Physician-Perceived Predictive Factors for the Effectiveness of Drugs for Treating Cancer Dyspnea: Results of a Nationwide Survey of Japanese Palliative Care Physicians

Abstract

Background: Dyspnea is a common and distressing symptom in patients with advanced cancer. Opioids, benzodiazepines, and corticosteroids are commonly prescribed pharmacological treatments for cancer dyspnea. Objective: The objective of this survey was to investigate physician-perceived predictive factors for the effectiveness of opioids, benzodiazepines, and corticosteroids in treating cancer dyspnea. Design: This study involves a nationwide survey using self-report questionnaires. Setting/Subjects: Random sampling selected 268 Japanese certified palliative care physicians in Japan. Measurements: We inquired about the 12 physician-perceived predictive factors for the effectiveness of drugs (opioids, benzodiazepines, and corticosteroids) in treating cancer dyspnea. Results: The frequently selected physician-perceived predictive factors for the effectiveness of opioids were tachypnea, respiratory effort, opioid naive, Eastern Cooperative Oncology Group Performance Status 0-2, multiple lung tumors, dry cough, pleural effusion, and pleural lesion. Benzodiazepines were predicted to be effective against dyspnea in patients with depression and severe anxiety. Meanwhile, corticosteroids were predicted to be effective against dyspnea in patients with lymphangitis carcinomatosa, superior vena cava syndrome, major airway obstruction, and audible wheezing. Japanese palliative care physicians anticipate that different drug classes will be effective for treating dyspnea in patients with specific factors. Conclusions: Japanese palliative care physicians expect that different drugs will be effective for dyspnea in patients with specific predictive factors. Future prospective studies are required to assess the effectiveness of each drug class against specific dyspnea.

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

“…There was a trend for opioids to be less effective for dyspnea in patients with a physician prognosis of days. The aforementioned survey among palliative care physicians has also shown that 81% of physicians reported expecting opioids to be effective for the treatment of dyspnea in patients with ECOG PS 0-2 (23). As the disease progresses, the intensity of dyspnea increases, impairing the patient's quality of life (2)(3)(4)(5)(6)(7)25).…”

“…Opioids tended to be more effective for dyspnea in patients with lung cancer with pleural dissemination. In a survey among palliative care physicians to investigate physician-perceived predictive factors for the effectiveness of opioids in the treatment of cancer dyspnea, a high proportion of physician participants reported expecting opioids to be effective for treating dyspnea in patients with pleural lesions ( 23 ). This result is in line with our result.…”