1. Morphine Versus Midazolam as Upfront Therapy to Control Dyspnea Perception in Cancer Patients While Its Underlying Cause Is Sought or Treated 
Alfredo H. Navigante, MD, PhD, Monica A. Castro, MD, Leandro C. Cerchietti, MD 
Journal of Pain and Symptom Management 
Volume 39, Issue 5, Pages (May 2010)
DOI: /j.jpainsymman
Copyright © 2010 U.S. Cancer Pain Relief Committee Terms and Conditions

2. Fig. 1
Flowchart of the study design. The protocol was spatially and temporally divided in three parts, including the initial assessment that took place in the ambulatory clinic, where the dyspnea was graded and characterized and specific treatment and tests were ordered; the FTP that took place in a procedure room in the ambulatory clinic, where patients were randomized and treated accordingly; and the FUP that took place as programmed visits to the ambulatory clinic (where the maintenance medication was adjusted and dyspnea graded) and in other places, where additional tests and/or procedures were performed.
Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman )
Copyright © 2010 U.S. Cancer Pain Relief Committee Terms and Conditions

3. Fig. 2
Suspected active contributing factors and patient's dyspnea descriptors. a) Each column represents one patient (n=63), whereas each row indicates one cause (on the left) with its corresponding frequency (on the right). Patients are ordered from left to right in an increasing number of contributing factors presented. The patients presenting one, two, three, or four contributing factors are shown in the bottom as percentages. The specific causes of dyspnea and dyspnea syndromes in the questionnaire included interstitial lung disease (including lymphangitis carcinomatosis), thoracic vessel involvement (pulmonary veno-occlusion and pulmonary embolism), pulmonary metastasis, pleural effusion, pericardial effusion without heart failure, major airway external compression (adenomegaly and tumor mass), chest wall infiltration, lung parenchymal and/or pleural tumor, respiratory muscle weakness, abnormal diaphragm mechanics (cancer cachexia, steroid myopathy, paraneoplastic syndrome, phrenic nerve paralysis, ascites, and hepatomegaly), pneumonitis (radiation and chemotherapy related), pneumonia (microaspiration and permanent tracheoesophageal fistula), anemia, metabolic acidosis, and others. b) Patients' dyspnea descriptors (n=63). The number of patients (and percentages) is shown for each descriptor.
Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman )
Copyright © 2010 U.S. Cancer Pain Relief Committee Terms and Conditions

4. Fig. 3
Patients who received additional tests and/or procedures. Each pie represents the total number of patients evaluated over the five days of the protocol, whereas the dotted portion represents the number of patients who received additional tests or procedures to control their dyspnea in each group. The number of tests and procedures is listed for each group. More than one test or procedure per patient were prescribed.
Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman )
Copyright © 2010 U.S. Cancer Pain Relief Committee Terms and Conditions

5. Fig. 4
Flowchart of the FTP. Patients were randomized in two groups (morphine and midazolam). Individualized doses were determined for each patient in the trial. The number of patients in each dosing step represents the patients whose dyspnea was alleviated 50% or more. One patient from each group withdrew their consent to continue with the protocol because they were unable or unwilling to comply with the programmed follow-up visits.
Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman )
Copyright © 2010 U.S. Cancer Pain Relief Committee Terms and Conditions

6. Fig. 5
Dyspnea control (intensity and breakthrough episodes) during the FUP. a) Each box plot represents the central tendency and variability of the data over the days (x axes) for morphine (gray) and midazolam (crosshatched). The box encloses the middle half of the data and is bisected by a line representing the median. The vertical whiskers indicate the range of typical values. Possible outliers are displayed as asterisks. The P-values immediately over each box represent the comparison with the previous day value (pre-post intragroup comparison). The P-values representing the intergroup comparison (morphine vs. midazolam) are shown on the top. Statistically significant values are shown in bold. b) The high of each column represents the total number of patients evaluated over the days (x axes), whereas the colored part represents the number of patients with one or more episodes of BD (in gray for morphine and in crosshatch for midazolam). The line indicates approximately the 50% zone for both groups. The P-values immediately over each column represent the comparison with the previous day percentage (pre-post intragroup comparison). The P-values representing the intergroup comparison (morphine vs. midazolam) are shown on the top. Statistically significant values are shown in bold. c) Numbers of episodes of BD for each group per day. The circle represents the mean, whereas the length of the bars represents the 95% CI.
Journal of Pain and Symptom Management  , DOI: ( /j.jpainsymman )
Copyright © 2010 U.S. Cancer Pain Relief Committee Terms and Conditions