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Hydromorphone for dyspnoea in terminally ill patients with cancer: case series
  1. Tatsuma Sakaguchi and
  2. Toru Kajiyama
  1. Department of Palliative Care, Kitano Hospital, Osaka, Japan
  1. Correspondence to Dr Tatsuma Sakaguchi, Department of palliative care, Kitano Hospital, Osaka 530-8480, Japan; sakaguchi.tatsuma{at}


Objective Opioids can mitigate dyspnoea, but the efficacy of hydromorphone use for dyspnoea in patients with cancer is not well known.

Methods Patients with cancers with more than mild dyspnoea treated with subcutaneous injection of hydromorphone between March 2020 and February 2022 at Kitano Hospital (Osaka, Japan) were reviewed retrospectively. Only patients who could self-report their symptoms ≥3 days after the start of hydromorphone therapy were included. Dyspnoea severity was rated on a five-point scale (0: ‘not bothersome'; 1: ‘mild’; 2: ‘moderate’; 3: ‘severe’; 4: ‘overwhelming’).

Results Fifteen patients (2 with moderate, 12 with severe and 1 with overwhelming dyspnoea) were deemed eligible. The median interval from the start of hydromorphone initiation to death was 19 (IQR, 11–37) days. Thoracic drainage and palliative sedation after the start of hydromorphone therapy was undertaken in three and two patients, respectively. At 3 days, the median score of the Dyspnoea Rating Scale was improved significantly from 3 to 2 compared with that at baseline (p=0.0023). The intensity of dyspnoea was improved in 11 patients (73%). Opioid-related adverse events were not observed within 3 days.

Conclusions Using hydromorphone for dyspnoea in patients with cancer seems to be appropriate if morphine use is contraindicated.

  • Cancer
  • Hospice care
  • Quality of life
  • Dyspnoea

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  • Contributors TS and TK contributed equally to the conception and design of the study, collection, analyses and interpretation of data, and drafting of the manuscript. All authors gave final approval of this manuscript for submission and publication, and took accountability for study data.

  • Funding This research was supported by a grant from the Osaka Cancer Society in 2021.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.