Effectiveness and safety of opioids for dyspnea in patients with lung cancer: secondary analysis of multicenter prospective observational study

Yoshihiko Taniguchi; Yoshinobu Matsuda; Masanori Mori; Madoka Ito; Tomoo Ikari; Akihiro Tokoro; Sayo Aiki; Shunya Hoshino; Daisuke Kiuchi; Kozue Suzuki; Yuko Igarashi; Takuya Odagiri; Kiyofumi Oya; Emi Kubo; Takashi Yamaguchi

doi:10.21037/tlcr-22-512

Effectiveness and safety of opioids for dyspnea in patients with lung cancer: secondary analysis of multicenter prospective observational study

Transl Lung Cancer Res. 2022 Dec;11(12):2395-2402. doi: 10.21037/tlcr-22-512.

Authors

Yoshihiko Taniguchi¹, Yoshinobu Matsuda², Masanori Mori³, Madoka Ito⁴, Tomoo Ikari⁵, Akihiro Tokoro², Sayo Aiki⁶, Shunya Hoshino⁷, Daisuke Kiuchi^{8

9}, Kozue Suzuki¹⁰, Yuko Igarashi¹¹, Takuya Odagiri¹², Kiyofumi Oya¹³, Emi Kubo¹⁴, Takashi Yamaguchi¹¹

Affiliations

¹ Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan.
² Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan.
³ Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
⁴ Department of Palliative Care, Konan Medical Center, Kobe, Japan.
⁵ Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan.
⁶ Department of Palliative Care, National Hospital Organization Osaka National Hospital, Osaka, Japan.
⁷ Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan.
⁸ Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan.
⁹ Department of Palliative Care, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
¹⁰ Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
¹¹ Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
¹² Department of Palliative Care, Komaki City Hospital, Komaki, Japan.
¹³ Peace Home Care Clinic, Otsu, Japan.
¹⁴ Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.

Abstract

Background: Patients with lung cancer are more likely to have comorbidities [e.g., interstitial lung disease (ILD)], chronic obstructive pulmonary disease) and metastases that may affect dyspnea and the effectiveness and safety of opioids for dyspnea than other cancer types. Therefore, this study examined the effectiveness and safety of opioids for dyspnea, among the patients with lung cancer.

Methods: The present study is a secondary analysis of a multicenter prospective observational study examining the effectiveness and safety of opioids for dyspnea in patients with cancer in Japan. For this secondary analysis, patients with lung cancer with a documented dyspnea Numerical Rating Scale (NRS) at baseline were included. The primary outcome was dyspnea NRS, and Integrated Palliative care Outcome Scale/Support Team Assessment Schedule (IPOS/STAS) scores change between baseline and 24 hours after baseline. As secondary outcomes, we investigated the predictors of opioid effectiveness for dyspnea improvement and adverse events (nausea, somnolence, and delirium).

Results: This study analyzed 124 patients with lung cancer with known dyspnea NRS at baseline. The median age was 74, and the Eastern Cooperative Oncology Group performance status of 107 patients were 3-4. Both NRS and IPOS/STAS score of dyspnea significantly improved 24 hours after opioid initiation [-1.64, 95% confidence interval (CI): -2.12 to -1.17, P<0.001; -1.03; 95% CI: -1.21 to -0.85, P<0.001; respectively]. Moreover, the improvement of NRS score was greater than the minimal clinically important difference of 1 point. In the multivariate logistic regression analysis, ILD was significantly associated with a better improvement [(hazard ratio (HR): 3.39, 95% CI: 1.34-11.09, P=0.043]. Somnolence was the most common grade 3-4 adverse event (n=16), followed by delirium (n=9).

Conclusions: Opioids were effective and safe for treating dyspnea in patients with lung cancer. Furthermore, lung cancer patients with ILD may benefit more from opioids.

Keywords: Lung cancer; dyspnea; interstitial lung disease (ILD); morphine; opioid.