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Guitart-Vela J, Magrone Á, González G, Folch J. Effectiveness and Safety of Sublingual Fentanyl in the Treatment of Breakthrough Cancer Pain in Older Patients with Cancer: Results from a Retrospective Observational Study. J Pain Palliat Care Pharmacother 2024:1-12. [PMID: 39115710 DOI: 10.1080/15360288.2024.2385680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 06/03/2024] [Accepted: 07/20/2024] [Indexed: 08/10/2024]
Abstract
The study assessed sublingual fentanyl citrate (SFC) effectiveness and safety for breakthrough cancer pain (BtCP) in older patients. A multicenter, retrospective, observational study was conducted in three subgroups of cancer patients aged over 65 years with BtCP. The reports were collected by 20 oncologists across 12 hospitals. The primary goal was to measure changes in BtCP intensity with SFC treatment over 30 days; secondary objectives included pain relief onset and adverse events. A total of 127 patients with long-term cancer (mean: 3.3 years) were recruited. All of them had BtCP, mostly of mixed origin (62.5%). A significantly lower dose was needed in the high-age group at the final visit compared to baseline (212.90 ± 200.45 mcg vs. 206 ± 167.08 mcg; p = 0.000). Pain intensities at the beginning of the flare and at 30 min after SFC administration were significantly lower when the last and first visits were compared (1.9 vs. 2.3, p = 0.000; and 6.2 vs. 6.8 p = 0.006, respectively). The onset of analgesia was significantly more rapid for half of the patients ≥75 years, compared with 65-69 and 70-74 age groups. SFC appears then to be effective, well-tolerated, and safe to treat BtCP in older cancer patients.
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Affiliation(s)
| | | | | | - Jordi Folch
- Servicio de Patología del Dolor, Hospital Plató, Barcelona, Spain
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Guitart J, Vargas MI, De Sanctis V, Folch J, Salazar R, Fuentes J, Coma J, Ferreras J, Moya J, Tomás A, Estivill P, Rodelas F, Jiménez AJ, Sanz A. Effects of Age Among Elderly Cancer Patients on Breakthrough Pain Management with Sublingual Fentanyl Tablets. Drugs R D 2019; 19:247-254. [PMID: 31177479 PMCID: PMC6738361 DOI: 10.1007/s40268-019-0276-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Sublingual fentanyl tablets (SFTs) have been shown to be a safe and effective option in controlling breakthrough cancer pain (BTcP). However, further examination is required to investigate the use of SFTs among the elderly. The aim of this study was to examine the influence of age in BTcP management with SFTs in the elderly population. Methods We performed subgroup analyses of a recently completed trial in two subsets of individuals: patients aged 65–74 years (low age group) and patients ≥ 75 years (high age group). Pain intensity (PI), onset of pain relief, frequency and duration of BTcP episodes, and adverse events (AEs) were assessed at 3, 7, 15, and 30 days. Health status instruments used were the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) and the Short Form 12, version 2 (SF-12v2) questionnaire. Results Levels of PI at the end of the study improved significantly as compared with baseline in both the low and the high age groups (30.0% and 27.7% reduction, respectively). The onset of analgesia at the end of the study began in < 10 min in 85.0% of young–old subjects and in 62.5% of patients ≥ 75 years, but no significant differences were found. BTcP episodes lasted < 15 min in 75.0% of patients in the low age group and 58.3% in the high age group (p = 0.24). Most of patients in both groups experienced one to five BTcP daily episodes, at all assessment points. HADS-D decreased from 10.78 (± 4.33) to 8.21 (± 3.57) in the low age group, and from 10.96 (± 4.26) to 9.36 (± 3.35) in the high age group (p = 0.02). Significant differences in HADS-A scores from baseline to the end of the study were also observed in both subgroups (p < 0.05). Patients in the low age group had less favorable mental component summary (MCS) and physical component summary (PCS) scores than patients in the high age group. At the end of the study, 10.0% of young–old patients and 29.2% of patients aged ≥ 75 years reported AEs related to their treatment. The most commonly reported AEs included nausea, vomiting, constipation, somnolence, and skin disorders and they were generally mild to moderate in severity. Conclusions The results of this study showed that SFTs provided safe and clinically meaningful pain relief in both elderly subgroups. Clinical implications of these findings await validation in large, confirmatory studies to identify age subgroup divergences among elderly cancer patients treated with SFTs.
