1
|
Yamamoto Y, Tanaka S, Matsuura K, Yamamoto S, Urano K, Okita J, Kato E, Odagiri T, Deguchi Y. Effectiveness of opioid switching for dyspnea and its predictors in cancer patients: a single-center retrospective observational study. Jpn J Clin Oncol 2024; 54:549-555. [PMID: 38323655 DOI: 10.1093/jjco/hyae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Morphine is the most used opioid for dyspnea, but other opioids such as oxycodone and fentanyl are increasingly used, and opioid switching to these is sometimes undertaken. No studies have verified the effectiveness of opioid switching for relief of dyspnea. We retrospectively investigated the effectiveness of opioid switching for dyspnea and its predictors. METHODS All patients with opioid switching for dyspnea during hospitalization at Komaki City Hospital from January 2019 to August 2022 were included. Opioid switching was defined as a change to another opioid, and the assessment period for evaluating the effectiveness and adverse events of opioid switching was set as 1 week. Patients with Numeric Rating Scale or Japanese version of the Support Team Assessment Schedule reduction for dyspnea of at least 1, or with clear improvement based on medical records, were considered valid. Mitigating factors for dyspnea were identified using logistic regression analysis. RESULTS Of the 976 patients with opioid switching, 57 patients had opioid switching for relief of dyspnea. Of these, opioid switching was effective in 21 patients (36.8%). In a multivariate analysis, older patients (odds ratio: 5.52, 95% CI: 1.50-20.20, P < 0.01), short prognosis for post-opioid switching (odds ratio: 0.20, 95% CI: 0.04-0.87, P = 0.03) and cachexia (odds ratio: 0.12, 95% CI: 0.02-0.64, P < 0.01) were significantly associated with opioid switching effects for dyspnea. There were no serious adverse events after opioid switching. CONCLUSION This study indicates that opioid switching for dyspnea may have some effect. Furthermore, opioid switching for dyspnea may be more effective in older patients and less effective in terminally ill patients or in those with cachexia.
Collapse
Affiliation(s)
| | - Shion Tanaka
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Katsuhiko Matsuura
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Seiji Yamamoto
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Kimihiko Urano
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Junya Okita
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Eisuke Kato
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
- Department of Palliative Care, Seino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Yuko Deguchi
- Departments of Pharmacy, Komaki City Hospital, Komaki, Aichi, Japan
| |
Collapse
|
2
|
Hamatani Y, Iguchi M, Moriuchi K, Anchi Y, Inuzuka Y, Nishikawa R, Shimamura K, Kondo H, Mima H, Yamashita Y, Takabayashi K, Takenaka K, Korai K, Kawase Y, Murai R, Yaku H, Nagao K, Kitano M, Aono Y, Kitai T, Sato Y, Kimura T, Akao M. Effectiveness and safety of morphine administration for refractory dyspnoea among hospitalised patients with advanced heart failure: the Morphine-HF study. BMJ Support Palliat Care 2024; 13:e1300-e1307. [PMID: 37169517 DOI: 10.1136/spcare-2023-004247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Morphine is effective in alleviating dyspnoea in patients with cancer. We aimed to investigate the effectiveness and safety of morphine administration for refractory dyspnoea in patients with advanced heart failure (HF). METHODS We conducted a multicentre, prospective, observational study of hospitalised patients with advanced HF in whom morphine was administered for refractory dyspnoea. Morphine effectiveness was evaluated by dyspnoea intensity changes, assessed regularly by both a quantitative subjective scale (Visual Analogue Scale (VAS; graded from 0 to 100 mm)) and an objective scale (Support Team Assessment Schedule-Japanese (STAS-J; graded from 0 to 4 points)). Safety was assessed by vital sign changes and new-onset severe adverse events, including nausea, vomiting, constipation and delirium based on the Common Terminology Criteria for Adverse Events. RESULTS From 15 Japanese institutions between September 2020 and August 2022, we included 28 hospitalised patients with advanced HF in whom morphine was administered (mean age: 83.8±8.7 years, male: 15 (54%), New York Heart Association class IV: 26 (93%) and mean left ventricular ejection fraction: 38%±19%). Both VAS and STAS-J significantly improved from baseline to day 1 (VAS: 67±26 to 50±31 mm; p=0.02 and STAS-J: 3.3±0.8 to 2.6±1.1 points; p=0.006, respectively), and thereafter the improvements sustained through to day 7. After morphine administration, vital signs including blood pressure, pulse rate and oxygen saturation did not change, and no new-onset severe adverse events occurred through to day 7. CONCLUSIONS This study suggested acceptable effectiveness and safety for morphine administration in treating refractory dyspnoea in hospitalised patients with advanced HF.
Collapse
Affiliation(s)
- Yasuhiro Hamatani
- Cardiology, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Moritake Iguchi
- Cardiology, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Kenji Moriuchi
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuta Anchi
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasutaka Inuzuka
- Cardiovascular Medicine, Shiga Medical Center for Adults, Moriyama, Japan
| | - Ryusuke Nishikawa
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Hibiki Mima
- Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yugo Yamashita
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Kengo Korai
- Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yuichi Kawase
- Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryosuke Murai
- Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Kazuya Nagao
- Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Mariko Kitano
- Cardiovascular Center, Kitano Hospital, Osaka, Japan
| | - Yuya Aono
- Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Takeshi Kitai
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yukihito Sato
- Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | - Masaharu Akao
- Cardiology, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| |
Collapse
|
3
|
Matsuda Y, Hasuo H, Narita K, Matsuoka H, Morita R, Kiuchi D, Ikari T, Hori T, Okazaki K, Sakai K, Aiki S, Okabayashi H, Oyamada S, Ariyoshi K, Tokoro A, Fukunaga M. Relationship between dyspnoea and related factors in patients with cancer: a cross-sectional study. BMJ Support Palliat Care 2024; 13:e1126-e1132. [PMID: 38557730 DOI: 10.1136/bmjspcare-2021-003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Dyspnoea is a common and distressing symptom in patients with cancer. We aimed to analyse the association between dyspnoea and related factors and to estimate their causal relationship. METHODS A cross-sectional study was conducted. Patients with cancer with dyspnoea and a mean Numerical Rating Scale (NRS) of ≥3 over 24 hours were enrolled at 10 institutions in Japan from December 2019 to February 2021. The outcomes included dyspnoea, cough and pain NRS over 24 hours, Eastern Cooperative Oncology Group Performance Status, Hospital Anxiety and Depression Scale, Somatosensory Amplification Scale, opioids for dyspnoea and respiratory failure. Path analyses were conducted to estimate the direct and indirect paths with reference to dyspnoea and related factors. RESULTS A total of 209 patients were enrolled and 208 patients were included in the analysis. Cough worsened dyspnoea (β=0.136), dyspnoea increased emotional distress (β=1.104), emotional distress increased somatosensory amplification (β=0.249) and somatosensory amplification worsened cough (β=0.053) according to path analysis. CONCLUSION There may be a vicious circle among dyspnoea and related factors: cough worsened dyspnoea, dyspnoea increased emotional distress, emotional distress increased somatosensory amplification and somatosensory amplification worsened cough. When treating dyspnoea in patients with cancer, managing these factors aimed at interrupting this vicious circle may be useful. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000038820).
Collapse
Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| | - Keiichi Narita
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromichi Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kosei Medical Center, Akita, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuo Hori
- Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Koya Okazaki
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kiyohiro Sakai
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine Hospital, Osakasayama, Japan
| | - Sayo Aiki
- Department of Palliative Care, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hiroko Okabayashi
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| |
Collapse
|
4
|
Sakaguchi T. Cancer-related breathlessness: opioids other than morphine - comprehensive literature review. BMJ Support Palliat Care 2024; 13:e715-e729. [PMID: 37468224 DOI: 10.1136/spcare-2022-004115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Although there is low-quality evidence, there has been an increase in publications on the experience of evaluating and managing cancer-related breathlessness using opioids other than morphine. METHODS The author conducted a non-systematic literature review in the PubMed/Medline and Embase until 4 October 2022. Eligible studies have evaluated the efficacy of opioids other than morphine for cancer-related breathlessness. Studies focused on sedation, anaesthesia, paediatric patients, opioid toxicity or basic research were excluded. Reviews/meta-analyses and non-English language publications were also excluded. RESULTS A total of 1556 records were identified, of which 23 studies including 469 patients who were treated with fentanyl (n=223), oxycodone (n=171) and hydromorphone (n=75) were considered eligible. Six phase II randomised clinical trials (RCTs), four observational studies and four case reports of fentanyl were found. For breathlessness on exertion, fentanyl yielded promising results, but no RCT showed significant superiority of fentanyl to placebo or morphine. For terminal breathlessness, three RCTs, five non-randomised or observational studies and one case report on oxycodone or hydromorphone were found. Although the results of the observational studies suggested that oxycodone and hydromorphone might be effective alternatives to morphine, the superiority over placebo or non-inferiority to morphine had not been demonstrated in the RCTs. CONCLUSION As an alternative to morphine, the author recommends fentanyl for breathless crisis or breathlessness on exertion, and oxycodone or hydromorphone for terminal breathlessness in advanced cancer. Larger and well-designed studies based on firm research policies are needed to confirm this current knowledge.
