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Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
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Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
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2
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Zhang S, Waterhouse GIN, Xu F, He Z, Du Y, Lian Y, Wu P, Sun-Waterhouse D. Recent advances in utilization of pectins in biomedical applications: a review focusing on molecular structure-directing health-promoting properties. Crit Rev Food Sci Nutr 2021:1-34. [PMID: 34637646 DOI: 10.1080/10408398.2021.1988897] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The numerous health benefits of pectins justify their inclusion in human diets and biomedical products. This review provides an overview of pectin extraction and modification methods, their physico-chemical characteristics, health-promoting properties, and pharmaceutical/biomedical applications. Pectins, as readily available and versatile biomolecules, can be tailored to possess specific functionalities for food, pharmaceutical and biomedical applications, through judicious selection of appropriate extraction and modification technologies/processes based on green chemistry principles. Pectin's structural and physicochemical characteristics dictate their effects on digestion and bioavailability of nutrients, as well as health-promoting properties including anticancer, immunomodulatory, anti-inflammatory, intestinal microflora-regulating, immune barrier-strengthening, hypercholesterolemia-/arteriosclerosis-preventing, anti-diabetic, anti-obesity, antitussive, analgesic, anticoagulant, and wound healing effects. HG, RG-I, RG-II, molecular weight, side chain pattern, and degrees of methylation, acetylation, amidation and branching are critical structural elements responsible for optimizing these health benefits. The physicochemical characteristics, health functionalities, biocompatibility and biodegradability of pectins enable the construction of pectin-based composites with distinct properties for targeted applications in bioactive/drug delivery, edible films/coatings, nano-/micro-encapsulation, wound dressings and biological tissue engineering. Achieving beneficial synergies among the green extraction and modification processes during pectin production, and between pectin and other composite components in biomedical products, should be key foci for future research.
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Affiliation(s)
- Shikai Zhang
- College of Food Science and Engineering, Shandong Agricultural University, Taian, China
| | | | - Fangzhou Xu
- College of Food Science and Engineering, Shandong Agricultural University, Taian, China
| | - Ziyang He
- College of Food Science and Engineering, Shandong Agricultural University, Taian, China
| | - Yuyi Du
- College of Food Science and Engineering, Shandong Agricultural University, Taian, China
| | - Yujing Lian
- College of Food Science and Engineering, Shandong Agricultural University, Taian, China
| | - Peng Wu
- College of Food Science and Engineering, Shandong Agricultural University, Taian, China
| | - Dongxiao Sun-Waterhouse
- College of Food Science and Engineering, Shandong Agricultural University, Taian, China.,School of Chemical Sciences, The University of Auckland, Auckland, New Zealand
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3
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Structure and Applications of Pectin in Food, Biomedical, and Pharmaceutical Industry: A Review. COATINGS 2021. [DOI: 10.3390/coatings11080922] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pectin is a biocompatible polysaccharide with intrinsic biological activity, which may exhibit different structures depending on its source or extraction method. The extraction of pectin from various industrial by-products presents itself as a green option for the valorization of agro-industrial residues by producing a high commercial value product. Pectin is susceptible to physical, chemical, and/or enzymatic changes. The numerous functional groups present in its structure can stimulate different functionalities, and certain modifications can enable pectin for countless applications in food, agriculture, drugs, and biomedicine. It is currently a trend to use pectin to produce edible coating to protect foodstuff, antimicrobial bio-based films, nanoparticles, healing agents, and cancer treatment. Advances in methodology, use of different sources of extraction, and knowledge about structural modification have significantly expanded the properties, yields, and applications of this polysaccharide. Recently, structurally modified pectin has shown better functional properties and bioactivities than the native one. In addition, pectin can be used in conjunction with a wide variety of biopolymers with differentiated properties and specific functionalities. In this context, this review presents the structural characteristics and properties of pectin and information on the modification of this polysaccharide, its respective applications, perspectives, and future challenges.