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Affiliation(s)
- Jordi Guitart
- Department of Anesthesiology, Hospital Plató, C/Plató 21, 08006, Barcelona, Spain.
| | - María Isabel Vargas
- Department of Anesthesiology, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Vicente De Sanctis
- Pain Unit, Department of Anesthesiology, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Jordi Folch
- Department of Anesthesiology, Hospital Plató, C/Plató 21, 08006, Barcelona, Spain
| | - Rafael Salazar
- Department of Anesthesiology, Hospital Comarcal d'Inca, Palma de Mallorca, Spain
| | - José Fuentes
- Department of Anesthesiology, Pius Hospital de Valls, Tarragona, Spain
| | - Joan Coma
- Department of Anesthesiology, Hospital General de l'Hospitalet, Barcelona, Spain
| | - Julia Ferreras
- Pain Unit, Department of Anesthesiology, Hospital Residència Sant Camil, Barcelona, Spain
| | - Jordi Moya
- Pain Unit, Department of Anesthesiology, Hospital Mateu Orfila, Minorca, Spain
| | - Albert Tomás
- Pain Unit, Department of Anesthesiology, Fundació Hospital Sant Bernabé, Barcelona, Spain
| | - Pere Estivill
- Department of Anesthesiology, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Francisco Rodelas
- Department of Anesthesiology, Hospital Comarcal d'Inca, Palma de Mallorca, Spain
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Cheville AL, Mustian K, Winters-Stone K, Zucker DS, Gamble GL, Alfano CM. Cancer Rehabilitation. Phys Med Rehabil Clin N Am 2017; 28:1-17. [DOI: 10.1016/j.pmr.2016.08.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Alfano CM, Cheville AL, Mustian K. Developing High-Quality Cancer Rehabilitation Programs: A Timely Need. Am Soc Clin Oncol Educ Book 2017; 35:241-9. [PMID: 27249704 DOI: 10.1200/edbk_156164] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The number of survivors of cancer in the United States, already 14.5 million, is growing with improved cancer treatment and aging of the population. Two-thirds of cancer survivors will be older than age 65 and are likely to enter cancer treatment already deconditioned and with multiple comorbidities. Survivors of cancer face numerous adverse consequences of cancer treatment that add to or exacerbate the effects of existing comorbidities and increase risk of functional decline. Many of these problems are amenable to rehabilitation interventions, but referral to cancer rehabilitation professionals is not a standard part of care. We present an expanded prospective model of surveillance, cancer rehabilitation assessment, and referral efforts using a multidisciplinary team approach. In this model, cancer rehabilitation begins at the time of cancer diagnosis and continues through and beyond cancer treatment. Physical impairments and psychosocial symptoms are assessed and treated, and lifestyle and exercise interventions are provided to optimize functioning, health, and quality of life. We present a stepped-care framework to guide decisions on when, how, and where to refer survivors to cancer rehabilitation specialists depending on safety requirements and needs. This model has the potential to result in early identification of symptoms and impairments, appropriate referral and timely treatment, and, in turn, will better address and minimize both acute and long-term cancer morbidity.
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Affiliation(s)
- Catherine M Alfano
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Andrea L Cheville
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
| | - Karen Mustian
- From American Cancer Society, Washington, DC; Department of Physical Medicine and Rehabilitation, Program to Enhance Care Experiences Through Research, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
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Abstract
Evidence of the benefits of exercise for people with cancer from diagnosis through survivorship is growing. However, most cancers occur in older adults and little exercise advice is available for making specific recommendations for older adults with cancer. Individualized exercise prescriptions are safe, feasible, and beneficial for the geriatric oncology population. Oncology providers must be equipped to discuss the short- and long-term benefits of exercise and assist older patients in obtaining appropriate exercise prescriptions. This review provides detailed information about professionals and their roles as it relates to functional assessment, intervention, and evaluation of the geriatric oncology population. This review addresses the importance of functional status assessment and appropriate referrals to other oncology professionals.
