Visualizing How to Use Parenteral Opioids for Terminal Cancer Dyspnea: A Pilot, Multicenter, Prospective, Observational Study

Prognostication of the Last Days of Life

“…Individuals have their own preferences toward the balance between symptom relief and maintenance of communication capacity in the last days of life [ 71 ]. Thus, while managing severe distress such as dyspnea, agitation, and refractory suffering, clinicians should bear in mind the uniqueness of patients’ preferences when titrating medications with sedative effects (e.g., opioids, antipsychotics, benzodiazepines) [ 52 , 53 , 72 – 75 ].…”

The feasibility and effects of a pharmacological treatment algorithm for cancer patients with terminal dyspnea: A multicenter cohort study

“…8,17,21 We thus included various outcomes including validated and novel measurements to maximize the interpretability. 2,5,8,17 As expected, patient-rated NRS was available in only less than two-thirds of patients at 48 h. To complement it, we conducted LOCF analysis, and used physician-rated NRS and IPOS as well as respiratory rating; all of these consistently showed T A B L E 2 Actual treatment over 48 h significant improvement in dyspnea (reduction of NRS greater than an MCID) or tachypnea. In addition, patient-perceived goals were achieved and balanced outcomes were fulfilled in a majority of the patients.…”

“…11,16,17,19 We did not include titration of oral opioids in the algorithm, as terminally-ill cancer patients with severe dyspnea often lose consciousness and become unable to take medications orally. 3,5,8 The algorithm reflects a comprehensive treatment strategy that includes opioid initiation and titration, opioid switching, and the addition of low-dose benzodiazepine. As our primary intention was to provide a visual flow chart of comprehensive treatment strategies, and the most effective doses may change over time as new evidence emerges, we did not include specific values of medication doses in the algorithm.…”

“…[1][2][3] Previous research indicated the efficacy of opioids as the first-line therapy for terminal dyspnea patients. [4][5][6][7][8] The international guidelines also recommend that parenteral opioids and benzodiazepines be considered for patients with terminal dyspnea. 9-11 However, little evidence exists regarding how best to use these medications comprehensively.…”

“…Dyspnea is among the most frequent and deteriorating symptoms in the terminal phase of life of cancer patients (“terminal dyspnea”) 1–3 . Previous research indicated the efficacy of opioids as the first‐line therapy for terminal dyspnea patients 4–8 . The international guidelines also recommend that parenteral opioids and benzodiazepines be considered for patients with terminal dyspnea 9–11 .…”