Masanori Mori1, Tatsuya Morita2, Yoshinobu Matsuda3, Hirohide Yamada4, Keisuke Kaneishi5, Yoshihisa Matsumoto6, Naoki Matsuo7, Takuya Odagiri8, Etsuko Aruga9, Hiroaki Watanabe8, Ryohei Tatara10, Hiroki Sakurai11, Akira Kimura12, Hideki Katayama13, Akihiko Suga14, Tomohiro Nishi15, Akemi Naito Shirado16, Toshio Watanabe17, Aya Kuchiba18, Takuhiro Yamaguchi19, Satoru Iwase20. 1. Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan. masanori.mori@sis.seirei.or.jp. 2. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453, Mikatahara-Cho, Kita-Ku, Hamamatsu, Shizuoka, 433-8558, Japan. 3. Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, 591-8555, Japan. 4. Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan. 5. Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku, Tokyo, 162-0815, Japan. 6. Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. 7. Hospice Medical Corporation, Junkei-kai Sotoasahikawa Hospital, 42, Aza-Sangoden, Sotoasahikawa, Akita, 010-0802, Japan. 8. Komaki City Hospital, 1-20 Jobushi, Komaki City, Aichi, 485-8520, Japan. 9. Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan. 10. Osaka City General Hospital, 2-13-22 Miyakojima-hondoori, Miyakojima-ku, Osaka, 534-0021, Japan. 11. Department of Palliative Therapy, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. 12. Department of Palliative and Supportive Care, Obihiro Kousei General Hospital, 1, Minami-10, Nishi-14, Obihiro, Hokkaidou, 080-0024, Japan. 13. Department of Palliative and Supportive Care, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. 14. Department of Palliative Medicine, Shizuoka Saiseikai General Hospital, Oshika, Suruga, Shizuoka, 422-8527, Japan. 15. Kawasaki Municipal Ida Hospital, Nakahara-ku, Ida 2-27-1, Kawasaki-shi, Kanagawa, Japan. 16. Miyazaki Medical Association Hospital, 738-1 Funato Shinbeppu-cho, Miyazaki, 880-0834, Japan. 17. Toyama Prefectural Central Hospital, 2-78.2 chome, Nishinagae, Toyama-shi, Toyama, Japan. 18. Biostatistics Division, CRAS, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 19. Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. 20. Department of Emergency & Palliative Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan.
Abstract
PURPOSE: Parenteral morphine is widely used for dyspnea of imminently dying cancer patients, but the outcomes to expect over time remain largely unknown. We examined outcomes after the administration of parenteral morphine infusion over 48 h in cancer patients with a poor performance status. METHODS: This was a multicenter prospective observational study. Inclusion criteria were metastatic/locally advanced cancer, ECOG performance status = 3-4, a dyspnea intensity ≥ 2 on a Support Team Assessment Schedule, Japanese version (STAS-J), and receiving specialized palliative care. After initiating parenteral morphine infusion, we measured dyspnea STAS-J as well as Memorial Delirium Assessment Scale (MDAS), item 9, and Communication Capacity Scale (CCS), item 4, every 6 h over 48 h. RESULTS: We enrolled 167 patients (median survival = 4 days). The mean age was 70 years, 80 patients (48%) had lung cancer, and 109 (65%) had lung metastases. The mean STAS-J scores decreased from 3.1 (95% confidence interval (CI) = 3.0-3.2) at the baseline to 2.1 (95%CI = 1.9-2.2) at 6 h, and remained 1.6-1.8 over 12-48 h. The proportion of patients with dyspnea relief (STAS-J ≤ 1) increased to 39% at 6 h, and ranged between 49 and 61% over 12-48 h. In contrast, up to 6.6 and 20% of patients showed hyperactive delirium (MDAS item 9 ≥ 2) and an inability to communicate (CCS item 4 = 3), respectively, over 48 h. CONCLUSIONS: Overall, terminal dyspnea was relatively well controlled with parenteral morphine, though a significant number of patients continued to suffer from dyspnea. Future efforts are needed to improve outcomes following standardized dyspnea treatment using patient-reported outcomes for imminently dying patients.
PURPOSE: Parenteral morphine is widely used for dyspnea of imminently dying cancerpatients, but the outcomes to expect over time remain largely unknown. We examined outcomes after the administration of parenteral morphine infusion over 48 h in cancerpatients with a poor performance status. METHODS: This was a multicenter prospective observational study. Inclusion criteria were metastatic/locally advanced cancer, ECOG performance status = 3-4, a dyspnea intensity ≥ 2 on a Support Team Assessment Schedule, Japanese version (STAS-J), and receiving specialized palliative care. After initiating parenteral morphine infusion, we measured dyspnea STAS-J as well as Memorial Delirium Assessment Scale (MDAS), item 9, and Communication Capacity Scale (CCS), item 4, every 6 h over 48 h. RESULTS: We enrolled 167 patients (median survival = 4 days). The mean age was 70 years, 80 patients (48%) had lung cancer, and 109 (65%) had lung metastases. The mean STAS-J scores decreased from 3.1 (95% confidence interval (CI) = 3.0-3.2) at the baseline to 2.1 (95%CI = 1.9-2.2) at 6 h, and remained 1.6-1.8 over 12-48 h. The proportion of patients with dyspnea relief (STAS-J ≤ 1) increased to 39% at 6 h, and ranged between 49 and 61% over 12-48 h. In contrast, up to 6.6 and 20% of patients showed hyperactive delirium (MDAS item 9 ≥ 2) and an inability to communicate (CCS item 4 = 3), respectively, over 48 h. CONCLUSIONS: Overall, terminal dyspnea was relatively well controlled with parenteral morphine, though a significant number of patients continued to suffer from dyspnea. Future efforts are needed to improve outcomes following standardized dyspnea treatment using patient-reported outcomes for imminently dying patients.
Entities:
Keywords:
Cancer; Dyspnea; Morphine; Outcomes; Palliative care
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