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Yamada M, Uchida M, Hada M, Wakabayashi H, Inma D, Ariyoshi S, Kamimura H, Haraguchi T. Pharmacists' Behavioral Changes after Attending a Multi-Prefectural Palliative Care Education Program. PHARMACY 2024; 12:87. [PMID: 38921963 PMCID: PMC11207959 DOI: 10.3390/pharmacy12030087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
Central to the pharmacist's role in palliative care is symptom management through direct participation in patient care and the provision of optimal pharmacotherapy to support patient outcomes. Consequently, palliative care requires extensive knowledge and action for patients with cancer. Therefore, this study aimed to evaluate how pharmacists' behavior changed after attending a palliative care educational program. We conducted a web-based questionnaire survey examining the behavior of pharmacists regarding palliative care before participating in the program, two months after participating in the program, and eight months after participating in the program to determine their behavior and changes over time. For all questions, scores were higher at two and eight months after attending the program than before attending the program (p < 0.05). In addition, no significant difference was observed between two and eight months after attending the program for any question (p = 0.504-1.000). The knowledge gained from the educational program was used to repeatedly intervene with patients with cancer in order to address the various symptoms they experienced and maintain their behavior. The proven effectiveness of this program serves as a stepping stone for nationwide rollout across Japan's 47 prefectures.
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Affiliation(s)
- Masahiro Yamada
- Department of Pharmacy, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita, Kitakyushu 802-0077, Japan;
| | - Mayako Uchida
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women’s College of Liberal Arts, Kyotanabe 610-0395, Japan;
| | - Masao Hada
- Department of Pharmacy, Japan Community Health care Organization Nankai Medical Center, 7-8, Tokiwanishimachi, Saiki 876-0857, Japan;
| | - Haruka Wakabayashi
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women’s College of Liberal Arts, Kyotanabe 610-0395, Japan;
| | - Daigo Inma
- A Public Interest Incorporated Foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata, Fukuoka 812-0018, Japan; (D.I.); (S.A.); (H.K.); (T.H.)
| | - Shunji Ariyoshi
- A Public Interest Incorporated Foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata, Fukuoka 812-0018, Japan; (D.I.); (S.A.); (H.K.); (T.H.)
| | - Hidetoshi Kamimura
- A Public Interest Incorporated Foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata, Fukuoka 812-0018, Japan; (D.I.); (S.A.); (H.K.); (T.H.)
- Department of Pharmacy, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan, Fukuoka 814-0180, Japan
| | - Tohru Haraguchi
- A Public Interest Incorporated Foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata, Fukuoka 812-0018, Japan; (D.I.); (S.A.); (H.K.); (T.H.)
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Hasegawa-Moriyama M, Morioka Y, Hiroi S, Naya N, Suzuki Y, Koretaka Y, Hara E, Abe H, Uchida K, Sumitani M. High prevalence of severe pain is associated with low opioid availability in patients with advanced cancer: Combined database study and nationwide questionnaire survey in Japan. Neuropsychopharmacol Rep 2024. [PMID: 38735866 DOI: 10.1002/npr2.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/14/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVES Opioid availability for the palliative care of patients with advanced cancer is increasing globally. However, opioid availability remains extremely low in Japan. We investigated whether pain is appropriately controlled by low-dose opioid prescriptions in patients with advanced cancer in Japan. METHODS A web-based nationwide survey for caregivers from 2000 community comprehensive support care centers was performed in Japan to assess details about pain in the 30 days before patients died of end-stage cancer. Separately, the data for opioid prescription doses and medical services in the 90 days before the death of patients with cancer were extracted from a health insurance claim database. RESULTS Responses from 1034 responders were retrieved and 665 patients were included. In total, 254 patients (38.2%) complained of severe-to-intolerable cancer-related pain. The median cumulative prescription dose of opioids in the 90 days before patient death was 311.0 mg by oral morphine equivalent doses. Multiple regression analyses across prefectures revealed that the proportion of patients with severe-to-intolerable cancer-related pain was negatively associated with the cumulative opioid consumption expressed as morphine-equivalent doses within 90 days before death. CONCLUSIONS The very low availability of opioids for patients with end-stage cancer could result in high rate of severe-to-intolerable cancer-related pain patients. There were several limitations in this study, and the interpretations of the findings should be carefully. However, the increase in the absolute dose of opioids could improve the palliative care framework to the pain control levels of the global standard.
