The following is a summary of “Systemic Opioids for Dyspnea in Cancer Patients: A Real-world Observational Study,” published in the MAY 2023 issue of Pain Management by Yamaguchi, et al.

Systemic opioids are commonly prescribed for treating cancer-related dyspnea, but their effectiveness and safety must be evaluated in the real world. For a multicenter prospective observational study, researchers sought to assess the effectiveness and safety of regular systemic opioids for dyspnea in cancer patients in real-world palliative care practice.

Adult cancer patients with dyspnea who were starting regular opioids (morphine, oxycodone, hydromorphone, or fentanyl) were consecutively enrolled in 12 palliative care services. Dyspnea intensity was evaluated using the Numerical Rating Scale (NRS) and Integrated Palliative Outcome Scale (IPOS) every 24 hours until 72 hours after starting opioids (T1–T3). In addition, opioid-related adverse events (AEs) and other severe AEs were also assessed.

A total of 402 cancer patients were enrolled in the study. The proportion of responders was 68.8% (95% 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, dyspnea relief by regular systemic opioids was positively correlated with a baseline dyspnea NRS ≥6 and negatively correlated with liver metastasis, clinician-predicted survival days, and opioid tolerance.

The study demonstrated that regular systemic opioids were effective for dyspnea in real-world cancer patients, with a manageable safety profile.

Source: jpsmjournal.com/article/S0885-3924(23)00004-0/fulltext