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How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study

  • Masanori MoriEmail author
  • Tatsuya Morita
  • Yoshinobu Matsuda
  • Hirohide Yamada
  • Keisuke Kaneishi
  • Yoshihisa Matsumoto
  • Naoki Matsuo
  • Takuya Odagiri
  • Etsuko Aruga
  • Hiroaki Watanabe
  • Ryohei Tatara
  • Hiroki Sakurai
  • Akira Kimura
  • Hideki Katayama
  • Akihiko Suga
  • Tomohiro Nishi
  • Akemi Naito Shirado
  • Toshio Watanabe
  • Aya Kuchiba
  • Takuhiro Yamaguchi
  • Satoru Iwase
Original Article
  • 130 Downloads

Abstract

Purpose

Parenteral morphine is widely used for dyspnea of imminently dying cancer patients, but the outcomes to expect over time remain largely unknown. We examined outcomes after the administration of parenteral morphine infusion over 48 h in cancer patients with a poor performance status.

Methods

This was a multicenter prospective observational study. Inclusion criteria were metastatic/locally advanced cancer, ECOG performance status = 3–4, a dyspnea intensity ≥ 2 on a Support Team Assessment Schedule, Japanese version (STAS-J), and receiving specialized palliative care. After initiating parenteral morphine infusion, we measured dyspnea STAS-J as well as Memorial Delirium Assessment Scale (MDAS), item 9, and Communication Capacity Scale (CCS), item 4, every 6 h over 48 h.

Results

We enrolled 167 patients (median survival = 4 days). The mean age was 70 years, 80 patients (48%) had lung cancer, and 109 (65%) had lung metastases. The mean STAS-J scores decreased from 3.1 (95% confidence interval (CI) = 3.0–3.2) at the baseline to 2.1 (95%CI = 1.9–2.2) at 6 h, and remained 1.6–1.8 over 12–48 h. The proportion of patients with dyspnea relief (STAS-J ≤ 1) increased to 39% at 6 h, and ranged between 49 and 61% over 12–48 h. In contrast, up to 6.6 and 20% of patients showed hyperactive delirium (MDAS item 9 ≥ 2) and an inability to communicate (CCS item 4 = 3), respectively, over 48 h.

Conclusions

Overall, terminal dyspnea was relatively well controlled with parenteral morphine, though a significant number of patients continued to suffer from dyspnea. Future efforts are needed to improve outcomes following standardized dyspnea treatment using patient-reported outcomes for imminently dying patients.

Keywords

Dyspnea Morphine Outcomes Cancer Palliative care 

Notes

Funding information

This work was funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare. The funding source had no involvement in the study design; collection, analysis, or interpretation of data; writing of the manuscript; or the decision to submit the manuscript for publication.

Compliance with ethical standards

This study was conducted in accordance with the ethical standards of the Helsinki Declaration and the ethical guidelines for epidemiological research presented by the Ministry of Health, Labour and Welfare in Japan. The study was approved by the Institutional Review Boards (IRBs) of all participating institutions. The IRBs waived the requirement for obtaining written informed consent in this observational study based on the aforementioned ethical guidelines.

Conflict of interest

AK received honoraria for speaking at symposia by Chugai Pharmaceutical Co., Ltd. The other authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Masanori Mori
    • 1
    Email author
  • Tatsuya Morita
    • 2
  • Yoshinobu Matsuda
    • 3
  • Hirohide Yamada
    • 4
  • Keisuke Kaneishi
    • 5
  • Yoshihisa Matsumoto
    • 6
  • Naoki Matsuo
    • 7
  • Takuya Odagiri
    • 8
  • Etsuko Aruga
    • 9
  • Hiroaki Watanabe
    • 8
  • Ryohei Tatara
    • 10
  • Hiroki Sakurai
    • 11
  • Akira Kimura
    • 12
  • Hideki Katayama
    • 13
  • Akihiko Suga
    • 14
  • Tomohiro Nishi
    • 15
  • Akemi Naito Shirado
    • 16
  • Toshio Watanabe
    • 17
  • Aya Kuchiba
    • 18
  • Takuhiro Yamaguchi
    • 19
  • Satoru Iwase
    • 20
  1. 1.Palliative Care TeamSeirei Mikatahara General HospitalHamamatsuJapan
  2. 2.Palliative and Supportive Care DivisionSeirei Mikatahara General HospitalHamamatsuJapan
  3. 3.Department of Psychosomatic Internal MedicineNational Hospital Organization Kinki-Chuo Chest Medical CenterSakaiJapan
  4. 4.Seirei Hamamatsu General HospitalHamamatsuJapan
  5. 5.Department of Palliative Care UnitJCHO Tokyo Shinjuku Medical CenterTokyoJapan
  6. 6.Department of Palliative MedicineNational Cancer Center Hospital EastKashiwaJapan
  7. 7.Hospice Medical CorporationJunkei-kai Sotoasahikawa HospitalSotoasahikawaJapan
  8. 8.Komaki City HospitalKomaki CityJapan
  9. 9.Department of Palliative MedicineTeikyo University School of MedicineTokyoJapan
  10. 10.Osaka City General HospitalOsakaJapan
  11. 11.Department of Palliative TherapyCancer Institute HospitalTokyoJapan
  12. 12.Department of Palliative and Supportive CareObihiro Kousei General HospitalObihiroJapan
  13. 13.Department of Palliative and Supportive CareOkayama University HospitalOkayamaJapan
  14. 14.Department of Palliative MedicineShizuoka Saiseikai General HospitalSurugaJapan
  15. 15.Kawasaki Municipal Ida HospitalKawasaki-shiJapan
  16. 16.Miyazaki Medical Association HospitalMiyazakiJapan
  17. 17.Toyama Prefectural Central HospitalToyama-shiJapan
  18. 18.Biostatistics Division, CRASNational Cancer CenterTokyoJapan
  19. 19.Division of BiostatisticsTohoku University Graduate School of MedicineSendaiJapan
  20. 20.Department of Emergency & Palliative Medicine, Faculty of MedicineSaitama Medical UniversitySaitamaJapan

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