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Affiliation(s)
| | - Ashley Leak Bryant
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen M Mustian
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
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Christian A, Hudson SV, Miller SM, Bator A, Ohman-Strickland PA, Somer RA, Ferrante J. Perceptions of Primary Care Among Breast Cancer Survivors: The Effects of Weight Status. Health Serv Res Manag Epidemiol 2015; 2. [PMID: 26120589 PMCID: PMC4480862 DOI: 10.1177/2333392815587487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Obese breast cancer survivors (BCSs) are impacted by diminished quality of life (QOL), multiple comorbid conditions, and poor disease outcomes. Despite national guidelines recommending a healthy weight to improve QOL and outcomes posttreatment, support and education are not routinely provided to BCSs in primary care. To fill this gap, we assessed perceptions of primary care received among BCSs by weight status. Methods: Cross-sectional surveys were administered to early-stage BCSs (N = 188) from 2 New Jersey cancer centers between May 2012 and July 2013. Sociodemographics, medical history, functional health status, perceived satisfaction with one’s primary care provider (PCP), and PCP involvement in follow-up care were assessed. Results: In total, 82% of overweight BCSs and 30% of obese BCSs reported not being told by their doctor that they were overweight or obese, despite these conditions being highly prevalent (35% and 35%, respectively). Obese BCSs were more likely than healthy weight BCSs to be African American, have a higher comorbidity score, poorer functional health, and greater satisfaction with their PCPs. Conclusion: The PCP–patient encounter may represent an opportunity for PCPs to correct misperceptions and promote weight reduction efforts among BCSs, thus improving QOL and disease outcomes.
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Affiliation(s)
- Allison Christian
- Department of Health Education & Behavioral Science, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Shawna V Hudson
- Department of Health Education & Behavioral Science, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ ; Department of Family Medicine & Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, NJ
| | - Suzanne M Miller
- Psychosocial and Behavioral Medicine Program/Cancer Prevention and Control Program, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA
| | - Alicja Bator
- Department of Family Medicine & Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, NJ
| | - Pamela A Ohman-Strickland
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ ; Department of Family Medicine & Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, NJ ; Department of Biostatistics, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ
| | - Robert A Somer
- Division of Hematology and Medical Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ ; Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ
| | - Jeanne Ferrante
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ ; Department of Family Medicine & Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, NJ
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Bellury LM, Ellington L, Beck SL, Stein K, Pett M, Clark J. Elderly cancer survivorship: an integrative review and conceptual framework. Eur J Oncol Nurs 2011; 15:233-42. [PMID: 21530396 DOI: 10.1016/j.ejon.2011.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 03/22/2011] [Accepted: 03/25/2011] [Indexed: 12/27/2022]
Abstract
UNLABELLED The intersection of ageing and cancer in the phase of post-treatment survivorship represents a large and growing population with unique needs. PURPOSE The goal of this work is to review and integrate the current gerontology and oncology literature relevant to elderly cancer survivorship, to identify knowledge gaps and research opportunities and to propose a conceptual model to guide future research. The long-term, global goal is the prevention of morbidity and mortality in elderly cancer survivors by identification of vulnerable elders, maintenance of independence, tailoring of treatment, establishing intervention guidelines and planning for necessary resources within the entire trajectory of cancer survival for older survivors. METHODS Targeted and integrative review of selected literature from multiple disciplines. Search engines included PubMed, article reference lists and internet searches for epidemiological data (US Census, World Health Organization, American Cancer Society, Canadian Cancer Cancer Society, etc). RESULTS A conceptual model that incorporates the gerontologic, oncologic and personal characteristics of older cancer survivors is proposed that may provide a comprehensive approach by which to frame elderly survivorship research. CONCLUSION Cancer survivorship among the elderly is quantitatively and qualitatively different from cancer survivorship among other age groups. The current large numbers and predicted increase in elderly cancer survivors in the near future mandate attention to this population. Future research must consider the complexity of intersecting needs in the gero-oncology population.
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Mustian KM, Peppone LJ, Palesh OG, Janelsins MC, Mohile SG, Purnell JQ, Darling TV. Exercise and Cancer-related Fatigue. US ONCOLOGY 2009; 5:20-23. [PMID: 21853012 PMCID: PMC3156559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cancer-related fatigue is the most common side effect reported by cancer patients during and after treatment. Cancer-related fatigue significantly interferes with a patient's ability to perform activities of daily living and maintain functional independence and quality of life. Cancer-related fatigue can also interfere with a patient's ability to complete treatments. The purpose of this article is to provide an overview of cancer-related fatigue, its pathopsychophysiology, and the role of exercise in the management of this side effect.
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Affiliation(s)
- Karen M Mustian
- Assistant Professors, James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
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