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How Successful Is Parenteral Oxycodone for Relieving Terminal Cancer Dyspnea Compared With Morphine? A Multicenter Prospective Observational Study

2020; Elsevier BV; Volume: 62; Issue: 2 Linguagem: Inglês

10.1016/j.jpainsymman.2020.11.037

1873-6513

Masanori Mori, Takashi Kawaguchi, Kengo Imai, Naosuke Yokomichi, Takashi Yamaguchi, Kozue Suzuki, Ryo Matsunuma, Hiroaki Watanabe, Isseki Maeda, Yuko Uehara, Tatsuya Morita, Satoshi Inoue, Naosuke Yokomichi, Kengo Imai, Tatsuya Morita, Masanori Mori, Hiroaki Tsukuura, Toshihiro Yamauchi, Akemi Shirado Naito, Yu Uneno, Akira Yoshioka, Shuji Hiramoto, Ayako Kikuchi, Tetsuo Hori, Yosuke Matsuda, Hiroyuki Kohara, Hiromi Fanaki, Keiko Tanaka, Kozue Suzuki, Tina Kamei, Yukari Azuma, Koji Amano, Teruaki Uno, Jiro Miyamoto, Hirofumi Katayama, Hideyuki Kashiwagi, Eri Matsumoto, Kiyofumi Oya, Takeya Yamaguchi, Tomonao Okamura, Hoshu Hashimoto, Shunsuke Kosugi, Nao Ikuta, Yaichiro Matsumoto, Takashi Ohmori, Takehiro Nakai, Takashi Ikee, Yuto Unoki, Kazuki Kitade, Shu Koito, Nanao Ishibashi, Masaya Ehara, Kosuke Kuwahara, Shohei Ueno, Shunsuke Nakashima, Yuta Ishiyama, Akihiro Sakashita, Ryo Matsunuma, Hana Takatsu, Takashi Yamaguchi, Satoko Ito, Toru Terabayashi, Jun Nakagawa, Tetsuya Yamagiwa, Akira Inoue, Takuhiro Yamaguchi, Mitsunori Miyashita, Saran Yoshida, Yusuke Hiratsuka, Keita Tagami, Hiroaki Watanabe, Takuya Odagiri, Tetsuya Ito, Masayuki Ikenaga, Keiji Shimizu, Akira Hayakawa, Rena Kamura, Takeru Okoshi, Isseki Maeda, Tomohiro Nishi, Kazuhiro Kosugi, Yasuhiro Shibata, Takayuki Hisanaga, Takahiro Higashibata, Ritsuko Yabuki, Shingo Hagiwara, Miho Shimokawa, Satoshi Miyaké, Junko Nozato, Hiroto Ishiki, Tetsuji Iriyama, Keisuke Kaneishi, Mika Baba, Tomofumi Miura, Yoshihisa Matsumoto, Ayumi Okizaki, Yuki Watanabe, Yuko Uehara, Eriko Satomi, Kaoru Nishijima, Junichi Shimoinaba, Ryoichi Nakahori, Takeshi Hirohashi, Jun Hamano, Natsuki Kawashima, Takashi Kawaguchi, Megumi Uchida, Ko Sato, Yoichi Matsuda, Yutaka Hatano, Satoru Tsuneto, Sayaka Maeda, Yoshiyuki Kizawa, Hiroyuki Otani,

Pain Management and Opioid Use

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.