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Pardessus Otero A, Rafecas-Codern A, Porcel JM, Serra-Mitjà P, Ferreiro L, Botana-Rial M, Ramos-Hernández C, Brenes JM, Canales L, Camacho V, Romero-Romero B, Trujillo JC, Martinez E, Cases E, Barba A, Majem M, Güell E, Pajares V. Malignant Pleural Effusion: A Multidisciplinary Approach. OPEN RESPIRATORY ARCHIVES 2024; 6:100349. [PMID: 39091982 PMCID: PMC11293617 DOI: 10.1016/j.opresp.2024.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/10/2024] [Indexed: 08/04/2024] Open
Abstract
Malignant pleural effusion (MPE) has become an increasingly prevalent complication in oncological patients, negatively impacting their quality of life and casting a shadow over their prognosis. Owing to the pathophysiological mechanisms involved and the heterogeneous nature of the underlying disease, this entity is both a diagnostic and therapeutic challenge. Advances in the understanding of MPE have led to a shift in the treatment paradigm towards a more personalized approach. This article provides a comprehensive review and update on the pathophysiology of MPE and describes the diagnostic tools and the latest advances in the treatment of this complex clinical entity.
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Affiliation(s)
- Ana Pardessus Otero
- Interventional Pulmonology, Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma Barcelona (UAB), Barcelona, Spain
| | - Albert Rafecas-Codern
- Interventional Pulmonology, Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma Barcelona (UAB), Barcelona, Spain
- Chronic Respiratory Disease Group (GREC), Institut de Recerca Sant Pau (IR SANT PAU), Spain
| | - José M. Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
| | - Pere Serra-Mitjà
- Interventional Pulmonology, Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma Barcelona (UAB), Barcelona, Spain
| | - Lucía Ferreiro
- Pulmonology Department, University Clinical Hospital of Santiago, Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Maribel Botana-Rial
- Broncopleural Unit, Pulmonary Deparment, Hospital Álvaro Cunqueiro, EOXI Vigo, PneumoVigoI+i Research Group, Sanitary Research Institute Galicia Sur (IISGS), Vigo, Spain
- CIBER de Enfermedades Respiratorias, Spain
| | - Cristina Ramos-Hernández
- Pulmonary Deparment, Hospital Álvaro Cunqueiro, EOXI Vigo, PneumoVigoI+i Research Group, Sanitary Research Institute Galicia Sur (IISGS), Vigo, Spain
| | - José Manuel Brenes
- Radiology Department, Hospital Santa Creu i Sant Pau, Universitat Autónoma Barcelona (UAB), Barcelona, Spain
| | - Lydia Canales
- Radiology Department, Hospital Santa Creu i Sant Pau, Universitat Autónoma Barcelona (UAB), Barcelona, Spain
| | - Valle Camacho
- Nuclear Medicine Department, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Juan Carlos Trujillo
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elisabeth Martinez
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Enrique Cases
- Interventional Pulmonology, Hospital Universitario Politécnico La Fe, Valencia, Spain
| | - Andrés Barba
- Medical Oncology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Margarita Majem
- Medical Oncology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Ernest Güell
- Palliative Care Unit, Oncology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
| | - Virginia Pajares
- Interventional Pulmonology, Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma Barcelona (UAB), Barcelona, Spain
- Chronic Respiratory Disease Group (GREC), Institut de Recerca Sant Pau (IR SANT PAU), Spain
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Yamamoto Y, Tanaka S, Matsuura K, Yamamoto S, Urano K, Okita J, Kato E, Odagiri T, Deguchi Y. Effectiveness of opioid switching for dyspnea and its predictors in cancer patients: a single-center retrospective observational study. Jpn J Clin Oncol 2024; 54:549-555. [PMID: 38323655 DOI: 10.1093/jjco/hyae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Morphine is the most used opioid for dyspnea, but other opioids such as oxycodone and fentanyl are increasingly used, and opioid switching to these is sometimes undertaken. No studies have verified the effectiveness of opioid switching for relief of dyspnea. We retrospectively investigated the effectiveness of opioid switching for dyspnea and its predictors. METHODS All patients with opioid switching for dyspnea during hospitalization at Komaki City Hospital from January 2019 to August 2022 were included. Opioid switching was defined as a change to another opioid, and the assessment period for evaluating the effectiveness and adverse events of opioid switching was set as 1 week. Patients with Numeric Rating Scale or Japanese version of the Support Team Assessment Schedule reduction for dyspnea of at least 1, or with clear improvement based on medical records, were considered valid. Mitigating factors for dyspnea were identified using logistic regression analysis. RESULTS Of the 976 patients with opioid switching, 57 patients had opioid switching for relief of dyspnea. Of these, opioid switching was effective in 21 patients (36.8%). In a multivariate analysis, older patients (odds ratio: 5.52, 95% CI: 1.50-20.20, P < 0.01), short prognosis for post-opioid switching (odds ratio: 0.20, 95% CI: 0.04-0.87, P = 0.03) and cachexia (odds ratio: 0.12, 95% CI: 0.02-0.64, P < 0.01) were significantly associated with opioid switching effects for dyspnea. There were no serious adverse events after opioid switching. CONCLUSION This study indicates that opioid switching for dyspnea may have some effect. Furthermore, opioid switching for dyspnea may be more effective in older patients and less effective in terminally ill patients or in those with cachexia.
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Affiliation(s)
| | - Shion Tanaka
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Katsuhiko Matsuura
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Seiji Yamamoto
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Kimihiko Urano
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Junya Okita
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Eisuke Kato
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
- Department of Palliative Care, Seino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Yuko Deguchi
- Departments of Pharmacy, Komaki City Hospital, Komaki, Aichi, Japan
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