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4
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Van Cleave JH, Booker SQ, Powell-Roach K, Liang E, Kawi J. A Scoping Review of Nursing's Contribution to the Management of Patients with Pain and Opioid Misuse. Pain Manag Nurs 2021; 22:58-68. [PMID: 33414010 DOI: 10.1016/j.pmn.2020.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Nursing brings a unique lens to care of patients with pain and opioid misuse. AIMS This scoping review describes nursing's contribution to the literature on the management of patients with pain and opioid misuse, generating evidence to guide clinical care. DESIGN The scoping review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews guideline. DATA SOURCES Using combined key terms ("opioid misuse," "pain," "nursing") in systematic searches in PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases, snowball technique, and personal knowledge resulted in 108 relevant articles, reports, and websites. ANALYSIS METHOD Summative approach to content analysis was used to quantify and describe nursing's contribution to the literature. RESULTS Contributions of nurses emerged in the areas of research, clinical practice, policy, and education. The highest number of publications addressed research (50%, 54 of 108), whereas the fewest number of publications involved education (7%, 8 of 108). CONCLUSION Results provide a picture of the breadth of expertise and crucial leadership that nurses contribute to influence management of patients with pain and opioid misuse. IMPLICATIONS FOR NURSING This scoping review indicates the importance of continued support from key stakeholders, including training and interprofessional collaboration opportunities supported by the National Institutes of Health, to sustain nursing's contribution to quality care of patients with pain and opioid misuse. Ultimately, all health care professionals must collaborate to conduct rigorous research and construct evidence-based guidelines to inform policy initiatives and education strategies to solve the complex co-occurring epidemics of pain and opioid misuse.
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Affiliation(s)
| | - Staja Q Booker
- University of Florida, College of Nursing, Gainesville, Florida
| | | | - Eva Liang
- NYU Rory Meyers College of Nursing, New York, New York
| | - Jennifer Kawi
- University of Nevada, Las Vegas, School of Nursing, Las Vegas, Nevada
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5
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Lam JKW, Cheung CCK, Chow MYT, Harrop E, Lapwood S, Barclay SIG, Wong ICK. Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic. Adv Drug Deliv Rev 2020; 160:234-243. [PMID: 33137363 PMCID: PMC7603972 DOI: 10.1016/j.addr.2020.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/28/2022]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has led to a surge in need for alternative routes of administration of drugs for end of life and palliative care, particularly in community settings. Transmucosal routes include intranasal, buccal, sublingual and rectal. They are non-invasive routes for systemic drug delivery with the possibility of self-administration, or administration by family caregivers. In addition, their ability to offer rapid onset of action with reduced first-pass metabolism make them suitable for use in palliative and end-of-life care to provide fast relief of symptoms. This is particularly important in COVID-19, as patients can deteriorate rapidly. Despite the advantages, these routes of administration face challenges including a relatively small surface area for effective drug absorption, small volume of fluid for drug dissolution and the presence of a mucus barrier, thereby limiting the number of drugs that are suitable to be delivered through the transmucosal route. In this review, the merits, challenges and limitations of each of these transmucosal routes are discussed. The goals are to provide insights into using transmucosal drug delivery to bring about the best possible symptom management for patients at the end of life, and to inspire scientists to develop new delivery systems to provide effective symptom management for this group of patients.
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Affiliation(s)
- Jenny K W Lam
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region.
| | - Chucky C K Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region; School of Pharmacy, University of Nottingham, University Park, Nottingham, United Kingdom
| | - Michael Y T Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region; Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Emily Harrop
- Helen and Douglas House, Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Susie Lapwood
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Stephen I G Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region; Centre for Medicines Optimisation Research and Education (CMORE), Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
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6
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Wirz S, Schenk M, Hofbauer H, Wartenberg HC, Cascella M, Kieselbach K. [Use of rapid-onset fentanyl preparations beyond indication : A random questionnaire survey among congress participants and pain physicians]. Schmerz 2020; 35:114-123. [PMID: 32975670 DOI: 10.1007/s00482-020-00503-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/18/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite publicised advice and warnings, there are only scant data on the non-indicated prescription of rapid-onset preparations of fentanyl (ROF) in non-cancer pain (NCP). Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation. OBJECTIVE Initiated by the Working Group Cancer Pain and supported by the German Pain Society, a random sample survey was conducted to assess the non-indicated use of ROF. METHODS The survey addressed attendees of pain conferences who were given the option to fill in the questionnaires outside the conference or online. Primary endpoints of the structured questionnaire were quantitative and qualitative items with regard to the prescription of ROF, while secondary endpoints were opioid-induced side effects. RESULTS Obtaining a response rate of 44% (132/300) and an additional 51 online questionnaires revealed that 165 (90%) respondents had knowledge of non-indicated prescriptions or were involved in these. Of these, 65% were clinicians and 17% worked in an outpatient capacity. In all, 22% were trained pain or palliative physicians. Approximately 1205 patients were assessed indirectly. The main causes for dispensing ROF included NCP entities such as back pain (44%), neuropathic pain (33%), head or facial pain (12%), and dyspnea (5%) in cancer pain or lack of break-through pain or basic medication (44%). Sedation (32%), nausea/vomiting (31%), constipation (16%) and insufficient analgesia (31%) were the mostly commonly reported adverse effects. CONCLUSION Despite the non-ambiguous indication for ROF, physicians often demonstrate inappropriate prescription behaviour. Iatrogenic misuse of ROF should be minimized. The rates of adverse effects of ROF seems to be in line with other opioids.
