Vargas-Bermudez, A., Cardenal, F., & Porta-Sales, J. (2015). Opioids for the management of dyspnea in cancer patients: Evidence of the last 15 years—A systematic review. Journal of Pain and Palliative Care Pharmacotherapy, 29, 341–352. 

DOI Link

Purpose

STUDY PURPOSE: To review the evidence for opioids in the treatment of dyspnea in patients with cancer

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, CINAHL, ScienceDirect, Cochrane Library
 
INCLUSION CRITERIA: Studies in which patients with cancer made up more than 50% of the study sample; clinical studies in which any opioid by any route was administered
 
EXCLUSION CRITERIA: None specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 75
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Risk of Bias assessment; multiple sources of bias were identified in all studies.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 14 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 247
  • SAMPLE RANGE ACROSS STUDIES: 9–70
  • KEY SAMPLE CHARACTERISTICS: Lung and breast cancer were the most common. Other tumor types were included.

Phase of Care and Clinical Applications

PHASE OF CARE: Not specified or not applicable
 
APPLICATIONS: Palliative care

Results

Results per opioid examined were:
  • Morphine was examined in nine studies. All showed positive effects of morphine on dyspnea at rest or exercise, given by oral or subcutaneous routes.
  • Hydromorphone was examined in five studies. Most were nonrandomized studies, and all showed benefit in opioid-naïve and opioid-treated patients.
  • Fentanyl was examined in three studies. Mixed results were reported.
  • No respiratory depression episodes were reported with the use of opioids.

Conclusions

Overall, opioids were seen to be beneficial in reducing dyspnea.

Limitations

  • Limited search
  • Limited number of studies included
  • Low sample sizes

Nursing Implications

This review adds to the body of evidence regarding the efficacy of opioids for the management of dyspnea in patients with cancer. Morphine is the most frequently studied opioid.

Legacy ID

6459