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Benzodiazepines for cancer dyspnoea: a nationwide survey of palliative care physicians
  1. Yoshinobu Matsuda1,
  2. Ryo Matsunuma2,
  3. Kozue Suzuki3,
  4. Masanori Mori4,
  5. Hiroaki Watanabe5 and
  6. Takashi Yamaguchi6
  1. 1Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
  2. 2Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  3. 3Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Japan
  4. 4Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
  5. 5Department of Palliative Care, Komaki City Hospital, Komaki, Japan
  6. 6Division of Palliative care, Department of Medicine, Konan Hospital, Kobe, Japan
  1. Correspondence to Dr Yoshinobu Matsuda, Department of Psychosomatic Internal Medicine, Kinki Chuo Chest Medical Center, Sakai 591-8555, Japan; matsuda.yoshinobu.tx{at}


Objectives It is unclear whether patients with non-specific dyspnoea are suitable candidates for studies investigating the effectiveness of benzodiazepines against dyspnoea. The objective of this survey was to investigate suitable subjects for studies of benzodiazepines for cancer dyspnoea.

Methods A nationwide questionnaire survey was conducted among 536 Japanese-certified palliative care physicians. We randomly selected 268 physicians and inquired about their approach to dyspnoea management in patients with cancer, with and without anxiety, as follows: (1) Administration of a benzodiazepine. (2) Administration or titration of an opioid. We also asked them to consider their approach in the following situations: (1) Opioid-naïve. (2) Low-to-moderate baseline opioid dose. (3) High baseline opioid dose. We assessed the use of specific benzodiazepines separately.

Results Overall, 192 physicians responded to the questionnaire (71.6%). For patients without anxiety, the proportion of participants reporting that they frequently or very frequently ‘administer a benzodiazepine’ increased with baseline opioid dose (opioid-naïve: 5.2%, low-to-moderate: 11.5%, high: 26.0%). The proportion of participants reporting that they frequently or very frequently ‘administer or titrate an opioid’ decreased with baseline opioid dose (opioid-naïve: 83.3%, low-to-moderate: 73.4%, high: 41.1%). The pattern was similar for patients with anxiety, although more respondents said they prescribe benzodiazepine for these patients (naïve: 22.4%, low-to-moderate: 34.4%, high: 45.8%) and fewer prescribed an opioid. Alprazolam and lorazepam are frequently used.

Conclusion Patients with anxiety or receiving a high baseline opioid dose could be potential candidates for future studies investigating the effectiveness of benzodiazepines against cancer dyspnoea.

  • benzodiazepine
  • dyspnoea
  • cancer
  • opioid

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  • Correction notice This paper has been corrected since it was first published online. Takashi Yamaguchi's has been updated, so that is is spelt correctly.

  • Contributors YM, RM, KS, MM, HW and TY conceptualised, planned, constructed and conducted the study. YM led the data analysis. YM, RM, KS, MM, HW and TY were involved in data interpretation. YM drafted the manuscript. YM, RM, KS, MM, HW and TY reviewed the manuscript and approved the final version. TY was responsible for the overall content as a guarantor.

  • Funding This study was supported by a Grant-in-Aid for Young Scientists of the Ministry of Education, Culture, Sport, Science and Technology of Japan (18K15389).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institutional review board of Konan Hospital (Kobe, Japan).

  • Provenance and peer review Not commissioned; externally peer reviewed.