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Affiliation(s)
- Maiko Hasegawa-Moriyama
- Department of Pain and Palliative Medical Sciences, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shinzo Hiroi
- Medical Affairs Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Noriyuki Naya
- Medical Affairs Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Yura Suzuki
- Data Science Department, Shionogi & Co., Ltd., Osaka, Japan
| | | | - Erina Hara
- Department of Anesthesiology and Pain Relief, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroaki Abe
- Department of Pain and Palliative Medicines, The University of Tokyo Hospital, Tokyo, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicines, The University of Tokyo Hospital, Tokyo, Japan
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Abdel Shaheed C, Hayes C, Maher CG, Ballantyne JC, Underwood M, McLachlan AJ, Martin JH, Narayan SW, Sidhom MA. Opioid analgesics for nociceptive cancer pain: A comprehensive review. CA Cancer J Clin 2024; 74:286-313. [PMID: 38108561 DOI: 10.3322/caac.21823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 12/19/2023] Open
Abstract
Pain is one of the most burdensome symptoms in people with cancer, and opioid analgesics are considered the mainstay of cancer pain management. For this review, the authors evaluated the efficacy and toxicities of opioid analgesics compared with placebo, other opioids, nonopioid analgesics, and nonpharmacologic treatments for background cancer pain (continuous and relatively constant pain present at rest), and breakthrough cancer pain (transient exacerbation of pain despite stable and adequately controlled background pain). They found a paucity of placebo-controlled trials for background cancer pain, although tapentadol or codeine may be more efficacious than placebo (moderate-certainty to low-certainty evidence). Nonsteroidal anti-inflammatory drugs including aspirin, piroxicam, diclofenac, ketorolac, and the antidepressant medicine imipramine, may be at least as efficacious as opioids for moderate-to-severe background cancer pain. For breakthrough cancer pain, oral transmucosal, buccal, sublingual, or intranasal fentanyl preparations were identified as more efficacious than placebo but were more commonly associated with toxicities, including constipation and nausea. Despite being recommended worldwide for the treatment of cancer pain, morphine was generally not superior to other opioids, nor did it have a more favorable toxicity profile. The interpretation of study results, however, was complicated by the heterogeneity in the study populations evaluated. Given the limited quality and quantity of research, there is a need to reappraise the clinical utility of opioids in people with cancer pain, particularly those who are not at the end of life, and to further explore the effects of opioids on immune system function and quality of life in these individuals.
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Affiliation(s)
- Christina Abdel Shaheed
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Christopher Hayes
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Christopher G Maher
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Jane C Ballantyne
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- University Hospitals of Coventry and Warwickshire, Coventry, United Kingdom
| | - Andrew J McLachlan
- Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer H Martin
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sujita W Narayan
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia
| | - Mark A Sidhom
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Mütherig A, Scheffler G, Schuler US. [Pharmacological pain management in cancer patients]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:497-506. [PMID: 38597946 DOI: 10.1007/s00120-024-02347-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Pharmacological pain therapy in cancer patients is based on guideline recommendations, which, however, do not fully coincide in all aspects due to varying weighting of evidence. The present article discusses current issues including the decreasing significance of the World Health Organization (WHO) analgesic ladder, with its distinction between step 2 and 3 being increasingly questioned. Risks of nonopioid analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in older populations, are discussed. Paracetamol may potentially reduce the effectiveness of immunotherapies. Aspects of administering analgesics via a feeding tube are considered. Recommendations for the treatment of episodic pain, transitioning between different opioids, and some relevant interactions are also discussed.
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Affiliation(s)
- Anke Mütherig
- Palliativ-Zentrum, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Gesine Scheffler
- Klinik-Apotheke, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Ulrich S Schuler
- Palliativ-Zentrum, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Aguiar-Rosas S, Plancarte-Sanchez R, Hernandez-Porras BC, García-Andreu J, Lezcano-Velazquez BO, Reyes-Torres I, Alarcón-Barrios S. Pain management in cervical cancer. Front Oncol 2024; 14:1371779. [PMID: 38725634 PMCID: PMC11079655 DOI: 10.3389/fonc.2024.1371779] [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: 01/17/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Abstract
Cervical cancer (CC) occupies the second place in incidence and mortality among women in México. Despite this, Cervical Cancer continues to have a late diagnosis which leads to a high rate of complications. Pain represents the most feared and disabling symptom, being present in up to 86% of patients with advanced disease. The approach to managing pain in this population has not been studied and described to a full extent. In addition, there is a pressing need to provide concise recommendations to promote adequate pain control. We performed a review of the literature in CC and had experts in the field of pain management evaluate the evidence found. We then issued relevant recommendations on pharmacology and interventional pain management. Thus, the approach to pain management must be comprehensive and individualized, considering the timely and appropriate use of pharmacologic treatment as well as interventional procedures.
