Patient-Controlled Therapy of Breathlessness in Palliative Care: A New Therapeutic Concept for Opioid Administration?

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• 作者：Andrea Schmitz ; MD^a ; ^b ; Christian Schulz ; MD ; MSc^a ; ^{christian.schulz@med.uni-duesseldorf.de" class="auth_mail" title="E-mail the corresponding author} ; Uta Friebel ; MD^b ; Thomas Hohlfeld ; MD ; PhD^c ; Claudia Bausewein ; MD ; PhD^d
• 关键词：Breathlessness ; dyspnea ; therapy ; patient-controlled therapy ; opioid ; palliative care
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：51
• 期：3
• 页码：581-588
• 全文大小：542 K

文摘

Breathlessness is one of the most distressing symptoms experienced by patients with advanced cancer and noncancer diagnoses alike. Often, severity of breathlessness increases quickly, calling for rapid symptom control. Oral, buccal, and parenteral routes of provider-controlled drug administration have been described. It is unclear whether patient-controlled therapy (PCT) systems would be an additional treatment option.

Objectives

To investigate whether intravenous opioid PCT can be an effective therapeutic method to reduce breathlessness in patients with advanced disease. Secondary aims were to study the feasibility and acceptance of opioid PCT in patients with refractory breathlessness.

Methods

This was a pilot observational study with 18 inpatients with advanced disease and refractory breathlessness receiving opioid PCT. Breathlessness was measured on a self-reported numeric rating scale. Richmond Agitation Sedation Scale scores, Palliative Performance Scale scores, vital signs, and a self-developed patient satisfaction questionnaire were used for measuring secondary outcomes. Descriptive and interference analyses (Friedman test) and post hoc analyses (Wilcoxon tests and Bonferroni corrections) were performed.

Results

Eighteen of 815 patients (advanced cancer; median age = 57.5 years [range 36–81]; 77.8% female) received breathlessness symptom control with opioid PCT; daily morphine equivalent dose at Day 1 was median = 20.3 mg (5.0–49.6 mg); Day 2: 13.0 mg (1.0–78.5 mg); Day 3: 16.0 mg (8.3–47.0 mg). Numeric rating scale of current breathlessness decreased (baseline: median = 5 [range 1–10]; Day 1: median = 4 [range 0–8], P < 0.01; Day 2: median = 4 [range 0–5], P < 0.01). Physiological parameters were stable over time. On Day 3, 12/12 patients confirmed that this mode of application provided relief of breathlessness.

Conclusion

Opioid PCT is a feasible and acceptable therapeutic method to reduce refractory breathlessness in palliative care patients.