The Effectiveness of Regular Opioids for Dyspnea Among Opioid-Tolerant Patients with Cancer: A Comparison of Increasing Baseline Opioids Versus Opioid Switch/Combination Therapy.

Abstract

<b><i>Background:</i></b> Dyspnea is a common and distressing symptom in patients with cancer and often worsens even with the use of opioids for pain management. Understanding effective strategies for managing dyspnea in opioid-tolerant patients is essential for improving patient care. <b><i>Objective:</i></b> This study aimed to compare the effectiveness of different opioid treatment strategies for managing dyspnea in opioid-tolerant patients with cancer. <b><i>Design:</i></b> We conducted a secondary analysis of real-world data from a past observational study. <b><i>Setting/Subjects:</i></b> This study included 122 opioid-tolerant patients with cancer who experienced dyspnea. The patients were from 12 palliative care services across Japan. <b><i>Measurements:</i></b> We recorded patients' background, opioid usage, and dyspnea intensity using a numerical rating scale at baseline and every 24 hours for 72 hours after initiating treatment. <b><i>Results:</i></b> The overall response to treatment was 68%. The increase group (patients who increased their baseline opioid doses to manage dyspnea) saw a response of 63%, while the switch/combination group (patients who switched to another opioid or used a combination of opioids) saw a response of 73%. No significant differences were observed between the two groups. Multivariate analysis revealed that a dyspnea NRS score ≥7 was positively associated with dyspnea relief in all patients. <b><i>Conclusions:</i></b> Modification of systemic opioid administration is effective for dyspnea in opioid-tolerant patients with cancer, regardless of the treatment strategy employed. As this was an open-label observational study, randomized controlled trials are needed in the future.