Collapse
Affiliation(s)
- Tatsuma Sakaguchi
- Department of Palliative Care, Kitano Hospital, Osaka, Japan
- Palliative Care Centre, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
5
|
Takimoto T. Corticosteroids for pulmonary lymphangitic carcinomatosis. BMJ Support Palliat Care 2024; 13:e951-e952. [PMID: 36302614 DOI: 10.1136/spcare-2022-003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022]
Abstract
Pulmonary lymphangitic carcinomatosis (PLC) is a type of lymphangitic spread of cancer cells, from a primary site to the pulmonary vasculature and lymphatics. Corticosteroids are recommended for PLC by clinical guidelines, although scientific evidence for this traditional practice is still lacking. We report a patient with lung cancer who developed clinically diagnosed PLC and was successfully treated with steroid treatment. The pulmonary shadows suggestive of PLC were remarkably improved, as well as her symptom. Corticosteroids are worth trying when PLC is clinically suspected.
Collapse
Affiliation(s)
- Takayuki Takimoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| |
Collapse
|
6
|
Yamaguchi T, Yokomichi N, Yamaguchi T, Maeda I, Matsunuma R, Tanaka-Yagi Y, Akatani A, Suzuki K, Kohara H, Taniyama T, Matsuda Y, Nakajima N, Morita T, Tsuneto S, Mori M. Anticholinergic drugs for death rattle in dying patients with cancer: multicentre prospective cohort study. BMJ Support Palliat Care 2023; 13:462-471. [PMID: 36357162 DOI: 10.1136/spcare-2022-003823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/28/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study aimed to investigate the effectiveness of anticholinergics (AC) for death rattle in dying patients with cancer. METHODS This is a prospective cohort study enrolled Terminally ill adult (20 years or older) patients with cancer who developed substantial death rattle (Back score ≥2) from 23 palliative care units in Japan. AC treatment for death rattle was prescribed according to primary physician's decision. The primary outcome was the proportion of patients whose death rattle improved, which was defined as a Back score of ≤1. We compared the proportion of improved cases in patients treated with (AC group) and without (non-AC group) AC, controlling potential confounders by employing propensity score weighting. RESULTS Of the 1896 patients enrolled, we included 196 who developed a substantial death rattle. Of these, 81 received AC. 56.8% in the AC group and 35.4% in the non-AC group had an improved death rattle at 8 hours after baseline. In the weighted analysis, AC group showed significant improvements in death rattle, with an adjusted OR of 4.47 (95% CI 2.04 to 9.78; p=0.0024). All sensitivity analyses achieved essentially the same results. In the subgroup analysis, ACs were strongly associated with death rattle improvement in men, patients with lung cancer, and type 1 death rattle (adjusted OR 5.81, 8.38 and 9.32, respectively). CONCLUSIONS In this propensity score-weighted analysis, ACs were associated with death rattle improvement in terminally ill patients with cancer who developed substantial death rattle. TRIAL REGISTRATION NUMBER UMIN-CTR (UMIN00002545).
Collapse
Affiliation(s)
- Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine School of Medicine, Kobe, Hyogo, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Osaka, Japan
| | - Ryo Matsunuma
- Department of Palliative Care, Konan Medical Center, Kobe, Hyogo, Japan
| | | | - Asami Akatani
- Department of Palliative Medicine, Kobe University Graduate School of Medicine School of Medicine, Kobe, Hyogo, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Kohara
- Department of Palliative Care, Hatsukaichi Memorial Hospital, Hatsukaichi, Hiroshima, Japan
| | - Tomohiko Taniyama
- Department of Oncology and Palliative Care, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yosuke Matsuda
- Department of Palliative Care, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Nobuhisa Nakajima
- Division of Community Medicine and Internal Medicine, University of the Ryukyus Hospital, Nishihara, Okinawa, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
7
|
Mori M, Yamaguchi T, Suzuki K, Matsuda Y, Matsunuma R, Watanabe H, Ikari T, Matsumoto Y, Imai K, Yokomichi N, Miwa S, Yamauchi T, Okamoto S, Inoue S, Inoue A, Hui D, Morita T, Satomi E. Do Types of Opioids Matter for Terminal Cancer Dyspnea? A Preliminary Multicenter Cohort Study. J Pain Symptom Manage 2023; 66:e177-e184. [PMID: 37080479 DOI: 10.1016/j.jpainsymman.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
CONTEXT Dyspnea is among the most distressing symptoms in the last weeks to days of life (terminal dyspnea). While physicians frequently use parenteral opioids other than morphine for terminal dyspnea, little is known about their effects in cancer patients. OBJECTIVES To explore the effectiveness and safety of parenteral morphine, oxycodone, and hydromorphone for cancer patients with terminal dyspnea. METHODS This was a secondary analysis of a multicenter cohort study that consecutively enrolled advanced cancer patients with moderate/severe terminal dyspnea. Participating palliative care physicians initiated parenteral opioids (morphine/oxycodone/hydromorphone), utilizing a standardized treatment algorithm. We examined the dyspnea intensity (Integrated Palliative care Outcome Scale [IPOS]) at 24 and 48 hours. RESULTS Of 108 patients (mean age = 72), 66 (61%), 34 (32%), and 8 (7.4%) received morphine, oxycodone, and hydromorphone, respectively. At 24 hours, mean dyspnea IPOS scores significantly 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, the IPOS scores significantly reduced from 2.9 (0.1) at the baseline to 1.4 (0.1), 2.9 (0.1) to 1.6 (0.2), and 3.5 (0.2) to 1.2 (0.2) in the morphine (P < 0.001), oxycodone (P < 0.001), and hydromorphone (P = 0.004) groups, respectively. No significant differences in mean scores were found among the three groups at 24 (P = 0.080) and 48 hours (P = 0.322). Adverse events were rare. CONCLUSION Parenteral morphine, oxycodone, and hydromorphone may be similarly effective and safe for cancer patients with terminal dyspnea.
