Palliative Care Unit, Hospital Universitario NS La Candelaria, Crta del Rosario 145, 38010, Tenerife, SC, Spain.
School of Health Science (Medicine), Universidad de La Laguna, Tenerife, Spain.
Support Care Cancer. 2019 Jan;27(1):157-164. doi: 10.1007/s00520-018-4309-8. Epub 2018 Jun 18.
We assessed the effects of subcutaneous-endovenous fentanyl on dyspnoea in a cohort of advanced cancer patients.
We performed a retrospective study in a cohort of advanced cancer patients with dyspnoea at rest who received subcutaneous or intravenous fentanyl. Patients with no shortness of breath at rest or at minimal exertion, no rescue doses per 24 h, were deemed to be responders to fentanyl. The period of assessment was 6 days from the beginning of fentanyl treatment.
Seventy-two patients were evaluated: 65% males, 50% ≥ 75 years, Palliative Performance Scale (PPS) median of 30%. Seventy-six percent of the patients were responders to fentanyl. Fentanyl efficacy was not statistically related to age, gender, cancer type, previous opioid treatment, steroid and midazolam doses and PPS. The median fentanyl dose in responders was 25 mcg/h (interquartile range 12-70). It was significantly related to age (37 vs 12 mcg/h, for ≤ 75 vs > 75 years, respectively; p = 0.02). There was not a significant difference between fentanyl doses of responders and non-responder patients. Thirty-six, 23 and 15 patients had sustained improvements in dyspnoea over 48, 72 and 96 h. Fentanyl had no significant toxicity. The length of inclusion in the study and exclusion were related to low performance status (hazard ratio 0.961; CI 0.927-0.996; Cox-regression) but not to fentanyl doses (hazard ratio 0.875; CI 0.620-1.234; Cox-regression).
Our preliminary data suggest that subcutaneous-endovenous fentanyl may be associated with dyspnoea relief in dying patients. Further research is needed to confirm these findings.
我们评估了皮下-静脉芬太尼对一组晚期癌症呼吸困难患者的影响。
我们对一组有呼吸困难的晚期癌症患者进行了回顾性研究，这些患者在休息时接受皮下或静脉芬太尼治疗。在休息或最小活动时没有呼吸急促，24 小时内没有救援剂量的患者被认为对芬太尼有反应。评估期从开始芬太尼治疗的第 6 天开始。
共有 72 名患者接受了评估：男性占 65%，年龄≥75 岁的占 50%，姑息治疗表现量表（PPS）中位数为 30%。76%的患者对芬太尼有反应。芬太尼的疗效与年龄、性别、癌症类型、先前的阿片类药物治疗、类固醇和咪达唑仑剂量以及 PPS 无关。有反应的患者的芬太尼中位剂量为 25 mcg/h（四分位距 12-70）。芬太尼剂量与年龄显著相关（≤75 岁与>75 岁的分别为 37 与 12 mcg/h；p=0.02）。有反应者与无反应者的芬太尼剂量之间无显著差异。36、23 和 15 名患者的呼吸困难在 48、72 和 96 小时内持续改善。芬太尼没有明显的毒性。纳入和排除研究的时间长度与较低的表现状态有关（风险比 0.961；CI 0.927-0.996；Cox 回归），但与芬太尼剂量无关（风险比 0.875；CI 0.620-1.234；Cox 回归）。
我们的初步数据表明，皮下-静脉芬太尼可能与临终患者的呼吸困难缓解有关。需要进一步的研究来证实这些发现。
