The management of pain in terminally ill cancer patients with difficulty swallowing

Coluzzi, Paul; Fairbairn, Barbara Stock

doi:10.1177/104990919901600611

Cited by 5 publications

(5 citation statements)

References 35 publications

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“…Currently available treatment options for patients with chronic pain who cannot swallow solid oral dosage forms include transdermal patches, immediate-release opioids, methadone, and certain other ER opioids, each of which have limitations that can potentially result in inadequate pain management [ 8 – 11 ]. For example, transdermal patches may have unreliable absorption, particularly in the elderly, and are associated with dermal side effects such as skin rash and erythema.…”

Section: Introductionmentioning

confidence: 99%

“…For example, transdermal patches may have unreliable absorption, particularly in the elderly, and are associated with dermal side effects such as skin rash and erythema. Release kinetics can be altered by changes in temperature or use of occlusive dressings [ 8 – 10 ]. Most of the currently available ER opioids do not offer multiple modes of administration (e.g., the same opioid that can be taken via a method other than swallowing intact) or have restrictions for dosing (e.g., take with sufficient water to avoid getting stuck in the throat or do not chew to avoid a potentially fatal overdose).…”

Section: Introductionmentioning

confidence: 99%

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Tolerability, Safety, and Effectiveness of Oxycodone DETERx in Elderly Patients ≥65 Years of Age with Chronic Low Back Pain: A Randomized Controlled Trial

et al. 2017

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Trial DesignThis was a phase III, randomized withdrawal, double-blind, placebo-controlled, enriched enrollment, parallel-group, multicenter study intended to demonstrate the safety, tolerability, and analgesic efficacy of oxycodone DETERx® (Xtampza™ ER) compared with matching placebo.MethodsThis post hoc analysis was performed using data from a subpopulation of enrolled patients who were ≥65 years of age. The study enrolled male and female patients with a clinical diagnosis of moderate-to-severe chronic low back pain for a minimum of 6 months prior to screening who required around-the-clock opioid therapy. To be eligible for enrollment, patients were required to have an average 24-h pain intensity score of ≥5 and ≤9 on an 11-point (0–10) Pain Intensity—Numerical Rating Scale at the screening visit. The study enrolled both opioid-experienced and opioid-naïve patients. The study consisted of an open-label titration phase followed by a 12-week double-blind maintenance phase. The dose range was 40–160 mg oxycodone hydrochloride equivalent per day. This post hoc analysis evaluated the safety, tolerability, and effectiveness of oxycodone DETERx among patients ≥65 years of age. The effectiveness of oxycodone DETERx was evaluated based on average pain intensity scores, Patient Global Impression of Change, responder analysis, and Kaplan–Meier survival analysis. The safety and tolerability of oxycodone DETERx were also evaluated. Patients were randomized to either oxycodone DETERx or placebo using a blocked randomization scheme in a 1:1 ratio. Randomization was stratified by previous opioid use (naïve or experienced). The study drug was coded in a manner that maintained the blinding. Study personnel and patients remained blinded to the assigned treatments throughout the study.ResultsFor this post-hoc analysis, the intent-to-treat and randomized safety populations included 52 patients ≥65 years old, 26 each in the oxycodone DETERx and placebo groups, who participated in the study during the titration phase and were randomized to the double-blind maintenance phase. Clinically important pain reduction from screening was achieved with oxycodone DETERx, with the median pain intensity score decreasing from 7.50 at screening to 2.69 at Week 12. A clinically meaningful treatment difference of −0.9 in pain score between oxycodone DETERx and placebo was observed. All 18 elderly patients who completed the study reported improvement in pain, with 62% showing ≥30% improvement and 54% showing ≥50% improvement in pain intensity compared with patients on placebo (p = 0.0128 and p = 0.0501, respectively). Patients on oxycodone DETERx remained in the study longer than those on placebo. Of the 26 patients ≥65 years old randomized to continue oxycodone DETERx during the double-blind maintenance phase, 18 (69%) completed the study; only two patients (8%) in the oxycodone DETERx group discontinued due to adverse events. The safety and tolerability profiles showed no new or unexpected safety concerns. The adverse event profiles were similar betw...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tolerability, Safety, and Effectiveness of Oxycodone DETERx in Elderly Patients ≥65 Years of Age with Chronic Low Back Pain: A Randomized Controlled Trial

et al. 2017

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“…5,6 The low molecular weight, high potency, lipid solubility, and nonirritating properties of fentanyl make it suitable for delivery via the transdermal therapeutic system. 2,7,8 A transdermal formulation of fentanyl that delivers 25, 50, 75, and 100 mg/h is now widely available.…”

