding Information:
This work was supported in part by the Japan Hospice Palliative Care Foundation and Health, Labour, and Welfare Sciences Research Grant ( 19EA1011 , 22EA1004 ).
Publisher Copyright:
© 2023 American Academy of Hospice and Palliative Medicine
PY - 2023/8
Y1 - 2023/8
N2 - Context: Dyspnea is among the most distressing symptoms in the last weeks to days of life (terminal dyspnea). While physicians frequently use parenteral opioids other than morphine for terminal dyspnea, little is known about their effects in cancer patients. Objectives: To explore the effectiveness and safety of parenteral morphine, oxycodone, and hydromorphone for cancer patients with terminal dyspnea. Methods: This was a secondary analysis of a multicenter cohort study that consecutively enrolled advanced cancer patients with moderate/severe terminal dyspnea. Participating palliative care physicians initiated parenteral opioids (morphine/oxycodone/hydromorphone), utilizing a standardized treatment algorithm. We examined the dyspnea intensity (Integrated Palliative care Outcome Scale [IPOS]) at 24 and 48 hours. Results: Of 108 patients (mean age = 72), 66 (61%), 34 (32%), and 8 (7.4%) received morphine, oxycodone, and hydromorphone, respectively. At 24 hours, mean dyspnea IPOS scores significantly decreased from 3.0 (standard error (SE) = 0.1) at the baseline to 1.6 (0.1), 2.9 (0.1) to 2.0 (0.2), and 3.5 (0.2) to 1.2 (0.4) in the morphine (P < 0.001), oxycodone (P < 0.001), and hydromorphone (P = 0.011) groups, respectively. At 48 hours, the IPOS scores significantly reduced from 2.9 (0.1) at the baseline to 1.4 (0.1), 2.9 (0.1) to 1.6 (0.2), and 3.5 (0.2) to 1.2 (0.2) in the morphine (P < 0.001), oxycodone (P < 0.001), and hydromorphone (P = 0.004) groups, respectively. No significant differences in mean scores were found among the three groups at 24 (P = 0.080) and 48 hours (P = 0.322). Adverse events were rare. Conclusion: Parenteral morphine, oxycodone, and hydromorphone may be similarly effective and safe for cancer patients with terminal dyspnea.
AB - Context: Dyspnea is among the most distressing symptoms in the last weeks to days of life (terminal dyspnea). While physicians frequently use parenteral opioids other than morphine for terminal dyspnea, little is known about their effects in cancer patients. Objectives: To explore the effectiveness and safety of parenteral morphine, oxycodone, and hydromorphone for cancer patients with terminal dyspnea. Methods: This was a secondary analysis of a multicenter cohort study that consecutively enrolled advanced cancer patients with moderate/severe terminal dyspnea. Participating palliative care physicians initiated parenteral opioids (morphine/oxycodone/hydromorphone), utilizing a standardized treatment algorithm. We examined the dyspnea intensity (Integrated Palliative care Outcome Scale [IPOS]) at 24 and 48 hours. Results: Of 108 patients (mean age = 72), 66 (61%), 34 (32%), and 8 (7.4%) received morphine, oxycodone, and hydromorphone, respectively. At 24 hours, mean dyspnea IPOS scores significantly decreased from 3.0 (standard error (SE) = 0.1) at the baseline to 1.6 (0.1), 2.9 (0.1) to 2.0 (0.2), and 3.5 (0.2) to 1.2 (0.4) in the morphine (P < 0.001), oxycodone (P < 0.001), and hydromorphone (P = 0.011) groups, respectively. At 48 hours, the IPOS scores significantly reduced from 2.9 (0.1) at the baseline to 1.4 (0.1), 2.9 (0.1) to 1.6 (0.2), and 3.5 (0.2) to 1.2 (0.2) in the morphine (P < 0.001), oxycodone (P < 0.001), and hydromorphone (P = 0.004) groups, respectively. No significant differences in mean scores were found among the three groups at 24 (P = 0.080) and 48 hours (P = 0.322). Adverse events were rare. Conclusion: Parenteral morphine, oxycodone, and hydromorphone may be similarly effective and safe for cancer patients with terminal dyspnea.
KW - Hydromorphone
KW - Morphine
KW - Oxycodone
KW - Terminal dyspnea
KW - Treatment algorithm
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U2 - 10.1016/j.jpainsymman.2023.04.009
DO - 10.1016/j.jpainsymman.2023.04.009
M3 - Article
C2 - 37080479
AN - SCOPUS:85158171598
SN - 0885-3924
VL - 66
SP - e177-e184
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 2
ER -