Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki, Japan
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Oncologist. 2019 Jul;24(7):e583-e589. doi: 10.1634/theoncologist.2018-0468. Epub 2019 Jan 18.
Although the efficacy of parenteral morphine for alleviating dyspnea has been previously demonstrated in several studies, little is known regarding the efficacy of oral morphine for dyspnea among patients with cancer, including its response rate and predictive factors of effectiveness. Therefore, the aim of this study was to clarify the effectiveness of oral morphine on dyspnea in patients with cancer and elucidate the predictive factors of its effectiveness.
SUBJECTS, MATERIALS, AND METHODS: In this multicenter prospective observational study, we investigated the change in dyspnea intensity in patients with cancer before and after the administration of oral morphine by using a visual analog scale (VAS). We also administered a self-assessment questionnaire to determine whether the patients believed oral morphine was effective.
Eighty patients were enrolled in the study, and 71 of these patients were eligible. The least square mean of the VAS scores for dyspnea intensity was 53.5 at baseline, which decreased significantly to 44.7, 40.8, and 35.0 at 30, 60, and 120 minutes after morphine administration, respectively. Fifty-four patients (76.1%) reported that oral morphine was effective on the self-assessment questionnaire. Among the background factors, a high score for "sense of discomfort" on the Cancer Dyspnea Scale (CDS) and a smoking history of fewer pack-years were associated with greater effectiveness.
Oral morphine was effective and feasible for treating cancer-related dyspnea. A higher score for "sense of discomfort" on the CDS and a smaller cumulative amount of smoking may be predictive factors of the effectiveness of oral morphine.
This study demonstrated that oral morphine was effective in alleviating cancer-related dyspnea due to multiple factors including primary lung lesions, airway narrowing, and pleural effusion. Approximately 76% of patients reported that oral morphine was effective. A higher score for "sense of discomfort" on the Cancer Dyspnea Scale and a lower cumulative amount of smoking may be predictive factors for the effectiveness of oral morphine. Interestingly, respiratory rates in patients who reported the morphine to be effective decreased significantly after oral morphine administration, unlike the respiratory rates in "morphine-ineffective" patients.
虽然已有多项研究证实，注射用吗啡可有效缓解呼吸困难，但对于癌症患者口服吗啡缓解呼吸困难的疗效，包括其缓解率和有效性的预测因素，知之甚少。因此，本研究旨在阐明口服吗啡对癌症患者呼吸困难的疗效，并阐明其有效性的预测因素。
受试者、材料和方法：在这项多中心前瞻性观察研究中，我们使用视觉模拟量表（VAS）调查了癌症患者在口服吗啡前后呼吸困难强度的变化。我们还进行了一项自我评估问卷，以确定患者是否认为口服吗啡有效。
共纳入 80 例患者，其中 71 例符合纳入标准。基线时呼吸困难 VAS 评分的最小二乘均值为 53.5，分别在吗啡给药后 30、60 和 120 分钟时显著下降至 44.7、40.8 和 35.0。54 例（76.1%）患者在自我评估问卷中报告口服吗啡有效。在背景因素中，癌症呼吸困难量表（CDS）的“不适感觉”评分较高和吸烟包年数较少与疗效较好相关。
口服吗啡治疗癌症相关呼吸困难有效且可行。CDS 的“不适感觉”评分较高和累积吸烟量较小可能是口服吗啡疗效的预测因素。
本研究表明，口服吗啡通过多种因素缓解与原发性肺部病变、气道狭窄和胸腔积液相关的癌症相关呼吸困难，具有有效性。约 76%的患者报告口服吗啡有效。CDS 的“不适感觉”评分较高和累积吸烟量较低可能是口服吗啡疗效的预测因素。有趣的是，与“吗啡无效”患者相比，报告吗啡有效的患者在口服吗啡后呼吸频率明显下降。
