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Yu Y, Zhang P, Chen D, Jiang SF. Knowledge and practice of the management of breakthrough cancer pain among general practitioners providing palliative care in Shanghai, China: a cross-sectional survey. BMJ Open 2023; 13:e073670. [PMID: 37770268 PMCID: PMC10546098 DOI: 10.1136/bmjopen-2023-073670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE This study examined knowledge and practice of breakthrough cancer pain (BTcP) management among general practitioners (GPs) providing palliative care in Shanghai. DESIGN Cross-sectional study using a self-administered questionnaire. SETTING AND PARTICIPANTS A total of 393 GPs providing palliative care in 32 community health service centres in Shanghai were recruited by stratified cluster random sampling between 1 May and 30 June 2022. OUTCOME MEASURES Knowledge and practice concerning BTcP management. RESULTS A total of 375 questionnaires were collected and declared valid. The median knowledge score was 11 out of 21 points. Only 36.3% (n=136) of the participating GPs scored 11 points or more, which was categorised as good knowledge. Only 24.8% (n=93) of the GPs used Davies' adapted diagnostic algorithm as the gold standard for diagnosis. All of the GPs assessed the intensity of BTcP; however, less than a quarter of the GPs evaluated the relationship between background pain and BTcP (22.1%, n=83), the impact of BTcP on activities of daily living (24.0%, n=90), the impact of BTcP on social relationships (14.4%, n=54) and the impact of BTcP on mood (10.1%, n=38). 56.5% (n=212) of the GPs reported that they used pain tools in the assessment of BTcP. All of the GPs prescribed immediate-release morphine as rescue medication for relieving BTcP; however, 60.5% (n=227) prescribed the dose based on their personal experiences, irrespective of the basal opioid dose, and 57.3% (n=215) did not conduct dose titration after providing the initial dose. No GPs reported that they ever administered interventional treatment to their patients. CONCLUSIONS Insufficient knowledge and inappropriate behaviours in BTcP diagnosis, assessment and treatment were identified. There is an urgent need to improve BTcP management among GPs providing palliative care in Shanghai.
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Affiliation(s)
- Ying Yu
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, China
| | - Panpan Zhang
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, China
| | - Danxia Chen
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, China
| | - Sun Fang Jiang
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Health Management Center, Zhongshan Hospital Fudan University, Shanghai, China
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2
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Jing D, Zhao Q, Zhao Y, Lu X, Feng Y, Zhao B, Zhao X. Management of pain in patients with bone metastases. Front Oncol 2023; 13:1156618. [PMID: 37007073 PMCID: PMC10063159 DOI: 10.3389/fonc.2023.1156618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
Cancer-induced bone pain (CIBP) has a considerable impact on patients’ quality of life as well as physical and mental health. At present, patients with CIBP are managed according to the three-step analgesic therapy algorithm proposed by the World Health Organization. Opioids are commonly used as the first-line treatment for moderate-to-severe cancer pain but are limited due to addiction, nausea, vomiting and other gastrointestinal side effects. Moreover, opioids have a limited analgesic effect in some patients. In order to optimize the management of CIBP, we must first identify the underlying mechanisms. In some patients, surgery, or surgery combined with radiotherapy or radiofrequency ablation is the first step in the management of CIBP. Various clinical studies have shown that anti-nerve growth factor (NGF) antibodies, bisphosphonates, or RANKL inhibitors can reduce the incidence and improve the management of cancer pain. Herein, we review the mechanisms of cancer pain and potential therapeutic strategies to provide insights for optimizing the management of CIBP.
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Affiliation(s)
- Doudou Jing
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qian Zhao
- Department of Endocrine, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yibo Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiangdong Lu
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yi Feng
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Bin Zhao, ; Xiaofeng Zhao,
| | - Xiaofeng Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Bin Zhao, ; Xiaofeng Zhao,
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Virgen CG, Kelkar N, Tran A, Rosa CM, Cruz-Topete D, Amatya S, Cornett EM, Urits I, Viswanath O, Kaye AD. Pharmacological management of cancer pain: Novel therapeutics. Biomed Pharmacother 2022; 156:113871. [DOI: 10.1016/j.biopha.2022.113871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 12/24/2022] Open
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Bayesian Network Analysis for Prediction of Unplanned Hospital Readmissions of Cancer Patients with Breakthrough Cancer Pain and Complex Care Needs. Healthcare (Basel) 2022; 10:healthcare10101853. [PMID: 36292299 PMCID: PMC9601725 DOI: 10.3390/healthcare10101853] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Unplanned hospital readmissions (HRAs) are very common in cancer patients. These events can potentially impair the patients’ health-related quality of life and increase cancer care costs. In this study, data-driven prediction models were developed for identifying patients at a higher risk for HRA. Methods: A large dataset on cancer pain and additional data from clinical registries were used for conducting a Bayesian network analysis. A cohort of gastrointestinal cancer patients was selected. Logical and clinical relationships were a priori established to define and associate the considered variables including cancer type, body mass index (BMI), bone metastasis, serum albumin, nutritional support, breakthrough cancer pain (BTcP), and radiotherapy. Results: The best model (Bayesian Information Criterion) demonstrated that, in the investigated setting, unplanned HRAs are directly related to nutritional support (p = 0.05) and radiotherapy. On the contrary, BTcP did not significantly affect HRAs. Nevertheless, the correlation between variables showed that when BMI ≥ 25 kg/m2, the spontaneous BTcP is more predictive for HRAs. Conclusions: Whilst not without limitations, a Bayesian model, combined with a careful selection of clinical variables, can represent a valid strategy for predicting unexpected HRA events in cancer patients. These findings could be useful for calibrating care interventions and implementing processes of resource allocation.