Collapse
Affiliation(s)
- Masanori Mori
- Palliative and Supportive Care Division (M.M., N.Y., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Takashi Yamaguchi
- Department of Palliative Medicine (T.Y.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care (K.S.), Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine (Y.M.), National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Ryo Matsunuma
- Division of Palliative Care (R.M.), Department of Medicine, Konan Medical Center, Kobe, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care (H.W.), Komaki City Hospital, Komaki, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine (T.I., A.I.), Tohoku University School of Medicine, Sendai, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Therapy (Y.M.), Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice (K.I., S.M., T.Y., S.O., S.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division (M.M., N.Y., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Miwa
- Seirei Hospice (K.I., S.M., T.Y., S.O., S.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Toshihiro Yamauchi
- Seirei Hospice (K.I., S.M., T.Y., S.O., S.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Soichiro Okamoto
- Seirei Hospice (K.I., S.M., T.Y., S.O., S.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoshi Inoue
- Seirei Hospice (K.I., S.M., T.Y., S.O., S.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Inoue
- Department of Palliative Medicine (T.I., A.I.), Tohoku University School of Medicine, Sendai, Japan
| | - David Hui
- Department of Palliative (D.H.), Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tatsuya Morita
- Palliative and Supportive Care Division (M.M., N.Y., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Eriko Satomi
- Department of Palliative Medicine (E.S.), National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
8
|
Takagi Y, Sato J, Yamamoto Y, Matsunuma R, Watanabe H, Mori M, Hasegawa T, Matsuda Y, Kako J, Kasahara Y, Goya S, Kohara H, Nakayama T, Yamaguchi T. Opioids for the management of dyspnea in cancer patients: a systematic review and meta-analysis. Int J Clin Oncol 2023:10.1007/s10147-023-02362-6. [PMID: 37338727 PMCID: PMC10390357 DOI: 10.1007/s10147-023-02362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
Dyspnea is a prevalent symptom that significantly reduces quality of life of cancer patients. Palliative treatment is necessary when the symptoms do not respond to treatment for their cause. Opioids are widely used as pharmacological therapy, but evidence for individual agents is inconsistent. The purpose of this study was to evaluate the efficacy and safety of opioids for dyspnea in cancer patients. We searched the CENTRAL, MEDLINE, EMBASE, and ICHUSHI for studies using opioids for dyspnea in adult cancer patients reported by September 2019. Screening of the retrieved literature and assessment of risk of bias and outcomes were performed by two independent authors. A meta-analysis was performed on the primary endpoint, relief of dyspnea, and secondary endpoints including quality of life, somnolence as a side effect, and serious adverse events. Twelve randomized controlled trials were evaluated regarding relief of dyspnea. Somnolence and serious adverse events were evaluated in seven and four randomized controlled trials, respectively, but no randomized controlled trials were evaluable for quality of life. Overall, opioids were more effective than placebo for dyspnea (standardized mean difference - 0.43, 95% confidence interval [CI] - 0.75 to - 0.12). Although significant difference was found between systemic morphine and placebo in the drug-specific analysis, no significant difference could be detected in the other analyses. Systemic administration of opioids is more effective than placebo in relieving dyspnea in cancer patients. Robust evidence on the efficacy and safety of opioids on dyspnea in cancer patients is lacking, and further studies are needed.
Collapse
Affiliation(s)
- Yusuke Takagi
- Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Junya Sato
- Department of Pharmacy, International University of Health and Welfare Hospital, Nasu-Shiobara, Japan
| | | | - Ryo Matsunuma
- Department of Palliative Medicine, Konan Medical Center, Kobe, Japan
| | | | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takaaki Hasegawa
- Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, Kobe, Japan
| | - Yoko Kasahara
- Department of Pharmacy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Sho Goya
- Department of Respiratory Medicine, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Itami, Japan
| | - Hiroyuki Kohara
- Department of Internal Medicine, Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University, Kyoto, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
9
|
Mori M, Miwa S, Ikari T, Kako J, Hasegawa T, Matsunuma R, Suzuki K, Matsuda Y, Watanabe H, Morita T, Yamaguchi T. Current Management Options for Dyspnea in Cancer Patients. Curr Treat Options Oncol 2023; 24:565-579. [PMID: 37037975 DOI: 10.1007/s11864-023-01081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/12/2023]
Abstract
OPINION STATEMENT Dyspnea is one of the most frequent and distressing symptoms in patients with advanced cancer. As dyspnea deteriorates patients' quality of life markedly and tends to worsen as the disease progresses, comprehensive assessment and timely treatment of the underlying etiologies are essential. International guidelines recommend various non-pharmacological and pharmacological management options. However, there is a scarcity of confirmatory clinical trials on cancer dyspnea, and the overall level of evidence is weak. Recently, observational and survey studies indicated a wide range of practice patterns of palliative care specialists, providing important insight into the real-world management of dyspnea. In this paper, we summarize current management options for dyspnea in cancer patients, highlight major controversies in the literature, and propose future research directions toward quality care for patients with dyspnea and their families.
Collapse
Affiliation(s)
- Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, 433-8558, Japan.
| | - Satoru Miwa
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tomoo Ikari
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Ryo Matsunuma
- Division of Palliative Care, Konan Medical Center, Konan, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, 433-8558, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
10
|
Simon ST, Mori M, Ekström M, Pralong A, Yamaguchi T, Hui D. Should Benzodiazepines be Used for Reducing Dyspnea in Patients with Advanced Illnesses? J Pain Symptom Manage 2023; 65:e219-e223. [PMID: 36455801 DOI: 10.1016/j.jpainsymman.2022.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 11/30/2022]
Abstract
Dyspnea is a common and highly distressing symptom in patients with advanced illnesses. Many patients continue to experience chronic dyspnea despite optimal management of underlying disease(s) and various non-pharmacologic interventions, necessitating the consideration of pharmacologic therapies for palliation of dyspnea. One commonly asked question by clinicians is whether benzodiazepines have a role in the palliation of dyspnea. In this "Controversies in Palliative Care" article, three groups of thought leaders independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. All three groups suggest that benzodiazepines alone do not confer a benefit for dyspnea in advanced illnesses based on existing data. They also expressed concerns about the potential adverse effects such as delirium and drowsiness and recommended against benzodiazepines as first line pharmacologic therapy. Some groups suggest that benzodiazepines may be used in highly selected patients with severe anxiety associated with dyspnea. Some investigators may also consider the adjunctive use of benzodiazepines in patients with severe dyspnea despite opioids, particularly if life expectancy is limited. Benzodiazepines also have a role in palliative sedation for refractory dyspnea in the last days of life. More research is needed to confirm the benefit of benzodiazepines in these populations.
Collapse
Affiliation(s)
- Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology (S.T.S., A.P.), University Hospital of Cologne, Cologne, Germany
| | - Masanori Mori
- Palliative and Supportive Care Division (M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Magnus Ekström
- Respiratory Medicine, Allergology, and Palliative Medicine (M.E.), Lund University, Sweden
| | - Anne Pralong
- Department of Palliative Medicine and Center for Integrated Oncology (S.T.S., A.P.), University Hospital of Cologne, Cologne, Germany
| | - Takashi Yamaguchi
- Department of Palliative Medicine (T.Y.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine (D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
11
|
Mori M, Yamaguchi T, Suzuki K, Matsuda Y, Matsunuma R, Watanabe H, Ikari T, Matsumoto Y, Imai K, Yokomichi N, Miwa S, Yamauchi T, Okamoto S, Inoue S, Inoue A, Morita T, Satomi E. The feasibility and effects of a pharmacological treatment algorithm for cancer patients with terminal dyspnea: A multicenter cohort study. Cancer Med 2023; 12:5397-5408. [PMID: 36259645 PMCID: PMC10028104 DOI: 10.1002/cam4.5362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND How clinicians treat patients with terminal dyspnea widely varies, which could hamper quality care. We visualized comprehensive pharmacological treatment delivered by palliative care physicians. AIM To examine adherence to a comprehensive pharmacological treatment algorithm for patients with terminal dyspnea, and to explore its outcomes during 48 h. DESIGN A multicenter cohort study at five sites (February 2020 to June 2021). SETTING/PARTICIPANTS We prospectively enrolled consecutive patients with advanced cancer, Eastern Cooperative Oncology Group performance status 3-4, and moderate/severe dyspnea. Participating palliative care physicians initiated algorithm-based treatment. The primary outcome was the proportion of adherence to the treatment algorithm over 24 h (predefined goal, 70%). We evaluated the adherence, goal achievement, and dyspnea level with a numerical rating scale (NRS), as well as adverse events over 48 h. RESULTS All 108 patients received algorithm-based pharmacological treatment. Among 96 and 87 patients who were alive at 24 and 48 h, respectively, 96 (100%; 95% confidence interval [CI] = 96%-100%) and 82 (94%; 95%CI = 87%-98%) continued to receive the algorithm treatment, respectively, and 66 (69%; 95%CI = 59%-77%) and 64 (74%; 95%CI = 63%-82%) achieved the treatment goals, respectively. Using a complete case analysis with paired t-tests, mean dyspnea NRS scores significantly reduced from 7.3 (standard error, 0.2) at the baseline to 4.9 (0.3) at 24 h (n = 72; p < 0.001), and 7.2 (0.3) at the baseline to 4.6 (0.4) at 48 h (n = 55; p < 0.001). Most adverse events were mild to moderate. CONCLUSIONS The comprehensive pharmacological treatment algorithm was feasible, and the study data supports its preliminary efficacy and safety. The use of this algorithm may help clinicians improve care for patients with terminal dyspnea.
