How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study

Masanori Mori, Tatsuya Morita, Yoshinobu Matsuda, Hirohide Yamada, Keisuke Kaneishi, Yoshihisa Matsumoto, Naoki Matsuo, Takuya Odagiri, Etsuko Aruga, Hiroaki Watanabe, Ryohei Tatara, Hiroki Sakurai, Akira Kimura, Hideki Katayama, Akihiko Suga, Tomohiro Nishi, Akemi Naito Shirado, Toshio Watanabe, Aya Kuchiba, Takuhiro YamaguchiSatoru Iwase

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalSupportive Care in Cancer
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Dyspnea
Observational Studies
Prospective Studies
Morphine
Delirium
Neoplasms
Appointments and Schedules
Parenteral Infusions
Communication
Confidence Intervals
Palliative Care
Lung Neoplasms
Neoplasm Metastasis
Lung
Survival

Keywords

  • Cancer
  • Dyspnea
  • Morphine
  • Outcomes
  • Palliative care

ASJC Scopus subject areas

  • Oncology

Cite this

How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study. / Mori, Masanori; Morita, Tatsuya; Matsuda, Yoshinobu; Yamada, Hirohide; Kaneishi, Keisuke; Matsumoto, Yoshihisa; Matsuo, Naoki; Odagiri, Takuya; Aruga, Etsuko; Watanabe, Hiroaki; Tatara, Ryohei; Sakurai, Hiroki; Kimura, Akira; Katayama, Hideki; Suga, Akihiko; Nishi, Tomohiro; Shirado, Akemi Naito; Watanabe, Toshio; Kuchiba, Aya; Yamaguchi, Takuhiro; Iwase, Satoru.

In: Supportive Care in Cancer, 01.01.2019.

Research output: Contribution to journalArticle

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 2019, 'How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study', Supportive Care in Cancer. https://doi.org/10.1007/s00520-019-05081-9
Mori, Masanori ; Morita, Tatsuya ; Matsuda, Yoshinobu ; Yamada, Hirohide ; Kaneishi, Keisuke ; Matsumoto, Yoshihisa ; Matsuo, Naoki ; Odagiri, Takuya ; Aruga, Etsuko ; Watanabe, Hiroaki ; Tatara, Ryohei ; Sakurai, Hiroki ; Kimura, Akira ; Katayama, Hideki ; Suga, Akihiko ; Nishi, Tomohiro ; Shirado, Akemi Naito ; Watanabe, Toshio ; Kuchiba, Aya ; Yamaguchi, Takuhiro ; Iwase, Satoru. / How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study. In: Supportive Care in Cancer. 2019.
@article{5caa6e8be4f14188b55c9b858dd63241,
title = "How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study",
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.",
keywords = "Cancer, Dyspnea, Morphine, Outcomes, Palliative care",
author = "Masanori Mori and Tatsuya Morita and Yoshinobu Matsuda and Hirohide Yamada and Keisuke Kaneishi and Yoshihisa Matsumoto and Naoki Matsuo and Takuya Odagiri and Etsuko Aruga and Hiroaki Watanabe and Ryohei Tatara and Hiroki Sakurai and Akira Kimura and Hideki Katayama and Akihiko Suga and Tomohiro Nishi and Shirado, {Akemi Naito} and Toshio Watanabe and Aya Kuchiba and Takuhiro Yamaguchi and Satoru Iwase",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00520-019-05081-9",
language = "English",
journal = "Supportive Care in Cancer",
issn = "0941-4355",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - How successful are we in relieving terminal dyspnea in cancer patients? A real-world multicenter prospective observational study

AU - Mori, Masanori

AU - Morita, Tatsuya

AU - Matsuda, Yoshinobu

AU - Yamada, Hirohide

AU - Kaneishi, Keisuke

AU - Matsumoto, Yoshihisa

AU - Matsuo, Naoki

AU - Odagiri, Takuya

AU - Aruga, Etsuko

AU - Watanabe, Hiroaki

AU - Tatara, Ryohei

AU - Sakurai, Hiroki

AU - Kimura, Akira

AU - Katayama, Hideki

AU - Suga, Akihiko

AU - Nishi, Tomohiro

AU - Shirado, Akemi Naito

AU - Watanabe, Toshio

AU - Kuchiba, Aya

AU - Yamaguchi, Takuhiro

AU - Iwase, Satoru

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Cancer

KW - Dyspnea

KW - Morphine

KW - Outcomes

KW - Palliative care

UR - http://www.scopus.com/inward/record.url?scp=85074758795&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074758795&partnerID=8YFLogxK

U2 - 10.1007/s00520-019-05081-9

DO - 10.1007/s00520-019-05081-9

M3 - Article

C2 - 31630256

AN - SCOPUS:85074758795

JO - Supportive Care in Cancer

JF - Supportive Care in Cancer

SN - 0941-4355

ER -