Managing Dyspnea With Fentanyl in Patients With Cancer at End of Life
Dyspnea, or breathlessness, is commonly experienced by those with advanced cancer.
Subcutaneous-endovenous fentanyl may be an effective agent in relieving dyspnea among patients with cancer at the end of life, according to a study published in Supportive Care in Cancer.
A common symptom for patients with advanced cancer is dyspnea or breathlessness. Previous studies have assessed the effectiveness of opioids in dyspnea management among this patient population, but evidence for their efficacy remains controversial and is lacking among dying patients.
For this retrospective study, researchers assessed the outcomes of 72 patients with advanced cancer who had dyspnea at rest and received subcutaneous or intravenous fentanyl. Investigators defined responders to fentanyl as having no shortness of breath at rest or minimal exertion, and not requiring any rescue doses per day. Of the study patients, 65% were males, half were at least 75 years old, and had a Palliative Performance Scale (PPS) median of 30%.
Results showed that 76% of patients were fentanyl responders. Fentanyl efficacy was not statistically associated to age, gender, cancer type, previous opioid treatment, steroid and midazolam doses, or PPS.
The median fentanyl dose among responders was 25 mcg/hour, and was significantly related to age; the median fentanyl dose was 37 mcg/hour for patients aged 75 years and younger compared with 12 mcg/hour for patients older than 75 (P=.02). No significant differences in fentanyl dose were observed between responders and non-responders.
Sustained response and improvements in dyspnea were observed in 36 patients over 48 hours, 23 patients over 72 hours, and 15 patients over 96 hours.
The duration of inclusion and exclusion from study was not associated with fentanyl doses, but were related with low performance status.
The authors concluded that “this study provides promising results that justify considering intravenous or subcutaneous fentanyl as an option for improving dyspnea at rest in dying patients. Nevertheless, future studies have yet to clarify the actual benefit of fentanyl in the treatment of breathlessness in dying cancer and noncancer patients.”
Benitez-Rosario MA, Rosa-Gonzalez I, Gonzalez-Davila E, Sanz E. Fentanyl treatment for end-of-life dyspnoea relief in advanced cancer patients [published online June 18, 2018]. Support Care Cancer. doi: 10.1007/s00520-018-4309-8