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Affiliation(s)
- Stefan Wirz
- Abteilung für Anästhesie, Intensivmedizin, Schmerzmedizin/Palliativmedizin - Zentrum für Schmerzmedizin, Weaningzentrum, CURA Krankenhaus, Betriebsstätte der GFO-Kliniken Bonn, Schülgenstr. 15, 53604, Bad Honnef, Deutschland.
| | - Michael Schenk
- Zentrum für Integrative Medizin, Franziskus-Krankenhaus Berlin, Budapester Str. 15-19, 10787, Berlin, Deutschland
| | - Hannes Hofbauer
- Sektion Schmerztherapie, Klinik für Anästhesiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Hans-Christian Wartenberg
- Afdeling Anesthesiologie H1-115, Academisch Medisch Centrum, Universiteit van Amsterdam, Meibergdreef 9, NL-1105 AZ, Amsterdam, Niederlande
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, Via Mariano Semmola 52, 80131, Napoli, Italien
| | - Kristin Kieselbach
- Interdisziplinäres Schmerzzentrum ISZ, Universitätsklinikum Freiburg, Breisacherstr. 117, 79106, Freiburg, Deutschland
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Pointreau Y, Bensadoun RJ, Bera G, Sire C, Ruffier A, Janoray G, Calais G, Bollet M, Pinel B, Braniste V, Amores X. Patient Satisfaction with Fentanyl Pectin Nasal Spray in Breakthrough Cancer Pain Management During Radiotherapy for Head and Neck Cancer. Patient Prefer Adherence 2020; 14:859-868. [PMID: 32546980 PMCID: PMC7247611 DOI: 10.2147/ppa.s246757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/05/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The severity of breakthrough cancer pain (BTcP) impacts patients' quality of life, increases the risk of anxiety and depression, lowers functional capacities, and may lead to poor compliance with cancer treatments. The aim of the current study was to assess, in a real-life setting, patient satisfaction with a fentanyl-pectin-nasal-spray (FPNS) for BTcP management in head and neck (H&N) cancer patients treated by radiotherapy. MATERIALS AND METHODS This non-interventional, prospective study was conducted in 92 adult H&N-cancer patients undergoing radiotherapy and who started FPNS treatment for BTcP. Throughout the radiotherapy period, the patients completed self-diaries to assess their BTcP episodes, FPNS use, satisfaction on FPNS efficiency (primary outcome), tolerability and ease of use. RESULTS Prior to FPNS treatment, 86% of the patients were experiencing ≤4 BTcP episodes/day. During the radiotherapy period, the BTcP episodes were treated with a median dose of 100µg of FPNS. Patients were "satisfied/very-satisfied" with the efficiency (73% of assessments), ease of use (87% of assessments) and tolerability (87% of assessments) of FPNS. In total, 27% of patients reported at least one adverse event related to FPNS and 4% of patients discontinued treatment due to adverse events. None of the adverse events were serious. Patient quality of life was maintained throughout the radiotherapy period. CONCLUSION This study showed, in a real-life setting, that a clear majority of H&N cancer patients treated with FPNS for BTcP throughout radiotherapy expressed satisfaction with this analgesic treatment.
