Dexamethasone for Dyspnea in Cancer Patients: A Pilot Double-Blind, Randomized, Controlled Trial

Hui, David; Kilgore, Kelly; Frisbee-Hume, Susan; Park, Minjeong; Tsao, Anne S.; Guay, Marvin Delgado; Lu, Charles; William, William; Pisters, Katherine M.W.; Eapen, George A.; Fossella, Frank V.; Amin, Sapna; Bruera, Éduardo

doi:10.1016/j.jpainsymman.2015.10.023

Cited by 58 publications

(57 citation statements)

References 37 publications

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“…This observation is concerning given the high frequency of off-label use of opioids for dyspnea in our palliative care unit. Corticosteroids represent another therapeutic option that is even less studied than opioids but shows some promise in relieving dyspnea based on a recent double-blind, randomized controlled trial (23). Taken together, our study highlights the prevalence of off-label use of these two major classes of medications and the opportunities for further research in dyspnea management.…”

Section: Discussionmentioning

confidence: 99%

Off-Label Medication Use in the Inpatient Palliative Care Unit

Kwon

Kim

Bruera

et al. 2017

Journal of Pain and Symptom Management

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Context Although off-label medications are frequently prescribed in palliative care, there are no published studies examining their use in the United States. Objectives We examined the frequency of off-label medication use in cancer patients admitted to an acute palliative care unit (APCU). Methods This prospective observational study enrolled consecutive patients with advanced cancer admitted to the APCU of a tertiary care cancer center. We collected data on all prescription events, including indications for use, from admission to discharge. Off-label use was checked against the U.S. Food and Drug Administration approved indications. Results Among the 201 patients, median survival was 10 days (95% confidence interval 7-13), and 85 (42%) patients died in the APCU. We documented 6276 prescription events, and 2199 (35%) were off-label. Among off-label prescriptions, central nervous system agents (n=1606, 73%), hormones and synthetic substitutes (n= 302, 14%), and autonomic drugs (n=183, 8%) were most commonly prescribed. Haloperidol (n=720, 33%), chlorpromazine (n=292, 13%), dexamethasone (n=280, 13%), glycopyrrolate (n=175, 8%), hydromorphone (n=161, 7%), and morphine (n=156, 7%) were most frequently prescribed off-label. The most common indications for off-label prescribing were delirium (n=783, 36%) and dyspnea (n=449, 20%). 70% of all off-label prescription events had strong evidence supporting use, and 19% of prescription events had moderate or weak evidence for use. Conclusion One-third of prescription events in the APCU were off-label, with majority of off-label use having a strong level of supporting evidence. Our findings highlight the need for more research in key areas such as delirium and dyspnea management.

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Section: Discussionmentioning

confidence: 99%

Off-Label Medication Use in the Inpatient Palliative Care Unit

Kwon

Kim

Bruera

et al. 2017

Journal of Pain and Symptom Management

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“…(102) More recently, a separate randomized placebo-controlled trial that incorporated ESAS dyspnea as the primary outcome confirmed this observation. (103)…”

Section: Present Applicationsmentioning

confidence: 99%

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Hui

Bruera

2017

Journal of Pain and Symptom Management

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559

428

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Context Routine symptom assessment represents the cornerstone of symptom management. ESAS is one of the first quantitative symptom assessment batteries that allows for simple and rapid documentation of multiple patient-reported symptoms at the same time. Objective To discuss the historical development of ESAS, its current uses in different settings, and future developments. Methods Narrative review Results Since its development in 1991, ESAS has been psychometrically validated and translated into over 20 languages. We will discuss the variations, advantages and limitations with ESAS. From the clinical perspective, ESAS is now commonly used for symptom screening and longitudinal monitoring in patients seen by palliative care, oncology, nephrology, and other disciplines in both inpatient and outpatient settings. From the research perspective, ESAS has offered important insights into the nature of symptom trajectory, symptom clusters and symptom modulators. Furthermore, multiple clinical studies have incorporated ESAS as a study outcome and documented the impact of various interventions on symptom burden. On the horizon, multiple groups are actively investigating further refinements to ESAS, such as incorporating it in electronic health records, employing ESAS as a trigger for palliative care referral, and coupling ESAS with personalized symptom goals to optimize symptom response assessment. Conclusion ESAS has evolved over the past 25 years to become an important symptom assessment instrument in both clinical practice and research. Future efforts are needed to standardize this tool and explore its full potential to support symptom management.

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“…Previous studies have indicated that early postoperative cognitive dysfunction is one of the most common adverse effects in pediatric patients after tonsillectomy (30,31). DEX has been approved by the Chinese Food and Drug Administration for the treatment of inflammation (32). In addition, it has been suggested that DEX is an efficient drug for the treatment of postoperative cognitive dysfunction (33,34).…”

Section: Discussionmentioning

confidence: 99%

Beneficial effects of dexmedetomidine on early postoperative cognitive dysfunction in pediatric patients with tonsillectomy

Han

2018

Exp Ther Med

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According to clinical investigations, early postoperative cognitive dysfunction is the most common adverse event in pediatric patients after tonsillectomy. A previous study has indicated that dexmedetomidine (DEX) is an efficient drug for the treatment of postoperative cognitive dysfunction. However, the efficacy of DEX in alleviating early postoperative cognitive dysfunction in pediatric patients following tonsillectomy has remained elusive, which was therefore assessed in the present study. A total of 186 children presenting with cognitive dysfunction subsequent to tonsillectomy were recruited to analyze the efficacy of DEX. Patients were randomly divided into two groups and received intravenous treatment with DEX (n=112) or placebo (n=74). Duration of treatment, dose-limiting toxicities (DLT) and maximum tolerated dose (MTD) of DEX were evaluated in a preliminary experiment. The improvement of postoperative cognitive function in children with tonsillectomy was analyzed with a Mini-Mental State Examination (MMSE) following treatment with DEX. A 40-item quality of life (MONEX-40) questionnaire was used to assess the efficacy of DEX. The plasma levels of interleukin (IL)-6, IL-1, tumor necrosis factor (TNF)-α, superoxide dismutase (SOD), neuron-specific enolase (NSE), C-reactive protein (CRP), cortisol and melatonin were also analyzed. The preliminary experiment determined that the DLT was 10 mg/kg and the MTD was 15 mg/kg. In the major clinical trial, it was revealed that MMSE scores in the DEX treatment group were markedly improved, indicating that DEX had a beneficial effect in pediatric patients with early postoperative cognitive dysfunction after tonsillectomy. In addition, IL-1and TNF-α were downregulated, while IL-6 and SOD were upregulated in patients with cognitive dysfunction after treatment with DEX compared with those in the placebo group. Furthermore, DEX treatment markedly decreased the serum levels of CRP, NSE cortisol and melatonin, which are associated with the occurrence of postoperative cognitive dysfunction in pediatric patients following tonsillectomy. In conclusion, intravenous administration of DEX at a dose of 10 mg/kg improves postoperative cognitive function in pediatric patients with tonsillectomy by decreasing the serum levels of inflammatory factors and stress-associated signaling molecules. Trial registration no. QLSDHOS0200810102C (Qilu Hospital of Shandong University, Jinan, China).

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Dexamethasone for Dyspnea in Cancer Patients: A Pilot Double-Blind, Randomized, Controlled Trial

Cited by 58 publications

References 37 publications

Off-Label Medication Use in the Inpatient Palliative Care Unit

Off-Label Medication Use in the Inpatient Palliative Care Unit

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Beneficial effects of dexmedetomidine on early postoperative cognitive dysfunction in pediatric patients with tonsillectomy

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