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Affiliation(s)
- Sebastián Aguiar-Rosas
- Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
- Independent Researcher, Mexico City, Mexico
| | - Ricardo Plancarte-Sanchez
- Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
- Independent Researcher, Mexico City, Mexico
| | | | - Jorge García-Andreu
- Star Medica Hospital, Queretaro, Mexico
- Independent Researcher, Queretaro, Mexico
| | | | | | - Silvia Alarcón-Barrios
- Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
- Independent Researcher, Mexico City, Mexico
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Yamamoto Y, Yamamoto S, Tsuge T, Urano K, Matsuura K. Analysis of Nausea and Vomiting Frequency Following Opioid Dose Escalation and Its Risk Factors: A Single-Center Retrospective Observational Study. J Palliat Med 2024; 27:301-306. [PMID: 37733255 DOI: 10.1089/jpm.2023.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Background and Objective: Opioid-induced nausea and vomiting (OINV) is known to develop not only upon opioid introduction but also during opioid dose escalation, but the actual details are unclear. The aim of this study was to investigate the frequency of OINV in opioid dose escalation at a single center and to identify risk factors. Methods: A retrospective analysis of the medical records of hospitalized patients with cancer who underwent increased intake of oral oxycodone extended-release tablets at Komaki City Hospital between January 2016 and December 2019 was performed. Associations between the incidence of OINV and multiple factors were analyzed, including patient demographics, opioid daily dose, comorbidities, history of nausea after opioid introduction, and prophylactic antiemetic drugs. Results: Of the 132 patients analyzed, 56 (42.4%; grades 1 and 2, 36 and 20, respectively) developed opioid-induced nausea after opioid dose escalation, 26 (19.7%; grades 1 and 2, 19 and 7, respectively) developed opioid-induced vomiting, 58 (43.9%) had either opioid-induced nausea or vomiting. Thirty-five of 60 patients (55.0%) developed OINV among those who received prophylactic antiemetic drugs at opioid dose escalation. Performance status (≥2) (odds ratio [OR]: 2.36, 95% confidence interval [95% CI]: 1.15-4.84, p = 0.02) and history of nausea for opioid introduction (OR: 2.92, 95% CI: 1.20-7.10, p = 0.02) were detected as risk factors for the development of OINV. Conclusion: This study revealed a high incidence of OINV during opioid dose escalation, indicating that careful monitoring is required as at the time of opioid introduction. Further validation by a prospective study is required.
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Affiliation(s)
| | - Seiji Yamamoto
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Taiga Tsuge
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
- Department of Pharmacy, Ena Hospital, Ena, Gifu, Japan
| | - Kimihiko Urano
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Katsuhiko Matsuura
- Department of Pharmaceutical Health Care and Science, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
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Kessoku T, Higashibata T, Morioka Y, Naya N, Koretaka Y, Ichikawa Y, Hisanaga T, Nakajima A. Naldemedine and Magnesium Oxide as First-Line Medications for Opioid-Induced Constipation: A Comparative Database Study in Japanese Patients With Cancer Pain. Cureus 2024; 16:e55925. [PMID: 38601408 PMCID: PMC11004843 DOI: 10.7759/cureus.55925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Naldemedine and magnesium oxide are common first-line early laxative medications used in the real-world scenario in Japan, for patients with cancer pain who receive opioid prescriptions, as per a nationwide hospital claims database study. However, the real-world prescription patterns and associated outcomes are unknown. Methods In this retrospective, cohort study using the Medical Data Vision (MDV) database (January 2018 to December 2020), data were collected from eligible patients (who had a long-term prescription of strong opioids, for >30 days) in Japan with naldemedine or magnesium oxide as the first-line laxative prescription, for a long-term opioid prescription for cancer pain with ≥6 months post-opioid observation period. A laxative prescription within three days after the opioid prescription date was termed an "early" prescription. The composite incidence of dose increase or addition/change of laxatives at three months after the start of the opioid prescription was the primary endpoint after adjusting baseline characteristics between the treatment arms by propensity score matching. Results After propensity score matching, 1717 and 544 patients who were prescribed naldemedine and magnesium oxide each were included in the early prescription and non-early prescription groups, respectively. Even after matching, the incidence of death was not adjusted enough and was significantly higher in the naldemedine arm than in the magnesium oxide arm in the non-early group but comparable in the early group. The incidence of addition, change, or dose increase was significantly higher in the naldemedine arm than in the magnesium oxide arm of the early prescription group (hazard ratio (95% confidence interval), 1.08 (1.00, 1.17); p=0.0402); the incidence was comparable between the arms of the non-early group. Conclusion These findings may provide valuable insights into real-world clinical treatment patterns and preliminary evidence for the selection of first-line medications to mitigate opioid-induced constipation in Japanese patients with cancer pain.
