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- Title
Response to Oral Immediate‐Release Opioids for Breakthrough Pain in Patients with Advanced Cancer with Adequately Controlled Background Pain.
- Authors
Azhar, Ahsan; Kim, Yu Jung; Haider, Ali; Hui, David; Balankari, Vishidha R.; Epner, Margeaux Chiou; Park, Minjeong; Liu, Diane D.; Williams, Janet; Frisbee‐Hume, Susan E.; Allo, Julio A.; Bruera, Eduardo
- Abstract
Background: There is limited evidence about the response of breakthrough pain (BTP) to the most commonly used oral immediate‐release (IR) opioids. Our aim was to determine response rate to oral IR opioids for BTP control in patients with advanced cancer. Materials and Methods: In this prospective study, palliative care outpatients, with advanced cancer and adequately managed background pain, were asked to complete a self‐administered survey. We assessed patients' baseline demographics, pain characteristics, alcoholism (CAGE questionnaire), tobacco and substance abuse, and Edmonton Symptom Assessment Scores (ESAS). We determined the effectiveness of oral IR BTP opioids by using a 7‐point Likert scale ranging from "very ineffective" to "very effective." "Effective" and "very effective" were defined a priori as a good response to IR opioids for BTP. Results: Of 592 evaluable patients, 192 (32%) had background pain of ≤3 (ESAS pain scale 0–10). Among these 192 patients, 152 (79%) reported BTP, 143/152 (94%) took oral IR opioids for BTP, and 127/143 (89%) responded to a median dose of 10% of the total morphine equivalent daily dose. In univariate logistic regression analysis, younger age (odds ratio [OR], 0.94 per year; p =.008), higher ESAS scores for pain (OR, 1.32; p =.012), anxiety (OR, 1.24; p =.017), and dyspnea (OR, 1.31; p =.007) had statistically significant association with poor response to IR opioids for BTP. In multicovariate logistic regression, adjusted for age, a higher ESAS dyspnea score was significantly associated with poor response to oral IR opioids (OR, 1.44; p =.002). Conclusion: The vast majority of patients with advanced cancer with adequately controlled background pain reported a good response to oral IR opioids for BTP, supporting their use in clinical practice. Implications for Practice: Oral immediate‐release opioids are standard treatment for cancer breakthrough pain. However, information regarding treatment response to these commonly used opioids is limited. This study provides information that the vast majority of patients with advanced cancer, with adequately controlled background pain, reported good response to oral immediate release opioids for managing their breakthrough pain episodes. Results of this study support the use of conventional oral immediate release opioids that are relatively inexpensive and readily available for management of breakthrough pain in patients with advanced cancer. This article focuses on the response rate to short‐acting immediate‐release oral opioids for control of breakthrough pain in advanced cancer patients treated by palliative care physicians.
- Subjects
DIAGNOSIS of alcoholism; ANXIETY diagnosis; DIAGNOSIS of dyspnea; THERAPEUTIC use of narcotics; SUBSTANCE abuse diagnosis; CANCER patient psychology; DRUG delivery systems; LONGITUDINAL method; MORPHINE; NARCOTICS; ORAL drug administration; PALLIATIVE treatment; QUESTIONNAIRES; SELF-evaluation; STATISTICS; SURVEYS; TUMOR classification; LOGISTIC regression analysis; MULTIPLE regression analysis; PAIN measurement; TREATMENT effectiveness; BREAKTHROUGH pain; ODDS ratio
- Publication
Oncologist, 2019, Vol 24, Issue 1, p125
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2017-0583