Morphine versus methylprednisolone or aminophylline for relieving dyspnea in patients with advanced cancer in China: a retrospective study

Abstract

ContextDyspnea is one of the most common and distressing symptoms that occurs in terminal cancer patients. However, there are no existing treatment guidelines for this condition in China.ObjectiveThis single-center, retrospective, observational study aimed to compare the efficacy of using morphine, methylprednisolone, or aminophylline to relieve the symptom of breathlessness in patients with advanced malignant tumors and to investigate the safety of these regimens during the treatment of dyspnea.MethodsBetween August 2011 and January 2015 we retrospectively reviewed the medical records of 343 terminally ill cancer patients with dyspnea who received morphine, methylprednisolone, or aminophylline. The therapeutic effect of each treatment by means of visual analogue scale (VAS) scores was assessed and compared. Statistical methods included Chi square and analysis of variance tests. Differences were considered significant when P < 0.05.ResultsVAS scores after treatment were (16.82 ± 10.89), (25.72 ± 15.03), and (31.95 ± 16.00) points in the morphine, methylprednisolone, and aminophylline group, respectively. These differences were found to be significantly different (P < 0.05). The effectiveness ratings were 86.44, 62.16, and 49.12%, respectively (P < 0.05).ConclusionsWe found that morphine subcutaneous injection for advanced cancer patients with dyspnea was safe and typically more effective than methylprednisolone or aminophylline. Therefore, morphine treatment could significantly improve the quality of life in terminal cancer patients with short life expectancies who are experiencing shortness of breath.

Pharmacologic Interventions for Breathlessness in Patients With Advanced Cancer

“…A total of 7729 unique citations were identified, of which 18 studies (17 RCTs and 2 retrospective studies) that included a total of 1424 patients assessed the benefits of medications for management of breathlessness in advanced cancer or reported harms 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 (eFigure 2 in the Supplement ). The most commonly reported type of cancer was lung cancer.…”

“…One single-center retrospective cohort study 29 evaluated morphine compared with methylprednisolone or aminophylline. Specifically, methylprednisolone improved breathlessness more than aminophylline (calculated SMD, 0.41; 95% CI, 0.15-0.68), and morphine improved breathlessness more than either of the other agents (morphine vs aminophylline: calculated SMD, 1.18; 95% CI, 0.90-1.46; morphine vs methylprednisolone: calculated SMD, 0.76; 95% CI, 0.49-1.03).…”

“…Specifically, methylprednisolone improved breathlessness more than aminophylline (calculated SMD, 0.41; 95% CI, 0.15-0.68), and morphine improved breathlessness more than either of the other agents (morphine vs aminophylline: calculated SMD, 1.18; 95% CI, 0.90-1.46; morphine vs methylprednisolone: calculated SMD, 0.76; 95% CI, 0.49-1.03). Given only 1 retrospective cohort study, 29 we concluded that evidence was insufficient to evaluate the effectiveness of opioids vs corticosteroids vs bronchodilators for treatment of breathlessness.…”

“…eTable 3 in the Supplement summarizes the physiologic outcomes in 12 studies. 15 , 17 , 18 , 19 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 No study reported any significant effects from any drugs on physiologic outcomes (eFigures 4–13 in the Supplement ).…”

“…Fourteen studies 15 , 16 , 17 , 18 , 19 , 21 , 22 , 25 , 26 , 27 , 29 , 30 , 31 , 33 (12 RCTs 15 , 16 , 17 , 18 , 19 , 21 , 22 , 25 , 26 , 27 , 30 , 31 and 2 retrospective studies 29 , 33 ) addressed the adverse effects and dropout associated with pharmacologic interventions (eTable 4 in the Supplement ). No study reported harms of opioids compared with other opioids or other opioid dosing.…”