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Subcutaneous Morphine for Dyspnea in Cancer Patients
- Eduardo Bruera, MD;
- Tara MacEachern, RN, BScN;
- Carla Ripamonti, MD; and
- John Hanson, MSc
- From Edmonton General Hospital, Edmonton, Alberta, Canada, Cross Cancer Institute, Edmonton, Alberta, Canada, and National Cancer Institute, Milano, Italy. Requests for Reprints: Eduardo Bruera, MD, Edmonton General Hospital, Palliative Care Program, Room 9Y39, 11111 Jasper Avenue, Edmonton, Alberta, T5K 0L4, Canada.
Dyspnea has been defined as an uncomfortable awareness of breathing [1]. It occurs in approximately 29% to 74% of patients with terminal cancer [2, 3] and is perceived as one of the most devastating symptoms by the patient and the family. Controlled single-dose trials have suggested that opioids are effective in the management of dyspnea associated with chronic obstructive lung disease [4]. However, opioids were poorly tolerated in these patients during repeated administration, mostly because of sedation and nausea [5]. These side effects usually disappear with the development of tolerance and are rarely a cause for discontinuing treatment among the approximately 80% of terminal cancer patients who receive opioids for pain [6]. However, the effects of opioids on the dyspnea of cancer have not been the focus of prospective studies.
A previous uncontrolled study by our group suggested that subcutaneous morphine was able to decrease the intensity of dyspnea without statistically modifying oxygen saturation, respiratory rate, …
