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Patient-Controlled Therapy (PCT) of Breathlessness in Palliative Care: A New Therapeutic Concept for Opioid Application?
J Pain Symptom Manage. 2015 Nov 11;
Authors: Schmitz A, Schulz C, Friebel U, Hohlfeld T, Bausewein C
Abstract
CONTEXT: Breathlessness is one of the most distressing symptoms experienced by patients with advanced cancer and non-cancer diagnoses alike. Often, severity of breathlessness increases quickly, calling for rapid symptom control. Oral, buccal, and parenteral routes of provider-controlled drug administration have been described. It is unclear whether patient-controlled therapy systems (PCT) would be an additional treatment option.
OBJECTIVES: To investigate whether intravenous opioid PCT can be an effective therapeutic method to reduce breathlessness in patients with advanced disease. Secondary aims were to study the feasibility and acceptance of opioid PCT in patients with refractory breathlessness.
METHODS: This was a pilot observational study with 18 inpatients with advanced disease and refractory breathlessness receiving opioid PCT. Breathlessness was measured on a self-reported numerical rating scale (NRS). Richmond Agitation Sedation Scale (RASS) scores, Palliative Performance Scale (PPS) scores, vital signs and a self-developed patient satisfaction questionnaire were used for measuring secondary outcomes. Descriptive and interference analyses (Friedman test) and post-hoc analyses (Wilcoxon tests and Bonferroni corrections) were performed.
RESULTS: Eighteen of 815 patients (advanced cancer; median age=57.5 years [range 36-81]; 77.8% female) received breathlessness symptom control with opioid PCT; daily morphine equivalent dose at day 1 was median=20.3 mg (5.0-49.6 mg); day 2: 13.0 mg (1.0-78.5 mg); day 3: 16.0 mg (8.3-47.0 mg). NRS of current breathlessness decreased (baseline: median=5 (range 1-10); day 1: median=4 (range 0-8), P<0.01; day 2: median=4 (range 0-5), P<0.01). Physiological parameters were stable over time. On day 3, 12/12 patients confirmed that this mode of application provided relief of breathlessness.
CONCLUSION: Opioid PCT is a feasible and acceptable therapeutic method to reduce refractory breathlessness in palliative care patients.
PMID: 26578404 [PubMed - as supplied by publisher]