Collapse
Affiliation(s)
- Masanori Mori
- Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Kozue Suzuki
- Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Japan
| | - Yoshinobu Matsuda
- National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | | | | | - Tomoo Ikari
- Tohoku University School of Medicine, Sendai, Japan
| | - Yoshihisa Matsumoto
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Satoru Miwa
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Soichiro Okamoto
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoshi Inoue
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Inoue
- Tohoku University School of Medicine, Sendai, Japan
| | | | | | | |
Collapse
|
12
|
Yasuda S, Sugano K, Matsuda Y, Kako J, Takagi Y, Watanabe H, Kasahara Y, Goya S, Kohara H, Mori M, Nakayama T, Yamaguchi T. Systematic review and meta-analysis of the efficacy of benzodiazepines for dyspnea in patients with cancer. Jpn J Clin Oncol 2023; 53:327-334. [PMID: 36636762 PMCID: PMC10064324 DOI: 10.1093/jjco/hyac206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/17/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE the role of benzodiazepines in relieving dyspnea in patients with cancer has not yet been established. This systematic review and meta-analysis aimed to determine the efficacy and safety of benzodiazepines alone or in combination with opioids for dyspnea in patients with cancer. METHODS Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and Ichushi-Web were searched for articles published from database inception to 23 September 2019. Studies of benzodiazepines alone or in combination with opioids for dyspnea were included. The primary outcome measure was the relief of dyspnea. The secondary outcome measures were anxiety, somnolence and severe adverse events. RESULTS of 505 publications initially identified, two trials and one trial were included in the meta-analysis of midazolam alone and in combination with morphine, respectively. With regard to the relief of dyspnea, midazolam alone showed no significant difference compared with morphine alone, with a relative risk of 0.95 (95% confidence interval: 0.47-1.89). Meanwhile, midazolam plus morphine was significantly more effective than morphine alone, with a relative risk of 1.33 (95% confidence interval: 1.02-1.75). For anxiety relief, a meta-analysis could not be performed because of insufficient data. The incidence of somnolence and severe adverse events was not significantly different between the experimental and control groups for either midazolam alone or in combination with morphine. CONCLUSIONS benzodiazepines alone do not significantly improve dyspnea compared with opioids alone, but a combination of benzodiazepines and opioids may be more effective. Evidence from randomized controlled trials focusing on patients with cancer has not been generated in recent years. Further appropriately designed randomized controlled trials are required.
Collapse
Affiliation(s)
- Shuntaro Yasuda
- Department of Pharmacy, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Koji Sugano
- Division of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Yusuke Takagi
- Department of Palliative Medicine, Teikyo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | | | - Yoko Kasahara
- Department of Pharmacy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Sho Goya
- Department of Respiratory Medicine, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Itami, Japan
| | - Hiroyuki Kohara
- Department of Internal Medicine, Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
| | - Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
13
|
Yamaguchi T, Matsunuma R, Matsuda Y, Tasaki J, Ikari T, Miwa S, Aiki S, Takagi Y, Kiuchi D, Suzuki K, Oyamada S, Ariyoshi K, Kihara K, Mori M. Systemic Opioids for Dyspnea in Cancer Patients: A Real-world Observational Study. J Pain Symptom Manage 2023; 65:400-408. [PMID: 36641006 DOI: 10.1016/j.jpainsymman.2022.12.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
CONTEXT Although Systemic opioids are recommended as a pharmacological treatment for cancer-related dyspnea, their effectiveness and safety needs to be investigated in a real-world context OBJECTIVES: To evaluate the effectiveness and safety of systemic regular opioids for dyspnea in cancer patients, in the real-world palliative care practice. METHODS This was a multicenter prospective observational study. We consecutively enrolled adult cancer patients starting regular opioids (morphine, oxycodone, hydromorphone, or fentanyl) for dyspnea from 12 palliative care services across Japan. We evaluated dyspnea intensity using the Numerical Rating Scale (NRS) and Integrated Palliative Outcome Scale (IPOS) every 24 hours until 72 hours after starting opioids (T1-T3). We also evaluated common opioid-related adverse events (AEs) and other severe AEs. RESULTS We enrolled 402 cancer patients. The proportion of responders was 68.8% (95%confidence intervals (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, baseline dyspnea NRS ≥6 had a positive correlation with dyspnea relief by systemic regular opioids, while liver metastasis, clinician-predicted survival days, and opioid tolerance had a negative correlation. CONCLUSION Regular systemic opioids were effective for dyspnea in real-world cancer patients.
Collapse
Affiliation(s)
- Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine (T.Y.), Kobe, Japan.
| | - Ryo Matsunuma
- Department of Palliative Care, Konan Hospital (R.M., J.T.), Kobe, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center (Y.M.), Sakai, Japan
| | - Junichi Tasaki
- Department of Palliative Care, Konan Hospital (R.M., J.T.), Kobe, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine, Tohoku University School of Medicine (T.I.), Sendai, Japan; Department of Respiratory Medicine, Hokkaido University Faculty of Medicine and Graduate School of Medicine (T.I.), Sapporo, Japan
| | - Satoru Miwa
- Seirei Hospice, Seirei Mikatahara General Hospital (S.M.), Hamamatsu, Japan
| | - Sayo Aiki
- Department of Palliative Medicine, National Hospital Organization Osaka Medical Center (S.A.), Osaka, Japan
| | - Yusuke Takagi
- Department of Palliative Medicine, Teikyo University School of Medicine ( Y.T.), Tokyo, Japan
| | - Daisuke Kiuchi
- Department of Palliative Care, Center Hospital of the National Center for Global Health and Medicine (D.K.), Tokyo, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital (K.S.), Tokyo, Japan
| | - Shunsuke Oyamada
- Japanese Organisation for Research and Treatment of Cancer (JORTC) (S.O., K.A., K.K.), Tokyo, Japan
| | - Keisuke Ariyoshi
- Japanese Organisation for Research and Treatment of Cancer (JORTC) (S.O., K.A., K.K.), Tokyo, Japan
| | - Kota Kihara
- Japanese Organisation for Research and Treatment of Cancer (JORTC) (S.O., K.A., K.K.), Tokyo, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital (M.M.), Hamamatsu, Japan
| |
Collapse
|
14
|
Mori M, Kawaguchi T, Imai K, Yokomichi N, Yamaguchi T, Suzuki K, Matsunuma R, Watanabe H, Maeda I, Matsumoto Y, Matsuda Y, Morita T. Visualizing How to Use Parenteral Opioids for Terminal Cancer Dyspnea: A Pilot, Multicenter, Prospective, Observational Study. J Pain Symptom Manage 2021; 62:936-948. [PMID: 33992759 DOI: 10.1016/j.jpainsymman.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT How physicians use opioids for dyspnea in imminently dying cancer patients (terminal dyspnea) varies markedly, which could hamper quality care. OBJECTIVES To examine the adherence to an algorithm-based treatment for terminal dyspnea, and explore its outcomes over 24 hours. METHODS This was a pre-planned subgroup analysis of a multicenter prospective observational study. Inclusion criteria were: advanced cancer patients admitted to palliative care units, ECOG performance status = 3-4, and a dyspnea intensity ≥2 on the Integrated Palliative care Outcome Scale (IPOS). We developed an algorithm to visualize how palliative care physicians would use parenteral opioids. Participating physicians (palliative care specialists) initiated parenteral opioids, choosing whether to use the algorithm based on their preference. We measured the adherence rate to the algorithm over 24 hours (predefined goal = 70%), and compared dyspnea IPOS scores and adverse events between patients with and without algorithm-based treatment. RESULTS Of 164 patients (median survival = 5 days), 71 (43%) received algorithm-based treatment, and 70 (99%; 95% confidence interval = 92%-100%) adhered to it over 24 hours. In a complete case analysis, mean dyspnea IPOS scores significantly decreased from 2.9 (standard error = 0.1) to 1.5 (0.1) in the algorithm group (n = 54; P < 0.001), and 2.9 (0.1) to 1.6 (0.1) in the non-algorithm group (n = 72; P < 0.001). There was no significant between-group difference in changes in dyspnea IPOS scores (P = 0.65). Adverse events were rare (n = 5). CONCLUSION The algorithm-based treatment was feasible, and might be as effective and safe as the usual care by palliative care specialists. Its implementation may help physicians provide quality care for terminal dyspnea.
