Abstract
Context
Although Systemic opioids are recommended as a pharmacological treatment for cancer-related
dyspnea, their effectiveness and safety needs to be investigated in a real-world context
Objectives
To evaluate the effectiveness and safety of systemic regular opioids for dyspnea in
cancer patients, in the real-world palliative care practice.
Methods
This was a multicenter prospective observational study. We consecutively enrolled
adult cancer patients starting regular opioids (morphine, oxycodone, hydromorphone,
or fentanyl) for dyspnea from 12 palliative care services across Japan. We evaluated
dyspnea intensity using the Numerical Rating Scale (NRS) and Integrated Palliative
Outcome Scale (IPOS) every 24 hours until 72 hours after starting opioids (T1–T3).
We also evaluated common opioid-related adverse events (AEs) and other severe AEs.
Results
We enrolled 402 cancer patients. The proportion of responders was 68.8% (95%confidence
intervals (CI): 0.63–0.74) at T1, 75.7% (95%CI: 0.70–0.81) at T2, and 82.1% (95%CI:
0.76–0.87) at T3. The mean differences in dyspnea NRS from baseline were 1.73 (95%CI:
1.46–1.99) at T1, 1.99 (95%CI: 1.71–2.28) at T2, and 2.47 (95%CI:2.13–2.82) at T3.
The most common treatment-emergent AE was somnolence with an incidence of the severe
form of approximately 10% throughout the study period. In the multivariate analysis,
baseline dyspnea NRS ≥6 had a positive correlation with dyspnea relief by systemic
regular opioids, while liver metastasis, clinician-predicted survival days, and opioid
tolerance had a negative correlation.
Conclusion
Regular systemic opioids were effective for dyspnea in real-world cancer patients.
Key Words
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Article info
Publication history
Published online: January 11, 2023
Accepted:
December 24,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