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Affiliation(s)
- Takaomi Kessoku
- Department of Palliative Medicine, International University of Health and Welfare Narita Hospital, Narita, JPN
- Department of Gastroenterology, International University of Health and Welfare School of Medicine, Narita, JPN
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, JPN
| | - Takahiro Higashibata
- Department of Palliative and Supportive Care, University of Tsukuba Hospital, Tsukuba, JPN
| | | | - Noriyuki Naya
- Department of Medical Affairs, Shionogi & Co. Ltd., Osaka, JPN
| | | | - Yasushi Ichikawa
- Department of Oncology, Yokohama City University School of Medicine, Yokohama, JPN
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, JPN
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, JPN
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Mitsuboshi S, Imai S, Kizaki H, Hori S. Comparison of different sustained-release opioids and acute respiratory conditions in patients with cancer and chronic kidney disease. Pharmacotherapy 2024; 44:122-130. [PMID: 37943163 DOI: 10.1002/phar.2892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STUDY OBJECTIVE Few data are available on the association between the use of oxycodone in patients with chronic kidney disease (CKD) and acute respiratory conditions. The aim of this study was to investigate whether oxycodone is associated with an increased risk of acute respiratory conditions in patients with cancer and CKD compared with other opioids. DESIGN AND SETTING The data were obtained from a claims database in Japan. Patients with cancer and CKD who had received sustained-release opioids, including oral oxycodone, oral morphine, or transdermal fentanyl, between April 2014 and May 2021 were selected. The primary outcome was defined as an acute respiratory condition. Data for age and sex, morphine equivalent daily dose, concomitant use of specified medications, comorbidities defined based on the modified Charlson comorbidity index, substance use disorder, and lung cancer or metastatic lung cancer were investigated as covariates. Distribution of acute respiratory conditions was compared among the three sustained-release opioid groups using the log-rank test. Estimates of the incidence of acute respiratory conditions were compared among the groups using a Cox proportional hazards model with time-varying variables. MAIN RESULTS A significant difference in the distribution of acute respiratory conditions was found among the three groups (p < 0.01). Cox regression analysis showed a significantly higher risk of acute respiratory conditions with morphine (hazard ratio [HR]: 3.04, 95% confidence interval [CI]: 1.07-8.65, p = 0.04) compared with oxycodone but no significant difference in risk with oxycodone (HR 0.67, 95% CI: 0.32-1.38, p = 0.27) compared with fentanyl. CONCLUSIONS The findings suggest that the risk of acute respiratory conditions may be lower in patients with CKD who use oxycodone for cancer pain than in those who use morphine. Additionally, no difference in the risk of acute respiratory conditions was found between oxycodone and fentanyl use.
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Affiliation(s)
- Satoru Mitsuboshi
- Department of Pharmacy, Kaetsu Hospital, Niigata, Japan
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Shungo Imai
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Hayato Kizaki
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
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Tagami K, Chiu SW, Kosugi K, Ishiki H, Hiratsuka Y, Shimizu M, Mori M, Kubo E, Ikari T, Arakawa S, Eto T, Shimoda M, Hirayama H, Nishijima K, Ouchi K, Shimoi T, Shigeno T, Yamaguchi T, Miyashita M, Morita T, Inoue A, Satomi E. Cancer Pain Management in Patients Receiving Inpatient Specialized Palliative Care Services. J Pain Symptom Manage 2024; 67:27-38.e1. [PMID: 37730073 DOI: 10.1016/j.jpainsymman.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
CONTEXT Cancer pain is a common complication that is frequently undertreated in patients with cancer. OBJECTIVES This study is aimed at assessing the time needed to achieve cancer pain management goals through specialized palliative care (SPC). METHODS This was a multicenter, prospective, longitudinal study of inpatients with cancer pain who received SPC. Patients were continuously followed up until they considered cancer pain management successful, and we estimated this duration using the Kaplan-Meier method. We investigated the effectiveness of pain management using multiple patient-reported outcomes (PROs) and quantitative measures, including pain intensity change in the Brief Pain Inventory. A paired-sample t-test was used to compare the pain intensity at the beginning and end of the observation period. RESULTS Cancer pain management based on the PROs was achieved in 87.9% (385/438) of all cases. In 94.5% (364/385) of these cases, cancer pain management was achieved within 1 week, and the median time to pain management was 3 days (95% confidence interval [CI], 2-3). The mean worst pain intensity in the last 24 h at the start and end of observation were 6.9 ± 2.2 and 4.0 ± 2.3, respectively, with a difference of -2.9 (95% CI, -3.2 to -2.6; p < 0.01). Overall, 81.6% of the patients reported satisfaction with cancer pain management, and 62 adverse events occurred. CONCLUSION SPC achieved cancer pain management over a short period with a high level of patient satisfaction resulting in significant pain reduction and few documented adverse events.