Section: Introductionmentioning

confidence: 99%

“…2,4 As peak analgesia is not achieved until eight to 24 hrs after initial application, it is essential to provide alternative analgesia for the first 24 hours following administration and when titrating doses. 4,7 Transdermal fentanyl offers a noninvasive approach to the management of patients with chronic cancer pain. Transdermal delivery offers distinct advantages for patients where oral administration of opioids is difficult as a consequence of progressive disease, gastrointestinal disturbances, or decreased level of consciousness, and in patients whose compliance with oral medications is poor.…”

Section: Introductionmentioning

confidence: 99%

“…Transdermal delivery offers distinct advantages for patients where oral administration of opioids is difficult as a consequence of progressive disease, gastrointestinal disturbances, or decreased level of consciousness, and in patients whose compliance with oral medications is poor. [7][8][9] A lower concentration of a more potent opioid such as fentanyl is likely to result in less stimulation of the chemoreceptor trigger zone and of the receptors in the gastrointestinal tract, resulting in less interference with peristalsis, and therefore reduced symptoms of nausea and constipation. 8,9 Studies undertaken in adults have highlighted efficacy, enhanced quality of life, and reduction in constipation.…”

Section: Introductionmentioning

confidence: 99%

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The use of transdermal fentanyl in pediatric oncology palliative care

Noyes

Irving

2001

Am J Hosp Palliat Care

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Transdermal fentanyl offers a noninvasive approach to the management of patients with opioid dependent and stable, chronic cancer pain. The transdermal delivery system offers distinct advantages where oral administration of opioids is difficult as a consequence of progressive disease and in patients whose compliance with oral medications is poor. Thirteen patients ranging in age from three years and nine months to 18 years and seven months were treated with transdermal fentanyl for between six hours and 112 days. All had previously been receiving oral morphine prior to the commencement of fentanyl and were transferred to fentanyl because of oral opioid side effects and poor oral compliance. Fentanyl was well tolerated and provided effective pain relief for 11 of 13 patients. Overall, patients and parents experienced satisfaction with fentanyl, both in terms of pain relief and improvement in quality of life.

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Edoxaban and the Issue of Drug-Drug Interactions: From Pharmacology to Clinical Practice

Corsini

Ferri

Proietti

et al. 2020

Drugs

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Edoxaban, a direct factor Xa inhibitor, is the latest non-vitamin K antagonist oral anticoagulants (NOACs). Despite being marketed later than other NOACs, its use is now spreading in current clinical practice, being indicated for both thromboprophylaxis in patients with non-valvular atrial fibrillation (NVAF) and for the treatment and prevention of venous thromboembolism (VTE). In patients with multiple conditions, the contemporary administration of several drugs can cause relevant drug-drug interactions (DDIs), which can affect drugs' pharmacokinetics and pharmacodynamics. Usually, all the NOACs are considered to have significantly fewer DDIs than vitamin K antagonists; notwithstanding, this is actually not true, all of them are affected by DDIs with drugs that can influence the activity (induction or inhibition) of P-glycoprotein (P-gp) and cytochrome P450 3A4, both responsible for NOACs disposition and metabolism to a different extent. In this review/expert opinion, we focused on an extensive report of edoxaban DDIs. All the relevant drugs categories have been examined to report on significant DDIs, discussing the impact on edoxaban pharmacokinetic and pharmacodynamic and the evidence for dose adjustment. Our analysis found that, despite a restrained number of interactions, some strong inhibitors/inducers of P-gp and drug-metabolising enzymes can affect edoxaban concentration, just as it happens with other NOACs, implying the need for a dose adjustment. However, our analysis of edoxaban DDIs suggests that given the small propensity for interaction of this agent, its use represents an acceptable clinical decision. Still, DDIs can be significant in certain clinical situations and a careful evaluation is always needed when prescribing NOACs.

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The management of pain in terminally ill cancer patients with difficulty swallowing

Cited by 5 publications

References 35 publications

Tolerability, Safety, and Effectiveness of Oxycodone DETERx in Elderly Patients ≥65 Years of Age with Chronic Low Back Pain: A Randomized Controlled Trial

Tolerability, Safety, and Effectiveness of Oxycodone DETERx in Elderly Patients ≥65 Years of Age with Chronic Low Back Pain: A Randomized Controlled Trial

The use of transdermal fentanyl in pediatric oncology palliative care

Edoxaban and the Issue of Drug-Drug Interactions: From Pharmacology to Clinical Practice

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