Boyd, K.J., & Kelly, M. (1997). Oral morphine as symptomatic treatment of dyspnoea in patients with advanced cancer. Palliative Medicine, 11, 277–281.

DOI Link

Study Purpose

To assess the effect of regularly administered extended-release morphine for dyspnea in patients receiving standard hospice care

Intervention Characteristics/Basic Study Process

  • Regular administration of extended-release oral morphine 10 mg twice daily or 30% dose increase for those already on morphine
  • Patients received 15 mg twice-daily metoclopramide for the first five days and a laxative.

Sample Characteristics

  • N = 15 (13 completed 48-hour assessment, 9 completed final assessment)
  • MEAN AGE = 73 years
  • MALES: 7, FEMALES: 8
  • KEY DISEASE CHARACTERISTICS: Patients with cancer in hospice; mixed diagnoses—mostly lung primary or lung metastases, but four also had chronic obstructive pulmonary disease; patients with dyspnea from irreversible causes
  • OTHER KEY SAMPLE CHARACTERISTICS: 13 were opioid-naive, and 2 were opioid-tolerant

Setting

  • Eight patients were at home, and seven were hospice inpatients.

Study Design

  • Open, nonrandomized, uncontrolled

Measurement Instruments/Methods

  • Dyspnea visual analog scale (VAS)
  • Support Team Assessment Schedule
  • Borg Scale
  • Respiratory rate
  • Sedation VAS
  • State-Trait Anxiety Inventory
  • Pain (0–10)
  • Assessments at baseline, 48 hours, and 7–10 days

Results

Decline in dyspnea VAS scores for six patients was not statistically significant (p = 0.06). No clinically significant decline was found in respiratory function. No change was seen in anxiety, but actual scores were not reported. The authors stated that the high incidence of sedation and dizziness was of concern and indicated a need to monitor patients carefully. The authors also stated that the use of immediate-release morphine on an as-needed basis might be effective and cause less sedation.

Conclusions

Although the authors claimed that morphine should be trialed in patients, the evidence from this study does not support that. The problem may be the use of modified-release morphine 10 mg opposed to immediate release.

Limitations

  • The study had a small sample size with attrition.
  • Three patients died, and three asked to withdraw because of side effects.
  • Sedation at 48 hours was the main problem.
  • Two patients who withdrew and two who died reported excessive drowsiness.