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Light-Induced Activation of a Specific Type-5 Metabotropic Glutamate Receptor Antagonist in the Ventrobasal Thalamus Causes Analgesia in a Mouse Model of Breakthrough Cancer Pain. Int J Mol Sci 2022; 23:ijms23148018. [PMID: 35887364 PMCID: PMC9323585 DOI: 10.3390/ijms23148018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Breakthrough cancer pain (BTcP) refers to a sudden and transient exacerbation of pain, which develops in patients treated with opioid analgesics. Fast-onset analgesia is required for the treatment of BTcP. Light-activated drugs offer a novel potential strategy for the rapid control of pain without the typical adverse effects of systemic analgesic drugs. mGlu5 metabotropic glutamate receptor antagonists display potent analgesic activity, and light-induced activation of one of these compounds (JF-NP-26) in the thalamus was found to induce analgesia in models of inflammatory and neuropathic pain. We used an established mouse model of BTcP based on the injection of cancer cells into the femur, followed, 16 days later, by systemic administration of morphine. BTcP was induced by injection of endothelin-1 (ET-1) into the tumor, 20 min after morphine administration. Mice were implanted with optic fibers delivering light in the visible spectrum (405 nm) in the thalamus or prelimbic cortex to locally activate systemically injected JF-NP-26. Light delivery in the thalamus caused rapid and substantial analgesia, and this effect was specific because light delivery in the prelimbic cortex did not relieve BTcP. This finding lays the groundwork for the use of optopharmacology in the treatment of BTcP.
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Azhar A, Kim YJ, Haider A, Hui D, Balankari VR, Epner MC, Park M, Liu DD, Williams J, Frisbee-Hume SE, Allo JA, Bruera E. Response to Oral Immediate-Release Opioids for Breakthrough Pain in Patients with Advanced Cancer with Adequately Controlled Background Pain. Oncologist 2019; 24:125-131. [PMID: 30254187 PMCID: PMC6324637 DOI: 10.1634/theoncologist.2017-0583] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/31/2018] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Ahsan Azhar
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ali Haider
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vishidha R Balankari
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Margeaux Chiou Epner
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet Williams
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan E Frisbee-Hume
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julio A Allo
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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7
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Liu Q, Gao LL, Dai YL, Wang Y, Wang HX, Luo XJ, Chai XM, Mu GX, Liang XY, Zhang X, Liu J, Yu JQ, Li YX. Breakthrough Pain: A Qualitative Study of Patients with Advanced Cancer in Northwest China. Pain Manag Nurs 2018; 19:506-515. [DOI: 10.1016/j.pmn.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 09/25/2017] [Accepted: 11/06/2017] [Indexed: 10/17/2022]
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8
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Yaeger KA, Rothrock RJ, Kopell BH. Commentary: Neurosurgery and the Ongoing American Opioid Crisis. Neurosurgery 2018; 82:E79-E90. [DOI: 10.1093/neuros/nyx584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/14/2017] [Indexed: 11/12/2022] Open
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Mücke M, Conrad R, Marinova M, Cuhls H, Elsner F, Rolke R, Radbruch L. [Dose-finding for treatment with a transdermal fentanyl patch : Titration with oral transmucosal fentanyl citrate and morphine sulfate]. Schmerz 2017; 30:560-567. [PMID: 27072143 DOI: 10.1007/s00482-016-0106-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To date, no studies investigating titration with oral transmucosal fentanyl for the dose-finding of transdermal fentanyl treatment have been published. In an open randomized study 60 patients with chronic malignant (n = 39) or nonmalignant pain (n = 21), who required opioid therapy according to step three of the guidelines of the World Health Organization (WHO), were investigated. In two groups of 30 patients each titration with immediate release morphine (IRM) or oral transmucosal fentanyl citrate (OTFC) was undertaken. For measurement purposes the Brief Pain Inventory (BPI) and Minimal Documentation System (MIDOS) were used. After a 24-h