Collapse
Affiliation(s)
- Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Medical Center, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | |
Collapse
|
15
|
Yamamoto S, Arao H, Aoki M, Mori M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Masukawa K, Miyashita M. Care Associated With Satisfaction of Bereaved Family Members of Terminally Ill Cancer Patients With Dyspnea: A Cross-sectional Nationwide Survey. J Pain Symptom Manage 2021; 62:796-804. [PMID: 33848568 DOI: 10.1016/j.jpainsymman.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Terminal dyspnea in dying cancer patients is frequent and distressing, and the impact extends to their families. Families are often involved in providing care for terminal dyspnea. OBJECTIVES This study aimed to describe various care strategies for terminal dyspnea in cancer patients hospitalized in palliative care units (PCUs), evaluate families' satisfaction with care for terminal dyspnea, and explore determinants contributing to families' satisfaction. METHODS A nationwide, cross-sectional survey was conducted using a self-reported questionnaire among bereaved families of cancer patients who died in PCUs. The questionnaire consisted of questions on the perceptions of care offered to patients with terminal dyspnea and their families, satisfaction with care for terminal dyspnea, family-perceived intensity of terminal dyspnea, use of oxygen, and background data of patients and families. RESULTS In total, 533 participants (response rate = 54%) returned the completed questionnaires, and 231 reported that their loved one had experienced terminal dyspnea. Dedicated and compassionate care was perceived by 60%-89% of the participants as the strategy provided for patients. Care for family members was perceived by 58%-69% of the participants. Perception of dedicated and compassionate care for patients and that of care for family members were significantly associated with high satisfaction (odds ratio, 95% confidence interval: 8.64, 3.85-19.36 and 15.37, 5.00-47.25, respectively). CONCLUSION Dedicated and compassionate care may be the essential part of the care for terminal dyspnea. Dedicated and compassionate care for patients and care for family members have a potential of improving the care satisfaction among family caregivers.
Collapse
Affiliation(s)
- Sena Yamamoto
- Division of Health Sciences (S.Y., H.A., M.A.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Harue Arao
- Division of Health Sciences (S.Y., H.A., M.A.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Miwa Aoki
- Division of Health Sciences (S.Y., H.A., M.A.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (M.M., T.M.), Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (M.M., T.M.), Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine (Y.K.), Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences (S.T.), Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine (Y.S.), Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences (K.M., M.M.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences (K.M., M.M.), Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
16
|
Mori M, Kawaguchi T, Imai K, Yokomichi N, Yamaguchi T, Suzuki K, Matsunuma R, Watanabe H, Maeda I, Uehara Y, Morita T. How Successful Is Parenteral Oxycodone for Relieving Terminal Cancer Dyspnea Compared With Morphine? A Multicenter Prospective Observational Study. J Pain Symptom Manage 2021; 62:336-345. [PMID: 33290857 DOI: 10.1016/j.jpainsymman.2020.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/20/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
Abstract
CONTEXT Parenteral morphine is widely used for dyspnea of imminently dying cancer patients (terminal dyspnea). However, the efficacy of other opioids such as oxycodone remains largely unknown. OBJECTIVES To explore the efficacy of parenteral oxycodone vs. morphine by continuous infusion over 24 hours in cancer patients with terminal dyspnea. METHODS This was a pre-planned subgroup analysis of a multicenter prospective observational study. Inclusion criteria were advanced cancer patients admitted to palliative care units, Eastern Cooperative Oncology Group performance status = 3-4, and a dyspnea intensity ≥2 on the Integrated Palliative care Outcome Scale (IPOS) for which oxycodone or morphine was initiated by continuous infusion. We measured dyspnea IPOS scores over 24 hours. RESULTS We analyzed 164 patients who received oxycodone (n = 26) and morphine (n = 138) for dyspnea (median survival = 5 days). The mean age was 70 years, 58 patients (35%) had lung cancer, and 97 (59%) had lung metastases. Complete case analysis revealed that mean dyspnea IPOS scores decreased from 3.0 (standard deviation = 0.7) to 1.5 (0.7) in the oxycodone group (difference in means = 1.5; P < 0.001), and from 2.9 (0.7) to 1.6 (1.0) in the morphine group (difference in means = 1.3; P < 0.001). No significant between-group differences existed in the IPOS scores at 24 hours (P = 0.753). Adverse events were seen in no and 5 patients in the oxycodone and morphine groups, respectively. CONCLUSION Parenteral oxycodone may be equally effective and safe as morphine in the treatment of terminal dyspnea in cancer patients. Future randomized controlled trials should confirm the efficacy and safety of opioids other than morphine for terminal dyspnea.
Collapse
Affiliation(s)
- Masanori Mori
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-chuo Hospital, Osaka, Japan
| | - Yuko Uehara
- Department of Palliative Medicine, National Cancer Center Hospital East, Chiba, Japan; Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | |
Collapse
|
17
|
Matsuda Y, Matsunuma R, Suzuki K, Mori M, Watanabe H, Yamaguchi T. Physician-Perceived Predictive Factors for the Effectiveness of Drugs for Treating Cancer Dyspnea: Results of a Nationwide Survey of Japanese Palliative Care Physicians. Palliat Med Rep 2021; 1:97-102. [PMID: 34223464 PMCID: PMC8241347 DOI: 10.1089/pmr.2020.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Dyspnea is a common and distressing symptom in patients with advanced cancer. Opioids, benzodiazepines, and corticosteroids are commonly prescribed pharmacological treatments for cancer dyspnea. Objective: The objective of this survey was to investigate physician-perceived predictive factors for the effectiveness of opioids, benzodiazepines, and corticosteroids in treating cancer dyspnea. Design: This study involves a nationwide survey using self-report questionnaires. Setting/Subjects: Random sampling selected 268 Japanese certified palliative care physicians in Japan. Measurements: We inquired about the 12 physician-perceived predictive factors for the effectiveness of drugs (opioids, benzodiazepines, and corticosteroids) in treating cancer dyspnea. Results: The frequently selected physician-perceived predictive factors for the effectiveness of opioids were tachypnea, respiratory effort, opioid naive, Eastern Cooperative Oncology Group Performance Status 0–2, multiple lung tumors, dry cough, pleural effusion, and pleural lesion. Benzodiazepines were predicted to be effective against dyspnea in patients with depression and severe anxiety. Meanwhile, corticosteroids were predicted to be effective against dyspnea in patients with lymphangitis carcinomatosa, superior vena cava syndrome, major airway obstruction, and audible wheezing. Japanese palliative care physicians anticipate that different drug classes will be effective for treating dyspnea in patients with specific factors. Conclusions: Japanese palliative care physicians expect that different drugs will be effective for dyspnea in patients with specific predictive factors. Future prospective studies are required to assess the effectiveness of each drug class against specific dyspnea.
Collapse
Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital, Kobe, Japan
| |
Collapse
|
18
|
Yamada M, Uchida M, Hada M, Inma D, Ariyoshi S, Kamimura H, Haraguchi T. Evaluation of changes in pharmacist behaviors following a systematic education program on palliative care in cancer. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:417-422. [PMID: 33715805 DOI: 10.1016/j.cptl.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Attitudes, experience, and knowledge of healthcare professionals guide the care they provide and are particularly important factors affecting the quality of palliative care. Palliative care education for pharmacists is crucial for improving quality of care and effective participation on the palliative care team. EDUCATIONAL ACTIVITY AND SETTING We previously developed and reported a systematic and multifaceted pharmacist education program for cancer-related palliative care. We compared 12 behavioral changes immediately (August 2017) and two years after (October 2019) participation in this systematic education program (SEP) to evaluate if participants were performing pharmaceutical management appropriately and to assure that behaviors had not deteriorated. FINDINGS Of 88 participants in the SEP, 36 responded to the survey (response rate 40.9%). There was no significant difference in the behavioral change items of pharmacists immediately after participating in the SEP (2017) and two years later (2019) (4.47 vs. 4.58, P = .47). SUMMARY We confirmed that behavioral changes developed by the SEP were maintained over a significant time. This indicates that knowledge was firmly established in the participants such that they could continue utilizing it long after participating in the SEP. Our study showed that participating in this SEP not only enabled participants to acquire knowledge regarding palliative medicine but also led to continued behavioral changes based on this knowledge.
