Journal of palliative medicine · 2025
Effectiveness of Opioid Titration for Terminal Dyspnea in Opioid-Naïve and -Tolerant Patients with Advanced Cancer: A Multicenter Prospective Cohort Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Mori Masanori, Yamaguchi Takashi, Suzuki Kozue, Matsuda Yoshinobu, Matsunuma Ryo, Watanabe Hiroaki, Ikari Tomoo, Matsumoto Yoshihisa, Imai Kengo, Yokomichi Naosuke, Miwa Satoru, Yamauchi Toshihiro, Okamoto Soichiro, Inoue Satoshi, Inoue Akira, Hui David, Morita Tatsuya, Satomi Eriko, Japanese Dyspnea Relief Investigators
Аннотация
BACKGROUND: Terminal dyspnea is a distressing symptom in advanced cancer patients. Although opioids are standard treatment, their effectiveness may differ between opioid-naïve and -tolerant patients.
OBJECTIVES: To evaluate responses to opioid titration for terminal dyspnea and assess differences in palliative care physicians' perceptions of opioid effectiveness between opioid-naïve and -tolerant patients.
DESIGN: A pre-planned secondary analysis of a multicenter prospective cohort study.
SETTING/SUBJECTS: Advanced cancer patients (n = 108) with moderate to severe terminal dyspnea and an Eastern Cooperative Oncology Group performance status of 3-4, receiving continuous parenteral opioid infusions, were included and categorized as opioid-naïve (n = 48) or opioid-tolerant (n = 60).
MEASUREMENTS: Opioid doses were titrated in four predefined levels within 48 hours, with effectiveness assessed 6 hours post-titration using the Clinician Global Impression-Improvement scale. Opioid ineffectiveness was defined as the need for continuous sedatives or death without dyspnea relief, with doses recorded as the parenteral morphine-equivalent daily dose.
RESULTS: The mean age was 72 years, and lung cancer was present in 43 patients (40%). Opioid-naïve patients showed a 100% response after 12 titrations, while opioid-tolerant patients exhibited a 68% response after 34 titrations. At death or one month after treatment, opioids were determined to be ineffective in 8.3% of opioid-naïve and 38% of opioid-tolerant patients (p < 0.001). Median doses at ineffectiveness were 15 mg (IQR = 7.5-23) and 36 mg (IQR = 14-200), respectively.
CONCLUSIONS: Opioid-tolerant patients showed a lower-level response and were more likely to experience ineffectiveness than opioid-naïve patients. Larger studies are needed to confirm these findings and improve terminal dyspnea management.
OBJECTIVES: To evaluate responses to opioid titration for terminal dyspnea and assess differences in palliative care physicians' perceptions of opioid effectiveness between opioid-naïve and -tolerant patients.
DESIGN: A pre-planned secondary analysis of a multicenter prospective cohort study.
SETTING/SUBJECTS: Advanced cancer patients (n = 108) with moderate to severe terminal dyspnea and an Eastern Cooperative Oncology Group performance status of 3-4, receiving continuous parenteral opioid infusions, were included and categorized as opioid-naïve (n = 48) or opioid-tolerant (n = 60).
MEASUREMENTS: Opioid doses were titrated in four predefined levels within 48 hours, with effectiveness assessed 6 hours post-titration using the Clinician Global Impression-Improvement scale. Opioid ineffectiveness was defined as the need for continuous sedatives or death without dyspnea relief, with doses recorded as the parenteral morphine-equivalent daily dose.
RESULTS: The mean age was 72 years, and lung cancer was present in 43 patients (40%). Opioid-naïve patients showed a 100% response after 12 titrations, while opioid-tolerant patients exhibited a 68% response after 34 titrations. At death or one month after treatment, opioids were determined to be ineffective in 8.3% of opioid-naïve and 38% of opioid-tolerant patients (p < 0.001). Median doses at ineffectiveness were 15 mg (IQR = 7.5-23) and 36 mg (IQR = 14-200), respectively.
CONCLUSIONS: Opioid-tolerant patients showed a lower-level response and were more likely to experience ineffectiveness than opioid-naïve patients. Larger studies are needed to confirm these findings and improve terminal dyspnea management.