The following is a summary of “Do Types of Opioids Matter for Terminal Cancer Dyspnea? A Preliminary Multicenter Cohort Study,” published in the April 2023 issue of Pain Management by Mori, et al.

Terminal dyspnea is a distressing symptom experienced by cancer patients in the last weeks to days of life. Although physicians often use parenteral opioids other than morphine to manage terminal dyspnea, there was limited knowledge about their effects on cancer patients. For a study, researchers sought to explore the effectiveness and safety of parenteral morphine, oxycodone, and hydromorphone in managing terminal dyspnea in cancer patients.

The secondary analysis utilized data from a multicenter cohort study that included advanced cancer patients experiencing moderate/severe terminal dyspnea. Palliative care physicians initiated parenteral opioids (morphine, oxycodone, or hydromorphone) using a standardized treatment algorithm. Dyspnea intensity was measured using the Integrated Palliative care Outcome Scale (IPOS) at 24 and 48 hours after opioid initiation.

The study included 108 patients with a mean age of 72. Of these, 66 (61%), 34 (32%), and 8 (7.4%) received morphine, oxycodone, and hydromorphone, respectively. At 24 hours, the mean dyspnea IPOS scores significantly decreased from baseline in the morphine 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, similar reductions in IPOS scores were observed in all three groups (P < 0.001 for morphine, P < 0.001 for oxycodone, and P = 0.004 for hydromorphone). There were no significant differences in mean IPOS scores among the three groups at 24 hours (P = 0.080) or 48 hours (P = 0.322). Adverse events related to opioid use were rare.

The study suggested that parenteral morphine, oxycodone, and hydromorphone may have similar effectiveness and safety in managing terminal dyspnea in cancer patients.

Source: jpsmjournal.com/article/S0885-3924(23)00461-X/fulltex