Benitez-Rosario, M.A., Rosa-Gonzalez, I., Gonzalez-Davila, E., & Sanz, E. (2018). Fentanyl treatment for end-of-life dyspnoea relief in advanced cancer patients. Supportive Care in Cancer, 27, 157–164.

DOI Link

Study Purpose

The purpose of the study was to assess the effects of subcutaneous or IV fentanyl on dyspnea in patients with advanced cancer.

Intervention Characteristics/Basic Study Process

Subcutaneous or IV fentanyl for breathlessness at rest or with minimal exertion for patients with (a) decline in renal function and escalating doses transdermal fenatanyl/ or other opioid, and (b) alternative to transdermal fentanyl at discharge

Sample Characteristics

  • N = 72    
  • AGE: 50% younger than 75 years old, 21% = 75-80 years old, 29% = 81 or older 
  • MALES: 65%   
  • FEMALES: 35% 
  • CURRENT TREATMENT: Other
  • KEY DISEASE CHARACTERISTICS: Mixed diagnoses 
  • OTHER KEY SAMPLE CHARACTERISTICS: All patients with advanced cancer

Setting

  • SITE: Single site   
  • SETTING TYPE: Inpatient    
  • LOCATION: Spain

Phase of Care and Clinical Applications

PHASE OF CARE: End-of-life care
APPLICATIONS:  Pediatrics, elder care, palliative care

Study Design

Retrospective cohort study

Measurement Instruments/Methods

Breathlessness was measured on a 0-4 scale, other symptoms were measured with ESAS, MMSE/Pfeiffer, and Likert scales

Results

Total percent of responders to fentanyl was 76%. Fentanyl efficacy was not statistically related to age, gender, cancer type, previous opioid treatment, steroid and midazolam doses, and PPS. The median fentanyl dose in responders was 25 mcg/h (interquartile range = 12–70). It was significantly related to age (37 versus 12 mcg/h, for ≤ 75 versus > 75 years, respectively; p = 0.02). There was not a significant difference between fentanyl doses of responders and non-responders. 36, 23, and 15 patients had sustained improvements in dyspnea over 48, 72, and 96 hours. Fentanyl had no significant toxicity.

Conclusions

Subcutaneous and IV fentanyl may be associated with dyspnea relief in patients with advanced cancer. No severe adverse effects were noted.

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Subject withdrawals ≥ 10%
  • Other limitations/explanation: Single center experience

Nursing Implications

Subcutaneous and IV fentanyl may be related to dyspnea at rest relief in patients with advanced cancer. Additional research is need to confirm these results.