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Affiliation(s)
- Keita Tagami
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Shih-Wei Chiu
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizu Wakamatsu, Fukushima, Japan
| | - Masaki Shimizu
- Department of Palliative Care (M.S.), Kyoto-Katsura Hospital, Nishikyo-ku, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (M.M., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Emi Kubo
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Sayaka Arakawa
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Eto
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Mayu Shimoda
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hideyuki Hirayama
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Kaoru Nishijima
- Department of Palliative Care (K.N.), Kyowakai Medical Corporation, Daini Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Kota Ouchi
- Department of Medical Oncology (K.O.), Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology (T.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Shigeno
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (M.M., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan; Research Association for Community Health (T.M.), Hamamatsu, Shizuoka, Japan
| | - Akira Inoue
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Eriko Satomi
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
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Shinkai M, Katsumata N, Kawai S, Kuyama S, Sasaki O, Yanagita Y, Yoshida M, Uneda S, Tsuji Y, Harada H, Nishida Y, Sakamoto Y, Himeji D, Arioka H, Sato K, Katsuki R, Shomura H, Nakano H, Ohtani H, Sasaki K, Adachi T. Phase III study of bilayer sustained-release tramadol tablets in patients with cancer pain: a double-blind parallel-group, non-inferiority study with immediate-release tramadol capsules as an active comparator. Support Care Cancer 2023; 32:69. [PMID: 38157081 PMCID: PMC10756890 DOI: 10.1007/s00520-023-08242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE We investigated whether twice-daily administration of a bilayer tablet formulation of tramadol (35% immediate-release [IR] and 65% sustained-release) is as effective as four-times-daily IR tramadol capsules for managing cancer pain. METHODS This randomized, double-blind, double-dummy, active-comparator, non-inferiority study enrolled opioid-naïve patients using non-steroidal anti-inflammatory drugs or acetaminophen (paracetamol) to manage cancer pain and self-reported pain (mean value over 3 days ≥ 25 mm on a 100-mm visual analog scale [VAS]). Patients were randomized to either bilayer tablets or IR capsules for 14 days. The starting dose was 100 mg/day and could be escalated to 300 mg/day. The primary endpoint was the change in VAS (averaged over 3 days) for pain at rest from baseline to end of treatment/discontinuation. RESULTS Overall, 251 patients were randomized. The baseline mean VAS at rest was 47.67 mm (range: 25.6-82.7 mm). In the full analysis set, the adjusted mean change in VAS was - 22.07 and - 19.08 mm in the bilayer tablet (n = 124) and IR capsule (n = 120) groups, respectively. The adjusted mean difference was - 2.99 mm (95% confidence interval [CI] - 7.96 to 1.99 mm). The upper 95% CI was less than the predefined non-inferiority margin of 7.5 mm. Other efficacy outcomes were similar in both groups. Adverse events were reported for 97/126 (77.0%) and 101/125 (80.8%) patients in the bilayer tablet and IR capsule groups, respectively. CONCLUSION Twice-daily administration of bilayer tramadol tablets was as effective as four-times-daily administration of IR capsules regarding the improvement in pain VAS, with comparable safety outcomes. CLINICAL TRIAL REGISTRATION JapicCTI-184143/jRCT2080224082 (October 5, 2018).
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Affiliation(s)
| | | | | | - Shoichi Kuyama
- National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | | | | | | | - Shima Uneda
- Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | | | | | | | | | | | | | | | - Ryo Katsuki
- National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Hiroki Shomura
- Japan Community Health Care Organization Hokkaido Hospital, Hokkaido, Japan
| | - Hideshi Nakano
- Department of Clinical Development, Nippon Zoki Pharmaceutical Co., Ltd., Osaka, Japan
| | - Hideaki Ohtani
- Department of Clinical Development, Nippon Zoki Pharmaceutical Co., Ltd., Osaka, Japan
| | - Kazutaka Sasaki
- Department of Clinical Development, Nippon Zoki Pharmaceutical Co., Ltd., Osaka, Japan
| | - Takeshi Adachi
- Department of Clinical Development, Nippon Zoki Pharmaceutical Co., Ltd., Osaka, Japan
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11
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Koutake Y, Fujimoto A, Nakahara M, Tsuruyama M, Miyoshi T, Yamaguchi Y, Fukazawa M, Kawamata Y, Hanada K, Hashimoto M. Predictors for the Clinical Efficacy of Tramadol for Cancer Pain. Am J Hosp Palliat Care 2023; 40:1303-1309. [PMID: 36647180 DOI: 10.1177/10499091231152854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
CONTEXT Tramadol is conditionally recommended for cancer pain and is a less expensive drug compared to strong opioids. Thus, tramadol may help reduce health care costs. OBJECTIVES To investigate factors that predict the clinical efficacy of tramadol for cancer pain. METHODS A retrospective study using electronic medical records was conducted on patients who received tramadol for cancer pain from January 2016 to December 2020. Patients who continued tramadol for >28 days or discontinued tramadol before 28 days owing to pain improvement were considered as clinical efficacy cases. RESULTS We identified 183 eligible patients; 104 cases had clinical efficacy. The median starting tramadol daily dose was 100 mg, and the median administration duration was 22 days. Overall, 169 patients (92.3%) discontinued tramadol; pain improvement was the most common reason (34.9%). Age (>70 years), a performance status of 0-1, and an albumin-bilirubin grade of 1 were independent predictors for the clinical efficacy of tramadol. Patients with multiple predictors had significantly higher achievement rates than those without. CONCLUSION Tramadol could have greater clinical efficacy for cancer pain in patients who are elderly, have good performance status, and have good liver function.
