• Masanori Mori, Takashi Yamaguchi, Kozue Suzuki, Yoshinobu Matsuda, Ryo Matsunuma, Hiroaki Watanabe, Tomoo Ikari, Yoshihisa Matsumoto, Kengo Imai, Naosuke Yokomichi, Satoru Miwa, Toshihiro Yamauchi, Soichiro Okamoto, Satoshi Inoue, Akira Inoue, David Hui, Tatsuya Morita, Eriko Satomi, and Japanese Dyspnea Relief Investigators.
• Palliative and Supportive Care Division (M.M., N.Y., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan. Electronic address: masanori.mori@sis.seirei.or.jp.
• J Pain Symptom Manage. 2023 Aug 1; 66 (2): e177e184e177-e184.

ContextDyspnea is among the most distressing symptoms in the last weeks to days of life (terminal dyspnea). While physicians frequently use parenteral opioids other than morphine for terminal dyspnea, little is known about their effects in cancer patients.ObjectivesTo explore the effectiveness and safety of parenteral morphine, oxycodone, and hydromorphone for cancer patients with terminal dyspnea.MethodsThis was a secondary analysis of a multicenter cohort study that consecutively enrolled advanced cancer patients with moderate/severe terminal dyspnea. Participating palliative care physicians initiated parenteral opioids (morphine/oxycodone/hydromorphone), utilizing a standardized treatment algorithm. We examined the dyspnea intensity (Integrated Palliative care Outcome Scale [IPOS]) at 24 and 48 hours.ResultsOf 108 patients (mean age = 72), 66 (61%), 34 (32%), and 8 (7.4%) received morphine, oxycodone, and hydromorphone, respectively. At 24 hours, mean dyspnea IPOS scores significantly decreased from 3.0 (standard error (SE) = 0.1) at the baseline to 1.6 (0.1), 2.9 (0.1) to 2.0 (0.2), and 3.5 (0.2) to 1.2 (0.4) in the morphine (P < 0.001), oxycodone (P < 0.001), and hydromorphone (P = 0.011) groups, respectively. At 48 hours, the IPOS scores significantly reduced from 2.9 (0.1) at the baseline to 1.4 (0.1), 2.9 (0.1) to 1.6 (0.2), and 3.5 (0.2) to 1.2 (0.2) in the morphine (P < 0.001), oxycodone (P < 0.001), and hydromorphone (P = 0.004) groups, respectively. No significant differences in mean scores were found among the three groups at 24 (P = 0.080) and 48 hours (P = 0.322). Adverse events were rare.ConclusionParenteral morphine, oxycodone, and hydromorphone may be similarly effective and safe for cancer patients with terminal dyspnea.Copyright © 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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