Matsuda Yoshinobu, Matsunuma Ryo, Suzuki Kozue, Mori Masanori, Watanabe Hiroaki, Yamaguchi Takashi
Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan.
Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Palliat Med Rep. 2020 Jun 30;1(1):97-102. doi: 10.1089/pmr.2020.0050. eCollection 2020.
Dyspnea is a common and distressing symptom in patients with advanced cancer. Opioids, benzodiazepines, and corticosteroids are commonly prescribed pharmacological treatments for cancer dyspnea. The objective of this survey was to investigate physician-perceived predictive factors for the effectiveness of opioids, benzodiazepines, and corticosteroids in treating cancer dyspnea. This study involves a nationwide survey using self-report questionnaires. Random sampling selected 268 Japanese certified palliative care physicians in Japan. We inquired about the 12 physician-perceived predictive factors for the effectiveness of drugs (opioids, benzodiazepines, and corticosteroids) in treating cancer dyspnea. The frequently selected physician-perceived predictive factors for the effectiveness of opioids were tachypnea, respiratory effort, opioid naive, Eastern Cooperative Oncology Group Performance Status 0-2, multiple lung tumors, dry cough, pleural effusion, and pleural lesion. Benzodiazepines were predicted to be effective against dyspnea in patients with depression and severe anxiety. Meanwhile, corticosteroids were predicted to be effective against dyspnea in patients with lymphangitis carcinomatosa, superior vena cava syndrome, major airway obstruction, and audible wheezing. Japanese palliative care physicians anticipate that different drug classes will be effective for treating dyspnea in patients with specific factors. Japanese palliative care physicians expect that different drugs will be effective for dyspnea in patients with specific predictive factors. Future prospective studies are required to assess the effectiveness of each drug class against specific dyspnea.
呼吸困难是晚期癌症患者常见且令人痛苦的症状。阿片类药物、苯二氮䓬类药物和皮质类固醇是常用于治疗癌症呼吸困难的药物。本次调查的目的是研究医生认为的阿片类药物、苯二氮䓬类药物和皮质类固醇治疗癌症呼吸困难有效性的预测因素。本研究采用自填式问卷进行全国性调查。随机抽样选取了日本268名获得认证的姑息治疗医生。我们询问了医生认为的药物（阿片类药物、苯二氮䓬类药物和皮质类固醇）治疗癌症呼吸困难有效性的12个预测因素。医生认为阿片类药物有效性的常见预测因素为呼吸急促、呼吸用力、未使用过阿片类药物、东部肿瘤协作组体能状态0 - 2、多发肺肿瘤、干咳、胸腔积液和胸膜病变。预计苯二氮䓬类药物对伴有抑郁和严重焦虑的患者的呼吸困难有效。同时，预计皮质类固醇对伴有癌性淋巴管炎、上腔静脉综合征、大气道阻塞和可闻及哮鸣音的患者的呼吸困难有效。日本姑息治疗医生预计不同药物类别对具有特定因素的患者治疗呼吸困难有效。日本姑息治疗医生期望不同药物对具有特定预测因素的患者的呼吸困难有效。未来需要进行前瞻性研究以评估各类药物针对特定呼吸困难的有效性。