Collapse
Affiliation(s)
- Masahiro Yamada
- Department of Pharmacy, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka 802-0077, Japan.
| | - Mayako Uchida
- Pharmaceutical Sciences Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, 4-20-1 Nasahara, Takatsuki, Osaka 569-1094, Japan.
| | - Masao Hada
- Department of Pharmacy, Japan Community Health care Organization Nankai Medical Center, 7-8, Tokiwanishimachi, Saiki, Oita 876-0857, Japan.
| | - Daigo Inma
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
| | - Shunji Ariyoshi
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
| | - Hidetoshi Kamimura
- Department of Pharmacy, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Tohru Haraguchi
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
| |
Collapse
|
19
|
Hardy J, Haywood A, Rickett K, Sallnow L, Good P. Practice review: Evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer. Palliat Med 2021; 35:461-472. [PMID: 33499759 DOI: 10.1177/0269216320986717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It would be unusual for a patient with advanced cancer not to be prescribed corticosteroids at some stage of their disease course for a variety of specific and non-specific indications. AIM The aim of this practice review was to provide a pragmatic overview of the evidence supporting current practice and to identify areas in which further research is indicated. DESIGN A 'state-of-the-art' review approach was used to examine the evidence supporting the use of corticosteroids for the management of cancer-related complications and in symptom control, in the context of known risks and harms to inform quality use of this medicine. We developed 'Do', 'Do not', and 'Don't know' recommendations based on current literature and identified areas for future investigation and research. DATA SOURCES We searched MEDLINE, EMBASE and the Cochrane library from inception to 14th October 2020. Our initial search limited to reviews, reviews of reviews, randomised controlled trials (RCTs) and controlled trials was supplemented by supporting literature as appropriate. RESULTS Evidence to support common practice in the use of corticosteroids is lacking for most indications. This is in the context of strong evidence for the potential for significant toxicity and poor quality use of medicine. CONCLUSION Guidelines recommending the widespread use of corticosteroids should acknowledge the poor evidence base supporting much current dogma. Quality research is essential not only to define the role of corticosteroids in this context but to ensure good prescribing practice.
Collapse
Affiliation(s)
- Janet Hardy
- Mater Health, Brisbane, SEQ, Australia.,Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia
| | - Alison Haywood
- Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia.,School of Pharmacy and Pharmacology, Griffith University, Gold Coast, QLD, Australia
| | - Kirsty Rickett
- University of Queensland Library - Mater Misericordiae Hospital, Brisbane, QLD, Australia
| | - Libby Sallnow
- St Christopher's Hospice and UCL Marie Curie Palliative Care Department, London, UK.,St Vincent's Private Hospital Brisbane, Brisbane, QLD, Australia
| | - Phillip Good
- Mater Health, Brisbane, SEQ, Australia.,Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia.,St Vincent's Private Hospital Brisbane, Brisbane, QLD, Australia
| |
Collapse
|
20
|
Li JX, Shi YM, An LY, Yang JX, Qi YX, Yang T, Cen YY, Lin YY, Sun DL. Quality assessment of the guidelines for the management of malignant pleural effusions and ascites. World J Surg Oncol 2020; 18:331. [PMID: 33308239 PMCID: PMC7733286 DOI: 10.1186/s12957-020-02097-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives To fully assess the quality of the guidelines for the management of malignant pleural effusions (MPE) and ascites and reveal the heterogeneity of recommendations and possible reasons among guidelines. Methods A systematic search was performed in the database to obtain guidelines for the management of MPE and ascites. The AGREE IIGtool was used to assess the quality of these guidelines. The Measurement Scale of Rate of Agreement (MSRA) was introduced to assess the scientific agreement of formulated recommendations for the management of MPE and ascites among guidelines, and evidence supporting these recommendations was extracted and analyzed. Results Nine guidelines were identified. Only 4 guidelines scored more than 60% and are worth recommending. Recommendations were also heterogeneous among guidelines for the management of MPE, and the main reasons were the different emphases of the recommendations for the treatment of MPE, the contradictions in recommendations, and the unreasonably cited evidence for MPE. Conclusions The quality of the management guidelines for patients with MPE and malignant ascites was highly variable. Specific improvement of the factors leading to the heterogeneity of recommendations will be a reasonable and effective way for developers to upgrade the recommendations in the guidelines for MPE.
Collapse
Affiliation(s)
- Jia-Xi Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Yan-Mei Shi
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Li-Ya An
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Jin-Xu Yang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Yu-Xing Qi
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Ting Yang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Yun-Yun Cen
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China.
| | - Yue-Ying Lin
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China.
| | - Da-Li Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China.
| |
Collapse
|
21
|
Mori M, Yamaguchi T, Matsuda Y, Suzuki K, Watanabe H, Matsunuma R, Kako J, Imai K, Usui Y, Matsumoto Y, Hui D, Currow D, Morita T. Unanswered questions and future direction in the management of terminal breathlessness in patients with cancer. ESMO Open 2020; 5 Suppl 1:e000603. [PMID: 33558034 PMCID: PMC7046422 DOI: 10.1136/esmoopen-2019-000603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/01/2019] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
Breathlessness is among the most common and deteriorating symptoms in patients with advanced cancer, which may worsen towards the end of life. Breathlessness in patients with estimated life expectancy of weeks to days has unique clinical features: it tends to worsen rapidly over days to hours as death approaches often despite current symptom control measures. Breathlessness in patients during the last weeks to days of life can be called ‘terminal breathlessness’. While evidence has accumulated for the management of breathlessness in patients with cancer who are not dying, such evidence may not be fully applied to terminal breathlessness. Only a few studies have investigated the best practice of terminal breathlessness in patients with cancer. In this paper, we summarise the current evidence for the management of terminal breathlessness, and propose future directions of clinical research.
Collapse
Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
| | | | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Kako
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yuko Usui
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - David Currow
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| |
Collapse
|
22
|
Matsunuma R, Suzuki K, Matsuda Y, Mori M, Watanabe H, Yamaguchi T. Palliative care physicians' perspectives of management for terminally ill cancer patients with death rattle: a nationwide survey. Jpn J Clin Oncol 2020; 50:830-833. [PMID: 32419027 DOI: 10.1093/jjco/hyaa044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/14/2020] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
Death rattle occurs during the last days of life, and relatives of those afflicted frequently report that it is very distressful. However, there is no effective treatment for it. The purpose of this study was to investigate the perceptions of Japanese palliative care physicians in clinical practice in Japan. We conducted a nationwide survey of 268 physicians via an anonymous, self-report questionnaire. We assessed pharmacological and non-pharmacological management and anticholinergic agent choice. One hundred eighty-nine physicians (70.5%) returned the questionnaires. Fifty-five participants (29.1%) treating patients with Type-1 (real death rattle) and 36 participants (19%) treating patients with Type-2 (pseudo-death rattle) death rattle reported that they would frequently administer an anticholinergic agent. One-fourth would administer scopolamine butylbromide or scopolamine hydrobromide. In conclusion, more Japanese palliative care physicians thought that anticholinergic agents might be effective for treating Type-1 death rattle rather than Type-2. Further clinical trials of these agents are needed.
Collapse
Affiliation(s)
- Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer, and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital, Kobe, Japan
| |
Collapse
|
23
|
Matsuda Y, Matsunuma R, Suzuki K, Mori M, Watanabe H, Yamaguchi T. Benzodiazepines for cancer dyspnoea: a nationwide survey of palliative care physicians. BMJ Support Palliat Care 2019; 10:205-208. [PMID: 31818847 DOI: 10.1136/bmjspcare-2019-001997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES It is unclear whether patients with non-specific dyspnoea are suitable candidates for studies investigating the effectiveness of benzodiazepines against dyspnoea. The objective of this survey was to investigate suitable subjects for studies of benzodiazepines for cancer dyspnoea. METHODS A nationwide questionnaire survey was conducted among 536 Japanese-certified palliative care physicians. We randomly selected 268 physicians and inquired about their approach to dyspnoea management in patients with cancer, with and without anxiety, as follows: (1) Administration of a benzodiazepine. (2) Administration or titration of an opioid. We also asked them to consider their approach in the following situations: (1) Opioid-naïve. (2) Low-to-moderate baseline opioid dose. (3) High baseline opioid dose. We assessed the use of specific benzodiazepines separately. RESULTS Overall, 192 physicians responded to the questionnaire (71.6%). For patients without anxiety, the proportion of participants reporting that they frequently or very frequently 'administer a benzodiazepine' increased with baseline opioid dose (opioid-naïve: 5.2%, low-to-moderate: 11.5%, high: 26.0%). The proportion of participants reporting that they frequently or very frequently 'administer or titrate an opioid' decreased with baseline opioid dose (opioid-naïve: 83.3%, low-to-moderate: 73.4%, high: 41.1%). The pattern was similar for patients with anxiety, although more respondents said they prescribe benzodiazepine for these patients (naïve: 22.4%, low-to-moderate: 34.4%, high: 45.8%) and fewer prescribed an opioid. Alprazolam and lorazepam are frequently used. CONCLUSION Patients with anxiety or receiving a high baseline opioid dose could be potential candidates for future studies investigating the effectiveness of benzodiazepines against cancer dyspnoea.
