SAN FRANCISCOInhaled fentanyl can relieve the dyspnea that
afflicts 70% of cancer patients and improve oxygen saturation in these
patients. Patrick J. Coyne, RN, MSN, reported that fentanyl, currently used for
breakthrough cancer pain, can be given through usual home health-care services.
"Dyspnea may be the most ignored symptom in cancer
patients," Mr. Coyne told Oncology News International. "It occurs in 70% of cancer
patients, and there is currently no satisfactory treatment. Previous approaches
have included steroids, bronchodilators, and oral morphine. Our data show that
nebulized fentanyl works faster and causes fewer side effects. It is also very
economical, at $0.13 to $0.55 per dose." Mr. Coyne is clinical nurse
specialist in oncology/pain management at Medical College of Virginia Hospitals
in Richmond, Virginia.
Mr. Coyne and colleagues tested nebulized inhaled fentanyl
citrate (25 mg in 2 mL saline) on patient perceptions of dyspnea, respiratory
rate, and oxygen saturation in a convenience sample of 37 cancer patients on a
dedicated oncology unit. The investigators assessed patient perception of
whether breathing stayed the same, worsened, or improved with treatment. They
also measured the effect of inhaled fentanyl on respiratory rate and oxygen
saturation by pulse oximetry at baseline, 5, and 60 minutes.
Mr. Coyne said that the trial was not placebo controlled
because the institutional review board would not approve a placebo-controlled
trial design in this situation.
Twenty-six of 37 (79%) patients in this pilot study reported
improvement in breathing; 3 (9%) were unsure; and 4 (12%) reported no
improvement. Respiratory rates improved from a baseline of 28.4/min to 25.9/min
at 5 minutes and 24.1/min at 60 minutes:
improved from 94.6% at baseline to 96.8% at 5 minutes and 96.7% at 60 minutes.
No side effects were observed.
"Fentanyl citrate nebulizers appear to be safe and
effective in the treatment of dyspnea in individuals with a life-limiting
disease process," Mr. Coyne concluded. "Inhaled nebulized fentanyl
citrate significantly improved patient perception of breathing, respiratory
rate, and oxygen saturation. This inexpensive and readily available treatment
may offer substantial relief of dyspnea. Randomized clinical trials to
determine size and length of effect are ongoing."