{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:53:20Z","timestamp":1777935200371,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Health, Labour, and Welfare Sciences Research Grant","award":["19EA1011"],"award-info":[{"award-number":["19EA1011"]}]},{"name":"Health, Labour, and Welfare Sciences Research Grant","award":["22EA1004"],"award-info":[{"award-number":["22EA1004"]}]},{"DOI":"10.13039\/100020685","name":"Japan Hospice Palliative Care Foundation","doi-asserted-by":"crossref","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100020685","id-type":"DOI","asserted-by":"crossref"}]},{"name":"JSPS KAKENHI","award":["JP20K20618"],"award-info":[{"award-number":["JP20K20618"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Terminal dyspnea is a distressing symptom in advanced cancer patients. Although opioids are standard treatment, their effectiveness may differ between opioid-na\u00efve and -tolerant patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate responses to opioid titration for terminal dyspnea and assess differences in palliative care physicians\u2019 perceptions of opioid effectiveness between opioid-na\u00efve and -tolerant patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A pre-planned secondary analysis of a multicenter prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Subjects:<\/jats:title>\n                    <jats:p>\n                      Advanced cancer patients (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 108) with moderate to severe terminal dyspnea and an Eastern Cooperative Oncology Group performance status of 3\u20134, receiving continuous parenteral opioid infusions, were included and categorized as opioid-na\u00efve (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 48) or opioid-tolerant (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 60).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Opioid doses were titrated in four predefined levels within 48 hours, with effectiveness assessed 6 hours post-titration using the Clinician Global Impression-Improvement scale. Opioid ineffectiveness was defined as the need for continuous sedatives or death without dyspnea relief, with doses recorded as the parenteral morphine-equivalent daily dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age was 72 years, and lung cancer was present in 43 patients (40%). Opioid-na\u00efve patients showed a 100% response after 12 titrations, while opioid-tolerant patients exhibited a 68% response after 34 titrations. At death or one month after treatment, opioids were determined to be ineffective in 8.3% of opioid-na\u00efve and 38% of opioid-tolerant patients (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). Median doses at ineffectiveness were 15 mg (IQR = 7.5\u201323) and 36 mg (IQR = 14\u2013200), respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Opioid-tolerant patients showed a lower-level response and were more likely to experience ineffectiveness than opioid-na\u00efve patients. Larger studies are needed to confirm these findings and improve terminal dyspnea management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10966218251400154","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T16:42:36Z","timestamp":1764348156000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Opioid Titration for Terminal Dyspnea in Opioid-Na\u00efve and -Tolerant Patients with Advanced Cancer: A Multicenter Prospective Cohort Study"],"prefix":"10.1177","author":[{"given":"Masanori","family":"Mori","sequence":"first","affiliation":[{"name":"Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, Konan Medical Center, Kobe, 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