Evidence map›Paper›PMID 31792878›Full record

Trial reportSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2020

Oral morphine drops for prompt relief of breathlessness in patients with advanced cancer-a randomized, double blinded, crossover trial of morphine sulfate oral drops vs. morphine hydrochloride drops with ethanol (red morphine drops).

Birgit Aabom, Gunnar Laier, Poul Lunau Christensen, Tine Karlsson, May-Britt Jensen, Birte Hedal

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it, 9 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Observational
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Birgit AabomDepartment of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 13.1, DK-4000, Roskilde, Denmark. bimaa@regionsjaelland.dk.ORCID http://orcid.org/0000-0003-2997-0564
Gunnar LaierDepartment of Data and Innovation, Region Zealand, Alleen 15, DK-4180, Soroe, Denmark.
Poul Lunau ChristensenDepartment of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 13.1, DK-4000, Roskilde, Denmark.
Tine KarlssonDepartment of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 13.1, DK-4000, Roskilde, Denmark.
May-Britt JensenDepartment of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 13.1, DK-4000, Roskilde, Denmark.
Birte HedalHospice Zealand, Tonsbergvej 61, DK-4000, Roskilde, Denmark.
Zealand University Hospital · DKRegion Zealand · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeEpisodic breathlessness is frequent in palliative cancer patients. Opioids are the only pharmacological agents with sufficient evidence in treatment. In Denmark, the main recommendation is red morphine drops (RMD), an off-label solution of morphine, ethanol, and red color (cochenille) described since 1893 (Pharmacopoea Danica). In 2015, the Danish Medicines Agency increased focus on off-label medicines and recommended registered morphine drops without ethanol instead. However, our palliative patients told us that RMD was better. For that reason, we conducted a clinical trial to clarify any perceived difference between the two types of drops.

methodsWe conducted a randomized, double blinded, crossover trial. Patients were asked to perform standardized activity (2-min walk) aiming to provoke breathlessness. Primary endpoint (breathlessness NRS) and secondary endpoints (saturation, pulse, respiratory frequency) were measured before (t = 0) and after test medicine at t = 1, t = 3, t = 5, t = 10, and t = 20 min. After 2-4 days (washout period), the patients repeated the test, receiving the alternative drops in a blinded setup (crossover).

resultsIn the first 3 min, the relative drop in breathlessness for morphine drops with ethanol (RMD) was significant more than for morphine drops without ethanol. We found no significant difference in secondary endpoints.

conclusionsA conclusion could be that ethanol might facilitate morphine absorption in the mouth. Our results needs further research of opioid absorption in the mouth as well as trials, testing morphine vs. more lipophilic opioids. The RMD drops are cheap, easy to use, and noninvasive and keep the patient independent of health care professionals.

Indexed as

Administration, OralAgedAged, 80 and overCross-Over StudiesDouble-Blind MethodDyspneaEthanolFemaleHumansMaleMiddle AgedMorphineNeoplasmsEthanolMorphineAdvanced cancerBreathlessnessOpioids, Randomized crossover trialSublingual administration

Identifiers

PMID31792878
OpenAlexW2993406316

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.