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Affiliation(s)
- Yoshimichi Koutake
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Airi Fujimoto
- Department of Pharmacy, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Moeko Nakahara
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Moeko Tsuruyama
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takanori Miyoshi
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasuhiro Yamaguchi
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Mami Fukazawa
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yosei Kawamata
- Department of Pharmacy, National Hospital Organization Miyazaki Higashi Hospital, Miyazaki, Japan
| | - Kiyonori Hanada
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masashi Hashimoto
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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12
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Tsuzuki Y, Nishiyama T, Ishida Y, Maeda R, Tomino M, Ohseto K. A Case of Nerve Root Radiofrequency Thermocoagulation for Pain Due to Pleural Metastasis of Lung Cancer Leading to Improvement in the Patient's Quality of Life. Palliat Med Rep 2023; 4:288-291. [PMID: 37908493 PMCID: PMC10615080 DOI: 10.1089/pmr.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Advances in medicine have made long-term survival of cancer patients possible. Hence, it is now necessary to consider how to approach common symptoms, such as cancer-related pain, in these patients. In this study, we describe a lung cancer patient in whom relief of intractable thoracic pain caused by pleural metastasis was achieved through thoracic radiofrequency thermocoagulation (RF), improving his quality of life (QOL). The patient was a man in his 70s with right upper lobe lung cancer, left 9th -11th rib metastasis, and left thoracic pain associated with parietal pleural metastasis. The patient experienced insomnia and weight loss due to poor appetite caused by opioid analgesics and inadequate pain control. Therefore, RF was performed as interventional treatment, resulting in a decrease in the numerical rating scale score from 10/10 to 2/10, and an improvement in QOL. In cases wherein long-term survival is expected, a long-term treatment plan for chronic cancer-related pain, which has a tendency to become persistent, becomes necessary. RF for the nerve roots might be a viable option for pain caused by pleural metastasis in cancer survivors.
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Affiliation(s)
- Yumi Tsuzuki
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Takahisa Nishiyama
- Department of Anesthesiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Yusuke Ishida
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
- Department of Anesthesiology, Showa University Hospital, Shinagawa-ku, Japan
| | - Ryoji Maeda
- Department of Anesthesiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Mikiko Tomino
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Kiyoshige Ohseto
- Department of Anesthesiology, Tokyo Medical University, Shinjuku-ku, Japan
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13
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Nakamura T, Nakamura M, Kai M, Shibasaki Y, Tomita H, Watabe M, Yokokura H, Momomura SI. Clinical Use of Oral Opioid Therapy for Dyspnea in Patients With Advanced Heart Failure - A Single-Center Retrospective Study. Circ Rep 2023; 5:351-357. [PMID: 37693229 PMCID: PMC10483112 DOI: 10.1253/circrep.cr-23-0059] [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: 06/19/2023] [Revised: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023] Open
Abstract
Background: For patients with advanced heart failure, palliative care, including opioids, is needed as a treatment for refractory dyspnea. However, little evidence has been reported on the efficacy and safety of opioids, and their use is not well established. Methods and Results: We have introduced a protocol for the use of opioids for dyspnea in patients with advanced heart failure admitted to Saitama Citizens Medical Center. Following this protocol, differences in clinical variables and outcome were investigated between patients in whom opioids were initiated intravenously or subcutaneously (i.v./s.c. group; n=13) and patients in whom they were initiated orally (oral group; n=18). In a comparison of baseline characteristics, significantly more patients in the oral group had a history of hospitalization for heart failure within the past year, and significantly more patients were treated with dobutamine and tolvaptan. After initiation of opioid treatment, both groups showed improvement in dyspnea; however, serial changes in vital signs were significantly greater in the i.v./s.c. group. The survival rate was significantly higher in the oral group (P<0.0001), with 33% of patients discharged alive. Conclusions: The clinical use of oral opioids using a single-center protocol is reported, suggesting that oral opioids may be practical and effective for dyspnea in patients with advanced heart failure.