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Affiliation(s)
- Yoann Pointreau
- Radiotherapy Department, Interregional Cancer Institute (ILC) - Jean Bernard Center, Le Mans, France
- Correspondence: Yoann Pointreau Email
| | | | - Guillaume Bera
- Oncology and Radiotherapy Department, Southern Brittany Hospital Group, Lorient, France
| | - Christian Sire
- Oncology and Radiotherapy Department, Southern Brittany Hospital Group, Lorient, France
| | - Amandine Ruffier
- Oncology and Radiotherapy Department, University Hospital of Tours, Tours, France
| | - Guillaume Janoray
- Oncology and Radiotherapy Department, University Hospital of Tours, Tours, France
- Oncology and Radiotherapy Department, François Rabelais University, EA 7505, Education Ethique Santé (EES), Tours, France
| | - Gilles Calais
- Oncology and Radiotherapy Department, University Hospital of Tours, Tours, France
| | - Marc Bollet
- Radiotherapy Department, Hartmann Clinic, Neuilly-sur-Seine, France
| | - Baptiste Pinel
- Oncology and Radiotherapy Department, University Hospital of Poitiers, Poitiers, France
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Lara-Espinoza C, Carvajal-Millán E, Balandrán-Quintana R, López-Franco Y, Rascón-Chu A. Pectin and Pectin-Based Composite Materials: Beyond Food Texture. Molecules 2018; 23:E942. [PMID: 29670040 PMCID: PMC6017442 DOI: 10.3390/molecules23040942] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/07/2018] [Accepted: 04/12/2018] [Indexed: 12/03/2022] Open
Abstract
Pectins are plant cell wall natural heteropolysaccharides composed mainly of α-1-4 d-galacturonic acid units, which may or may not be methyl esterified, possesses neutral sugars branching that harbor functional moieties. Physicochemical features as pH, temperature, ions concentration, and cosolute presence, affect directly the extraction yield and gelling capacity of pectins. The chemical and structural features of this polysaccharide enables its interaction with a wide range of molecules, a property that scientists profit from to form new composite matrices for target/controlled delivery of therapeutic molecules, genes or cells. Considered a prebiotic dietary fiber, pectins meetmany regulations easily, regarding health applications within the pharmaceutical industry as a raw material and as an agent for the prevention of cancer. Thus, this review lists many emergent pectin-based composite materials which will probably palliate the impact of obesity, diabetes and heart disease, aid to forestall actual epidemics, expand the ken of food additives and food products design.
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Affiliation(s)
- Claudia Lara-Espinoza
- Research Center for Food and Development, CIAD, A.C., Carretera a La Victoria Km. 0.6, Hermosillo, Sonora 83304, Mexico.
| | - Elizabeth Carvajal-Millán
- Research Center for Food and Development, CIAD, A.C., Carretera a La Victoria Km. 0.6, Hermosillo, Sonora 83304, Mexico.
| | - René Balandrán-Quintana
- Research Center for Food and Development, CIAD, A.C., Carretera a La Victoria Km. 0.6, Hermosillo, Sonora 83304, Mexico.
| | - Yolanda López-Franco
- Research Center for Food and Development, CIAD, A.C., Carretera a La Victoria Km. 0.6, Hermosillo, Sonora 83304, Mexico.
| | - Agustín Rascón-Chu
- Research Center for Food and Development, CIAD, A.C., Carretera a La Victoria Km. 0.6, Hermosillo, Sonora 83304, Mexico.
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Janknegt R, van den Beuken M, Schiere S, Überall M, Knaggs R, Hanley J, Thronaes M. Rapid acting fentanyl formulations in breakthrough pain in cancer. Drug selection by means of the System of Objectified Judgement Analysis. Eur J Hosp Pharm 2017; 25:e2. [PMID: 29732145 PMCID: PMC5931243 DOI: 10.1136/ejhpharm-2016-001127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022] Open
Abstract
Drug selection of rapid acting fentanyl formulations in the treatment of breakthrough pain in patients with cancer is performed by the System of Objectified Judgement Analysis method. All seven available formulations were included in the analysis. The following selection criteria were used: number of available strengths, variability in the rate of absorption, interactions, clinical efficacy, side effects, ease of administration and documentation. No direct double-blind comparative studies between two or more formulations were identified and the clinical documentation of all formulations is limited. The most distinguishing criterion was ease of use. This led to slightly higher scores for Abstral, Instanyl and PecFent than for the other formulations. The pros and cons of each formulation should be discussed with the patient, and the most suitable formulation selected for each individual patient.
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Affiliation(s)
- Robert Janknegt
- Department of Clinical Pharmacy and Toxicology, Zuyderland Medical Centre, Sittard, The Netherlands
| | | | | | - Michael Überall
- IFNAP Institute for Neurosciences, Algesiology and Paediatrics, Nürnberg, Germany
| | - Roger Knaggs
- University of Nottingham, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Morten Thronaes
- Faculty of Medicine, Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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