[Successful management of a patient with pain and dyspnea from bone metastasis and lymphangitis carcinomatosa after surgery for non-small cell lung cancer (NSCLC) in whom optimal dosages of transdermal fentanyl were determined by titration with fentanyl injection, and oxycodone hydrochloride].

With recent progress in disease-modifying treatments for cancer, patients who have recurrences during a period of several years before entering the terminal stage are encountered frequently. Despite improved life expectancy with cancer therapy, for patients this means prolongation of the period in which various symptoms such as cancer pain and adverse reactions are undergone. In these conditions, although the recognition is not yet sufficient, the importance of palliative care along with disease-modifying treatment is recognized in Japan. We treated a 50s female with pain and dyspnea from bone metastasis and lymphangitis carcinomatosa after surgery for NSCLC in whom the optimal dosages of transdermal fentanyl (Durotep Patch) were determined by titration with fentanyl injection, and oxycodone hydrochloride (OxyContin) in a short period. The dosages after titration were transdermal fentanyl 35 mg, oxycodone hydrochloride 60 mg, and betamethasone 4 mg. Before her death, she was able to stay at home with her family for 3 days without severe symptoms. In the present study we describe the clinical course of this case, the difference of characteristics in these opioids, and the titration method with fentanyl injection.