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Affiliation(s)
- Tomohiro Nakamura
- Department of Internal Medicine, Saitama Citizens Medical Center Saitama Japan
| | - Mari Nakamura
- Department of Pharmacy, Saitama Citizens Medical Center Saitama Japan
| | - Mayumi Kai
- Department of Pharmacy, Saitama Citizens Medical Center Saitama Japan
| | - Yumiko Shibasaki
- Department of Pharmacy, Saitama Citizens Medical Center Saitama Japan
| | - Haruki Tomita
- Department of Nursing, Saitama Citizens Medical Center Saitama Japan
| | - Miku Watabe
- Department of Rehabilitation, Saitama Citizens Medical Center Saitama Japan
| | - Hatsumi Yokokura
- Department of Nutrition, Saitama Citizens Medical Center Saitama Japan
| | - Shin-Ichi Momomura
- Department of Internal Medicine, Saitama Citizens Medical Center Saitama Japan
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14
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Takahashi R, Miyashita M, Oba MS, Murakami Y. Impact of renal and hepatic function on first opioid prescriptions in cancer patients: an acute care hospital database study linked to medical claims data and laboratory data. Jpn J Clin Oncol 2023; 53:823-828. [PMID: 37282610 DOI: 10.1093/jjco/hyad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Cancer patients often have impaired renal and hepatic function. Opioids are essential to relieve painful symptoms in cancer patients. However, it is unknown which opioids are first prescribed for cancer patients with renal and hepatic impairment. The objective is to investigate the association between the type of first prescribed opioids and the renal/hepatic function of cancer patients. METHODS We used a multicenter database from 2010 to 2019. The number of days from the first opioid prescription to the death was defined as the prognostic period. This period was divided into six categories. The prevalence of opioid prescriptions was calculated for each assessment of renal and hepatic function, divided into prognostic periods. Multinomial logistic regression analysis was used to explore the influence of renal and hepatic function on the first opioid choice. RESULTS The study included 11 945 patients who died of cancer. In all prognostic period categories, the patients with worse renal function received fewer morphine prescriptions. No trend was observed in hepatic function. The odds ratio of oxycodone to morphine with reference to estimated glomerular filtration rate (eGFR) ≥90 was 1.707 (95% confidence interval: 1.433-2.034) for estimated glomerular filtration rate <30. The odds ratio of fentanyl to morphine with reference to estimated glomerular filtration rate ≥90 was 1.785 (95% confidence interval: 1.492-2.134) for estimated glomerular filtration rate <30. No association was identified between hepatic function and the choice of prescribed opioids. CONCLUSION Cancer patients with renal impairment tended to avoid morphine prescriptions, and no specific trend was observed in cancer patients with hepatic impairment.
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Affiliation(s)
- Richi Takahashi
- Division of Quality Assurance Program, National Cancer Center, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mari S Oba
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics, Faculty of Medicine, Toho University, Tokyo, Japan
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15
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Huerta MÁ, de la Nava J, Artacho-Cordón A, Nieto FR. Efficacy and Security of Tetrodotoxin in the Treatment of Cancer-Related Pain: Systematic Review and Meta-Analysis. Mar Drugs 2023; 21:md21050316. [PMID: 37233510 DOI: 10.3390/md21050316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023] Open
Abstract
The pharmacological treatment of cancer-related pain is unsatisfactory. Tetrodotoxin (TTX) has shown analgesia in preclinical models and clinical trials, but its clinical efficacy and safety have not been quantified. For this reason, our aim was to perform a systematic review and meta-analysis of the clinical evidence that was available. A systematic literature search was conducted in four electronic databases (Medline, Web of Science, Scopus, and ClinicalTrials.gov) up to 1 March 2023 in order to identify published clinical studies evaluating the efficacy and security of TTX in patients with cancer-related pain, including chemotherapy-induced neuropathic pain. Five articles were selected, three of which were randomized controlled trials (RCTs). The number of responders to the primary outcome (≥30% improvement in the mean pain intensity) and those suffering adverse events in the intervention and placebo groups were used to calculate effect sizes using the log odds ratio. The meta-analysis showed that TTX significantly increased the number of responders (mean = 0.68; 95% CI: 0.19-1.16, p = 0.0065) and the number of patients suffering non-severe adverse events (mean = 1.13; 95% CI: 0.31-1.95, p = 0.0068). However, TTX did not increase the risk of suffering serious adverse events (mean = 0.75; 95% CI: -0.43-1.93, p = 0.2154). In conclusion, TTX showed robust analgesic efficacy but also increased the risk of suffering non-severe adverse events. These results should be confirmed in further clinical trials with higher numbers of patients.