titration phase, in which patients documented the intensity of pain, nausea, and tiredness, treatment with transdermal fentanyl was evaluated over a 10-day period by means of the necessary dose adaptation (responder ≤ 1 dose adaptation; conversion formula 1:1 [OTFC group] vs 100:1 [IRM group]).The pain reduction over the first 24 h (titration phase) did not differ significantly between the groups. The number of responders (17 OTFC vs. 21 IRM) over the 10-day period did not show any difference either. In both groups there was a significant reduction in pain intensity (p < 0.001). Over the course of the study, there were significantly more drop-outs because of adverse effects in the OTFC group than in the IRM group (8 vs 1, p = 0.028).Oral transmucosal fentanyl citrate can be applied for the titration of transdermal fentanyl, but it does not show any clinically relevant advantage. For example, the risk of side effects-induced drop-outs was greater in the present study. Whether the unnecessary opioid switching to treat chronic pain and breakthrough pain is advantageous with regard to minimizing conversion errors cannot be definitively answered within the scope of this study.
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Affiliation(s)
- M Mücke
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland. .,Institut für Hausarztmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Marinova
- Radiologische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
| | - H Cuhls
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - F Elsner
- Klinik für Palliativmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - R Rolke
- Klinik für Palliativmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - L Radbruch
- Klinik für Palliativmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.,Zentrum für Palliativmedizin, Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Deutschland
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10
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Liu Q, Wang Y, Luo XJ, Wang NJ, Chen P, Jin X, Mu GX, Chai XM, Zhang YJ, Li YX, Yu JQ. A fixed inhaled nitrous oxide/oxygen mixture as an analgesic for adult cancer patients with breakthrough pain: study protocol for a randomized controlled trial. Trials 2017; 18:13. [PMID: 28077162 PMCID: PMC5225628 DOI: 10.1186/s13063-016-1739-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 12/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of breakthrough pain in cancer patients is always a challenge for medical professions. Occurring in 80% of cancer patients with advanced disease, breakthrough pain significantly decreases both patient's and caregiver's quality of life. The aim of this study is to assess the analgesic efficacy of a fixed inhaled nitrous oxide/oxygen mixture for adult cancer patients with breakthrough pain. METHODS/DESIGN This is a randomized, placebo-controlled, double-blind study; it will be conducted in the General Hospital of Ningxia Medical University. The target study subjects are at least 18 years old, and are hospitalized cancer patients who are receiving routine opioids to control cancer-related pain but still experience breakthrough pain. A total of 240 patients will be recruited and randomly allocated between three treatment groups (A, B, C) and a control group (group D) in a ratio of 3:1. All treatment groups (A, B, C) will receive standard pain treatment (oral immediate-release morphine) plus a pre-prepared nitrous oxide/oxygen mixture, and the control group (D) will receive the standard pain treatment plus oxygen. Patients, doctors, nurses, and data collectors are all blind to the experiment. Assessments will be taken before treatment (T0), at 5 min (T1) and 15 min (T2) during treatment, and at 5 min after treatment (T3). The primary endpoint measures will be the percentage of patients whose pain is relieved at T1, T2, and T3. Secondary outcome measures will include the safety of treatment, adverse events, and satisfaction from both health professionals and patients. DISCUSSION This study aims to provide an effective and practical intervention for a fast breakthrough pain relief and to improve cancer patients' quality of life significantly. The Evidence-Based Medicine Working Group claim that a randomized, double-blind, placebo-controlled experimental intervention is the most appropriate design to demonstrate its efficacy, so this study could give a new approach to controlling breakthrough pain episodes. TRIAL REGISTRATION ChiCTR-INC-16008075 . Registered on 8 March 2016.