Collapse
Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Takashi Yamaguchi
- Division of Palliative care, Department of Medicine, Konan Hospital, Kobe, Japan
| |
Collapse
|
24
|
Suzuki K, Matsunuma R, Matsuda Y, Mori M, Watanabe H, Yamaguchi T. A Nationwide Survey of Japanese Palliative Care Physicians' Practice of Corticosteroid Treatment for Dyspnea in Patients With Cancer. J Pain Symptom Manage 2019; 58:e3-e5. [PMID: 31472274 DOI: 10.1016/j.jpainsymman.2019.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital, Kobe, Japan
| |
Collapse
|
25
|
Mori M, Morita T, Matsuda Y, Yamada H, Kaneishi K, Matsumoto Y, Matsuo N, Odagiri T, Aruga E, Watanabe H, Tatara R, Sakurai H, Kimura A, Katayama H, Suga A, Nishi T, Shirado AN, Watanabe T, Kuchiba A, Yamaguchi T, Iwase S. How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study. Support Care Cancer 2019; 28:3051-3060. [DOI: 10.1007/s00520-019-05081-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/16/2019] [Indexed: 12/19/2022]
|
26
|
Watanabe H, Matsunuma R, Suzuki K, Matsuda Y, Mori M, Yamaguchi T. The Current Practice of Oxygen Therapy for Dyspnea in Terminally Ill Cancer Patients: A Nationwide Survey of Japanese Palliative Care Physicians. J Pain Symptom Manage 2019; 58:e2-e4. [PMID: 31283969 DOI: 10.1016/j.jpainsymman.2019.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan.
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Masanori Mori
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Internal Medicine, Konan Hospital, Higashi-Nada, Kobe, Japan; Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
27
|
Yamaguchi T, Matsunuma R, Suzuki K, Matsuda Y, Mori M, Watanabe H. The Current Practice of Opioid for Cancer Dyspnea: The Result From the Nationwide Survey of Japanese Palliative Care Physicians. J Pain Symptom Manage 2019; 58:672-677.e2. [PMID: 31201876 DOI: 10.1016/j.jpainsymman.2019.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/21/2022]
Abstract
CONTEXT Morphine is recommended as the first-line pharmacological therapy for cancer dyspnea. However, the detailed practice of morphine has not been evaluated and consensus about other opioids for cancer dyspnea has not been established. OBJECTIVES To explore the physician-reported practice of opioid for cancer dyspnea. METHODS A nationwide mail-questionnaire survey was conducted among 536 Japanese certified palliative care physicians. We randomly selected 268 and asked the following: 1) how the physicians themselves initiate and use morphine for cancer dyspnea, 2) opioid choice for dyspnea in patients who have already used opioid other than morphine regularly, and 3) opioid choice for dyspnea in patients with various degrees of renal impairment in their daily practice. RESULTS Overall, 192 physicians responded (response rate, 71.6%). The major (58.3%) practice of initiating morphine was "immediate-release morphine as needed" in opioid-naïve patients, and the mean % increase when they titrate morphine for cancer dyspnea was 29.4 ± 11.3% of the baseline dose. Although "titrate baseline oxycodone" was the most frequent (42.3%) for low-to-moderate-dose regular oxycodone cases, "stepwise switch to morphine" (30.0%) and "add morphine on baseline oxycodone" (27.1%) were the more frequent practices for high-dose regular oxycodone. Regardless of the baseline dose, "add morphine on baseline fentanyl" was the most frequent practice for regular transdermal fentanyl cases. Oxycodone was the most frequent choice in renal insufficiency cases, regardless of its degree. CONCLUSIONS Among Japanese palliative care physicians, using oxycodone for cancer dyspnea was relatively popular practice, whereas fentanyl was not. Oxycodone was the most preferred opioid for cancer dyspnea in the setting of renal insufficiency among Japanese palliative care physicians. We should conduct studies to confirm the safety and effectiveness of these opioid practices for cancer dyspnea.
Collapse
Affiliation(s)
- Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital, Kobe, Japan.
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| |
Collapse
|
28
|
Mori M, Matsunuma R, Suzuki K, Matsuda Y, Watanabe H, Yamaguchi T. Palliative Care Physicians' Practice in the Titration of Parenteral Opioids for Dyspnea in Terminally Ill Cancer Patients: A Nationwide Survey. J Pain Symptom Manage 2019; 58:e2-e5. [PMID: 30999067 DOI: 10.1016/j.jpainsymman.2019.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Ryo Matsunuma
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital, Kobe, Japan
| |
Collapse
|
29
|
Kawashima H, Ariizumi T, Yamagishi T, Ogose A, Ikoma M, Hotta T, Endo N. Symptom Burden and End-of-Life Palliative Treatments during the Last Two Weeks of Life in Patients with Advanced Musculoskeletal Sarcoma. J Palliat Med 2019; 22:908-914. [PMID: 30762454 DOI: 10.1089/jpm.2018.0415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Musculoskeletal sarcomas (MSSs) are rare cancers and often aggressive tumors that originate from mesenchymal tissue. Patients with advanced MSS often report difficulties with symptom burden, which can reduce their health-related quality-of-life. Objective: The aim of this study was to describe the patterns of the physical symptoms of MSS patients in the palliative setting and to detail the palliative treatment used in the last two weeks of life. Design: Retrospective study using the electronic patient records from a single institution. Setting/Subjects: A retrospective study was carried out in a sample of 46 consecutive MSS patients with locally advanced/metastatic disease, who were hospitalized and died in our department. The median age of these patients was 56 years at death. Measurements: Symptom burden and medical intervention during the last two weeks of life were collected. Results: The most frequent physical symptoms were pain and dyspnea in 93% and 78% of patients, respectively, while only 17% of patients suffered from nausea. A total of 98% of patients required opioids, and most patients were treated with morphine through either subcutaneous or intravenous continuous injection. Nonsteroidal anti-inflammatory drugs and acetaminophen were administered to 79% of patients. Corticosteroids were administered for the relief of dyspnea to 83% of patients. Of the patients, 46% received palliative chemotherapy within the last two weeks of life, and the oral treatment was continued until a median of 5.6 days before death. In addition, 39% of patients received a sedative treatment during the last two weeks of life for uncontrolled refractory symptoms. Conclusions: The symptom burden experienced by advanced MSS patients is profound at the end of life for all palliative approaches. Therefore, palliative medicine is an important and even crucial component of the continuum of care, allowing for aggressive symptom management with a variety of medical interventions, including palliative sedation.