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Affiliation(s)
- Miguel Á Huerta
- Department of Pharmacology, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, Biomedical Research Center, University of Granada, 18016 Granada, Spain
- Biosanitary Research Institute ibs. Granada, 18012 Granada, Spain
| | - Javier de la Nava
- Department of Pharmacology, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, Biomedical Research Center, University of Granada, 18016 Granada, Spain
| | - Antonia Artacho-Cordón
- Department of Pharmacology, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, Biomedical Research Center, University of Granada, 18016 Granada, Spain
- Biosanitary Research Institute ibs. Granada, 18012 Granada, Spain
| | - Francisco R Nieto
- Department of Pharmacology, University of Granada, 18016 Granada, Spain
- Institute of Neuroscience, Biomedical Research Center, University of Granada, 18016 Granada, Spain
- Biosanitary Research Institute ibs. Granada, 18012 Granada, Spain
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16
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Higashibata T, Kessoku T, Morioka Y, Koretaka Y, Mishima H, Shibahara H, Masuda Y, Ichikawa Y, Nakajima A, Hisanaga T. A Nationwide Hospital Claims Database Analysis of Real-World Patterns of Laxative Use for Opioid-Induced Constipation in Japanese Patients with Cancer. Pain Ther 2023:10.1007/s40122-023-00520-2. [PMID: 37195398 DOI: 10.1007/s40122-023-00520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Opioid-induced constipation (OIC) is one of the most common side effects in patients with cancer treated with opioid analgesics. The actual use of laxatives for OIC in Japan remains unelucidated. This study aimed to investigate the real-world patterns of laxative use for patients with cancer who newly initiated opioid analgesic therapy. METHODS We used a Japanese nationwide hospital claims database (January 2018-December 2019). Patients with cancer newly receiving opioid analgesic therapy were included and classified on the basis of opioid classes (weak or strong) and route of administration (oral or transdermal) at initiation. The patients were divided into two groups on the basis of whether they received early medication (starting laxatives within 3 days after initiating opioid analgesic therapy), and patterns of laxative use were analyzed. RESULTS There were 26,939 eligible patients, with 50.7% of them initiated with strong opioids. The proportion of patients who received early medication was 25.0% for weak opioids and 57.3% for strong opioids. Osmotic laxatives were most frequently used as first-line therapy in the early medication group (oral weak opioids: 12.3%, oral strong opioids: 29.4%, transdermal strong opioids: 12.8%). Stimulant laxatives were frequently used as first-line therapy, to the same extent or more than osmotic laxatives in the non-early medication group (oral weak opioids: 13.7%, oral strong opioids: 7.7%, transdermal strong opioids: 15.1%). Peripherally acting μ-opioid receptor antagonists were the second most frequently used in the early medication group for those on oral strong opioids (9.4%). CONCLUSION This study demonstrated for the first time that the patterns of laxative use for OIC in Japanese patients with cancer were different, depending on the opioid types at initiation and the timing of laxative medication.
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Affiliation(s)
- Takahiro Higashibata
- Department of Palliative and Supportive Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Takaomi Kessoku
- Department of Palliative Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
- Department of Gastroenterology, International University of Health and Welfare Narita Hospital, Narita, Japan
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | | | | | | | - Yasushi Ichikawa
- Department of Oncology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
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17
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Takei D, Tagami K. Management of cancer pain due to bone metastasis. J Bone Miner Metab 2022; 41:327-336. [PMID: 36418587 DOI: 10.1007/s00774-022-01382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022]
Abstract
Bone metastases frequently occur in patients with cancer. Skeletal-related events (SREs), including pain, impaired mobility, hypercalcemia, pathological fracture, spinal cord and nerve root compression, and bone marrow infiltration, can decrease the quality of life of the patients and increase the risk of morbidity. The mechanism of pain due to bone metastasis is complicated and involves various interactions among tumor cells, bone cells, activated inflammatory cells, and bone-innervating neurons. Cancer pain due to bone metastasis can be crippling and a chronic state that causes sarcopenia. For pain management, it is important to diagnose whether the pain is based on background pain or breakthrough pain due to bone metastasis. In addition, the management goal of cancer pain due to bone metastasis is not only to achieve pain relief but also to prevent pain progression and SREs. Pain mechanisms should be applied to achieve optimal management. This review aims to discuss the mechanisms of cancer pain due to bone metastasis and review the recommended drug therapies.
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Affiliation(s)
- Daisuke Takei
- Department of Pharmacy, Saitama Cancer Center, Saitama, Japan.
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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