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Affiliation(s)
- Qiang Liu
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
- Yinchuan Guolong Hospital, 536 Chang Cheng Road, Xing Qing Area, Yinchuan, 750004 China
| | - Yu Wang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Xiang-Jiang Luo
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Ning-Ju Wang
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Ping Chen
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Xin Jin
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
- Department of Nursing, Ningxia People’s Hospital, 301 Zheng Yuan Street, Yinchuan, 750004 China
| | - Guo-Xia Mu
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Xiao-Min Chai
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Yue-Juan Zhang
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Yu-Xiang Li
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Jian-Qiang Yu
- Department of Pharmacology, Pharmaceutical Institute of Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
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Daeninck P, Gagnon B, Gallagher R, Henderson J, Shir Y, Zimmermann C, Lapointe B. Canadian recommendations for the management of breakthrough cancer pain. Curr Oncol 2016; 23:96-108. [PMID: 27122974 PMCID: PMC4835001 DOI: 10.3747/co.23.2865] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Breakthrough cancer pain (btcp) represents an important element in the spectrum of cancer pain management. Because most btcp episodes peak in intensity within a few minutes, speed of medication onset is crucial for proper control. In Canada, several current provincial guidelines for the management of cancer pain include a brief discussion about the treatment of btcp; however, there are no uniform national recommendations for the management of btcp. That lack, accompanied by unequal access to pain medication across the country, contributes to both regional and provincial variability in the management of btcp. Currently, immediate-release oral opioids are the treatment of choice for btcp. This approach might not always offer optimal speed for onset of action and duration to match the rapid nature of an episode of btcp. Novel transmucosal fentanyl formulations might be more appropriate for some types of btcp, but limited access to such drugs hinders their use. In addition, the recognition of btcp and its proper assessment, which are crucial steps toward appropriate treatment selection, remain challenging for many health care professionals. To facilitate appropriate management of btcp, a group of prominent Canadian specialists in palliative care, oncology, and anesthesiology convened to develop a set of recommendations and suggestions to assist Canadian health care providers in the treatment of btcp and the alleviation of the suffering and discomfort experienced by adult cancer patients.
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Affiliation(s)
| | - B. Gagnon
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec City, QC
| | - R. Gallagher
- University of British Columbia, Vancouver, BC, and Division of Palliative Care, Providence Health Care, Toronto, ON
| | - J.D. Henderson
- Colchester East Hants Palliative Care Program, Truro, and Atlantic Palliative Medicine Group and Dalhousie University, Halifax, NS
| | - Y. Shir
- Alan Edwards Pain Management Unit, McGill University, Montreal, QC
| | - C. Zimmermann
- Palliative Services, University Health Network, University of Toronto, Toronto, ON
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Silva BMA, Borges AF, Silva C, Coelho JFJ, Simões S. Mucoadhesive oral films: The potential for unmet needs. Int J Pharm 2015; 494:537-51. [PMID: 26315122 DOI: 10.1016/j.ijpharm.2015.08.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/23/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
Oral drug delivery is the most common route of drug administration. Nevertheless, there are some important limitations that reinforce the need for developing new drug delivery systems. Mucoadhesive oral films (MOF) are promising dosage forms that adhere to the oral mucosa and deliver the drug through it, which present several advantages. These include: bypassing the hepatic first pass effect, fast onset of action, ease of transportation and handling. The use of such dosage form is beneficial for drugs that have poor oral bioavailability and also for drugs that need to be rapidly absorbed. In spite of the known benefits, the number of marketed MOF is still quite small. This review explores the products under development and corresponding clinical trials in respect to their status, therapeutic indication, companies involved and technologies. In this way, it was possible to identify the preferred therapeutic indications, new research and market trends as well as future prospects of MOF. Moreover, it is reasonable to expect an increase in the number of products on the market due to their great potential to satisfy unmet medical needs.
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Affiliation(s)
- Branca M A Silva
- Bluepharma-Indústria Farmacêutica, S.A., São Martinho do Bispo, 3045-016 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal.
| | - Ana Filipa Borges
- Bluepharma-Indústria Farmacêutica, S.A., São Martinho do Bispo, 3045-016 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Cláudia Silva
- Bluepharma-Indústria Farmacêutica, S.A., São Martinho do Bispo, 3045-016 Coimbra, Portugal
| | - Jorge F J Coelho
- CEMUC, Department of Chemical Engineering, University of Coimbra, Polo II, Rua Sílvio Lima, 3030-790 Coimbra, Portugal
| | - Sérgio Simões
- Bluepharma-Indústria Farmacêutica, S.A., São Martinho do Bispo, 3045-016 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
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13
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Sousa AM, Guimaraes GMN, Ashmawi HA. Response to Letter to the Editor: “Safety profile of intravenous patient-controlled analgesia for breakthrough pain in cancer patients: a case series study”. Support Care Cancer 2014; 22:2609. [DOI: 10.1007/s00520-014-2386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
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14
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Hastie BA, Gilson AM, Maurer MA, Cleary JF. An Examination of Global and Regional Opioid Consumption Trends 1980–2011. J Pain Palliat Care Pharmacother 2014; 28:259-75. [DOI: 10.3109/15360288.2014.941132] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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