Collapse
Affiliation(s)
- Hiroyuki Kawashima
- 1Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,2Palliative Care Team, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takashi Ariizumi
- 1Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tetsuro Yamagishi
- 1Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akira Ogose
- 3Department of Orthopedic Surgery, Uonuma Kikan Hospital, Niigata, Japan
| | - Miho Ikoma
- 2Palliative Care Team, Niigata University Medical and Dental Hospital, Niigata, Japan.,4Division of Palliative Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tetsuo Hotta
- 1Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Naoto Endo
- 1Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
30
|
Takahashi K, Kondo M, Ando M, Shiraki A, Nakashima H, Wakayama H, Kataoka K, Yamamoto M, Sugino Y, Nishikawa M, Imaizumi K, Kojima E, Sumida A, Takeyama Y, Saito H, Hasegawa Y. Effects of Oral Morphine on Dyspnea in Patients with Cancer: Response Rate, Predictive Factors, and Clinically Meaningful Change (CJLSG1101). Oncologist 2019; 24:e583-e589. [PMID: 30659079 DOI: 10.1634/theoncologist.2018-0468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/07/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although the efficacy of parenteral morphine for alleviating dyspnea has been previously demonstrated in several studies, little is known regarding the efficacy of oral morphine for dyspnea among patients with cancer, including its response rate and predictive factors of effectiveness. Therefore, the aim of this study was to clarify the effectiveness of oral morphine on dyspnea in patients with cancer and elucidate the predictive factors of its effectiveness. SUBJECTS, MATERIALS, AND METHODS In this multicenter prospective observational study, we investigated the change in dyspnea intensity in patients with cancer before and after the administration of oral morphine by using a visual analog scale (VAS). We also administered a self-assessment questionnaire to determine whether the patients believed oral morphine was effective. RESULTS Eighty patients were enrolled in the study, and 71 of these patients were eligible. The least square mean of the VAS scores for dyspnea intensity was 53.5 at baseline, which decreased significantly to 44.7, 40.8, and 35.0 at 30, 60, and 120 minutes after morphine administration, respectively. Fifty-four patients (76.1%) reported that oral morphine was effective on the self-assessment questionnaire. Among the background factors, a high score for "sense of discomfort" on the Cancer Dyspnea Scale (CDS) and a smoking history of fewer pack-years were associated with greater effectiveness. CONCLUSION Oral morphine was effective and feasible for treating cancer-related dyspnea. A higher score for "sense of discomfort" on the CDS and a smaller cumulative amount of smoking may be predictive factors of the effectiveness of oral morphine. IMPLICATIONS FOR PRACTICE This study demonstrated that oral morphine was effective in alleviating cancer-related dyspnea due to multiple factors including primary lung lesions, airway narrowing, and pleural effusion. Approximately 76% of patients reported that oral morphine was effective. A higher score for "sense of discomfort" on the Cancer Dyspnea Scale and a lower cumulative amount of smoking may be predictive factors for the effectiveness of oral morphine. Interestingly, respiratory rates in patients who reported the morphine to be effective decreased significantly after oral morphine administration, unlike the respiratory rates in "morphine-ineffective" patients.
Collapse
Affiliation(s)
- Kosuke Takahashi
- Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki, Japan
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Kondo
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Akira Shiraki
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Harunori Nakashima
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hisashi Wakayama
- Department of Respiratory Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Masashi Yamamoto
- Department of Respiratory Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Yasuteru Sugino
- Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan
| | - Mitsunori Nishikawa
- Department of Palliative Care, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Eiji Kojima
- Department of Respiratory Medicine, Komaki Municipal Hospital, Komaki, Japan
| | - Atsushi Sumida
- Department of Respiratory Medicine, Tsushima City Hospital, Tsushima, Japan
| | - Yoshihiro Takeyama
- Department of Respiratory Medicine, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Hiroshi Saito
- Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
31
|
Yamaguchi T, Matsuda Y, Matsuoka H, Hisanaga T, Osaka I, Watanabe H, Maeda I, Imai K, Tsuneto S, Wagatsuma Y, Kizawa Y. Efficacy of immediate-release oxycodone for dyspnoea in cancer patient: cancer dyspnoea relief (CDR) trial. Jpn J Clin Oncol 2018; 48:1070-1075. [DOI: 10.1093/jjco/hyy139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takashi Yamaguchi
- Division of Palliative Care, Department of Medicine, Konan Hospital, Kobe, Japan
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hiromichi Matsuoka
- Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Iwao Osaka
- Department of Palliative Medicine, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Isseki Maeda
- Gratia Hospice, Gratia Research and Clinical Education (GRACE) Center, Gratia Hospital, Minoh, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukiko Wagatsuma
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
32
|
Lin R, Che G, Xu Z, Wang M, Zhou K, Li P. [Simplification and Validation of Leicester Cough Questionnaire in Mandarin-Chinese]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 20:468-472. [PMID: 28738962 PMCID: PMC5972941 DOI: 10.3779/j.issn.1009-3419.2017.07.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 患者行肺部手术后常常出现咳嗽,目前尚缺乏专门评估术后咳嗽的工具。本研究对中文版莱斯特咳嗽问卷(Leicester Cough Questionnaire in Mandarin-Chinese, LCQ-MC)改良并进行验证,探讨其临床应用价值。 方法 2015年9月-2016年12月四川大学华西医院胸外科单个医疗组共250例行胸腔镜肺部手术的患者参与调查,其中121例患者完成LCQ-MC,129例患者完成简化LCQ-MC,并进行信度和效度检验。 结果 新问卷保留LCQ-MC的框架与评分方式,由生理、心理和社会3个维度,共12个条目构成。量表内容效度良好,内容效度指数达到0.83;与日间咳嗽症状积分对比标准效度高(r=-0.578, P<0.001),与夜间咳嗽症状积分和健康调查简表总分(Chinese version of the Medical Outcome Study 36-item Short-Form Healthy Survey, SF-36)对比标准效度中等(r=-0.358, P=0.004; r=0.346, P=0.030),与医院焦虑与抑郁评分总分(Hospital Anxiety and Depression Scale, HADS)对比标准效度较弱(r=-0.241, P=0.046);内部一致性良好,克朗巴赫α系数在0.71-0.84之间;1周后重测信度良好(n=30, r=0.81-0.95)。 结论 简化版中文版莱斯特咳嗽问卷有良好的信度和效度,可应用于临床。
Collapse
Affiliation(s)
- Rongjia Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhihua Xu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mingming Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
33
|
Yamamoto Y, Watanabe H, Sakurai A, Deguchi Y, Hirano S, Okumura Y, Kumon A, Watanabe N, Osada T, Yamamura K, Odagiri T. Effect of continuous intravenous oxycodone infusion in opioid-naïve cancer patients with dyspnea. Jpn J Clin Oncol 2018; 48:748-752. [DOI: 10.1093/jjco/hyy079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/31/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Yoshimi Okumura
- Department of Palliative Care, and Nursing, Komaki City Hospital, Komaki, Japan
| | - Akiko Kumon
- Department of Palliative Care, and Nursing, Komaki City Hospital, Komaki, Japan
| | - Norio Watanabe
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Takashi Osada
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Keiko Yamamura
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | | |
Collapse
|
34
|
Maeda T, Hayakawa T. Corticosteroids for alleviating dyspnea in patients with terminal cancer. PROGRESS IN PALLIATIVE CARE 2017. [DOI: 10.1080/09699260.2017.1392674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tsuyoshi Maeda
- Department of Pharmacy, Kasugai Municipal Hospital, 1-1-1, Takaki-cho, Kasugai, Aichi 486-8510, Japan
| | - Toru Hayakawa
- Department of Pharmacotherapy, Hokkaido Pharmaceutical University School of Pharmacy, 7-15-4-1 Maeda, Teine, Sapporo Hokkaido 006-8590, Japan
| |
Collapse
|
35
|
Sugimura A, Ando S, Tamakoshi K. Palliative care and nursing support for patients experiencing dyspnoea. Int J Palliat Nurs 2017; 23:342-351. [PMID: 28756753 DOI: 10.12968/ijpn.2017.23.7.342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To investigate the association between the type of support provided by nurses for dyspnoea and palliative care practice in Japan, a cross-sectional questionnaire survey was conducted in 2015. Of the 535 questionnaires sent to nurses working at 22 designated cancer hospitals, 344 were returned. The questionnaire assessed the demographic characteristics of the nurses, nursing support for dyspnoea, and palliative care practice measured by the 'Palliative care self-reported practices scale'. Multivariate analysis showed that the domains of palliative care practice influenced the provision of nursing support for patients with dyspnoea. In conclusion, palliative care practice is important for supporting patients with dyspnoea, and nurses should possess the requisite knowledge and skills to deliver this care appropriately.
Collapse
Affiliation(s)
- Ayumi Sugimura
- Doctoral Program, Fundamental and Clinical Nursing, Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences) Nagoya, Japan
| | - Shoko Ando
- Fundamental and Clinical Nursing, Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences) Nagoya, Japan
| | - Koji Tamakoshi
- Nursing for Developmental Health, Department of Nursing, Nagoya University Graduate School of Medicine (Health Sciences) Nagoya, Japan
| |
Collapse
|