Efficacy and Tolerability of Intranasal Fentanyl Spray in Cancer Patients With Breakthrough Pain

Thronæs, Morten; Popper, Lars; Eeg, Martin; Jaatun, Ellen Anna Andreassen; Kvitberg, Magnar; Kaasa, Stein

doi:10.1016/j.clinthera.2014.12.010

Cited by 16 publications

(13 citation statements)

References 29 publications

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“…A similar amount of pain reduction following treatment was observed in several intervention studies on CBTP 14,15…”

Section: Discussionsupporting

confidence: 76%

“…The study monitored for changes in LF and log LF/HF in patients with opioid treatment for CBTP, which is an abrupt, short-lived, and intense pain that “breaks through” the sustained-released analgesia provided to control persistent pain13 and responds to treatment with opioids within minutes 14,15. Pain was assessed using an NRS with a range from 0 to 10 on which 0 was defined as “no pain” and 10 was defined as “worst pain imaginable”.…”

Section: Methodsmentioning

confidence: 99%

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Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Masel

Huber

Engler

et al. 2016

JPR

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BackgroundDecisions on the intensity of analgesic therapy and judgments regarding its efficacy are difficult at the end of life, when many patients are not fully conscious and pain is a very common symptom. In healthy individuals and in postoperative settings, nociception and subsequent pain relief have been shown to induce changes in the autonomic nervous system (ANS), which can be detected by measuring heart rate variability (HRV).ObjectivesThe changes in the ANS were studied by measuring HRV during opioid therapy for cancer breakthrough pain (CBTP) in palliative-care patients with cancer and compared these changes with patient-reported pain levels on a numeric rating scale (NRS).Patients and methodsThe study included ten patients with advanced cancer and baseline opioid therapy. In each patient, a 24-hour peak-to-peak HRV measurement with a sampling rate of 4,000 Hz was performed. High frequency (HF), low frequency (LF), total power, pNN50 (indicating parasympathetic activity), and log LF/HF were obtained in two intervals prior to therapy and in four intervals thereafter. Intensity of CBTP was recorded using a patient-reported NRS prior to therapy and 30 minutes afterward.ResultsCBTP occurred in seven patients (three males and four females; mean age: 62 ± 5.2 years) and was treated with opioids. A highly significant positive correlation was found between opioid-induced reduction in patient-reported pain intensity based on NRS and changes in log LF/HF (r > 0.700; p < 0.05). Log LF/HF decreased in patients who had a reduction in pain of >2 points on the NRS but remained unchanged in the other patients.ConclusionOur data suggest that log LF/HF may be a useful surrogate marker for alleviation of CBTP in patients with advanced cancer and might allow detection of pain without active contribution from patients.

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“…A similar amount of pain reduction following treatment was observed in several intervention studies on CBTP 14,15…”

Section: Discussionsupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Masel

Huber

Engler

et al. 2016

JPR

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“… 72 A further study identified was excluded because fewer than 20 patients were included in each treatment arm. 78 …”

Section: Clinical Efficacymentioning

confidence: 99%

Rapid acting fentanyl formulations in breakthrough pain in cancer. Drug selection by means of the System of Objectified Judgement Analysis

et al. 2017

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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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“…We have already conducted collaborative research projects in palliative radiotherapy of lung cancer (37), radiotherapy of painful bone metastases (38) and of symptom management during chemotherapy (39). The key challenge is to develop the standardised care pathways detailed enough so that the "patient flow" can be planned according to the needs of each individual patient.…”

Section: A Structure Of Integration Between Clinical Practice and Resmentioning

confidence: 99%

Integration between Oncology and Palliative Care: A Plan for the Next Decade?

Kaasa

Knudsen

Lundeby

et al. 2017

Tumori

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With the groundbreaking works of the three Milan professors, i.e. Bonadonna, Veronesi, and Ventafridda, in the 1980's as the starting point, this article aims to shed light on the potential benefits of a closer and more formal integration between oncology and palliative care. More specifically we will address why integration is needed, how to do it, and what are the potential benefits to the patients, the families and the society.The costs for cancer care are increasing rapidly. Especially during the last year of life, some treatments are futile and expensive without proven benefit for the patients in terms of prolonged survival with adequate quality of life (QoL). The latest WHO definition of palliative care supports an "upstream" introduction of palliative care.More recent studies indicate that such an early integration has the potential to improve the patients' QoL and reduce their symptom burden.Successful integration presupposes formal structures and explicit obligations on how and when to integrate. The Norwegian model for palliative care is presented. It covers the range of oncological and palliative services from community health care via the local hospital to the tertiary hospital and rests on standardised care pathway as the key instrument to promote integration.Our present state of knowledge indicates that integration does not shorten life, perhaps even the opposite. Futile oncological treatment can be reduced and the QoL of patients and carers improved. We need more evidence on the potential effect upon costs, but present data indicate that integration does not increase them. 3 KeywordsOncology, palliative care, integration, futile treatment, end of life care, research collaboration 4

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Efficacy and Tolerability of Intranasal Fentanyl Spray in Cancer Patients With Breakthrough Pain

Cited by 16 publications

References 29 publications

Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study

Rapid acting fentanyl formulations in breakthrough pain in cancer. Drug selection by means of the System of Objectified Judgement Analysis

Integration between Oncology and Palliative Care: A Plan for the Next Decade?

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