• Steffen T Simon, Peyla Köskeroglu, Jan Gaertner, and Raymond Voltz.
• Center of Palliative Medicine and Clinical Trials Unit (BMBF 01KN1106), University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany. Electronic address: steffen@steffensimon.de.
• J Pain Symptom Manage. 2013 Dec 1;46(6):874-86.

ContextFentanyl is a potent opioid that has been proven to provide effective treatment for breakthrough cancer pain. Although opioids are the only drug group with evidence for the symptomatic treatment of breathlessness, evidence about the efficacy of fentanyl for the relief of breathlessness is unknown.ObjectivesWe performed a systematic review to evaluate the current evidence for the use of fentanyl for the relief of breathlessness.MethodsThe review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendation for systematic reviews. Four databases (MEDLINE, EMBASE, Cochrane Library, International Pharmaceutical Abstracts) were screened using "fentanyl" and "dyspnoea" (and synonyms) as search terms. Hand search and contact with relevant authors completed the search.ResultsA total of 622 references were retrieved, 13 of which met the inclusion criteria for this review. Two randomized controlled trials (RCTs) evaluated fentanyl for breathlessness, but one only included two patients. The other studies were before-after (n = 2) and case studies (n = 9). All studies reported successful relief of breathlessness after fentanyl application, but the only (pilot-) RCT failed to demonstrate a statistically significant difference compared with placebo. The nature and incidence of adverse events were comparable with other opioids, and no respiratory depression was observed.ConclusionDescriptive studies yielded promising results for the use of fentanyl for the relief of breathlessness; however, efficacy trials are lacking. Fully powered RCTs are warranted to determine the efficacy of fentanyl for breathlessness relief, but these require pilot studies to evaluate effective size, study procedures, and outcome measures.Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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