Does transdermal fentanyl work in patients with low BMI? Patient-reported outcomes of pain and percent pain relief in cancer patients on transdermal fentanyl.
cancer management
clinical observations
medical oncology
nutrition
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
12
12
2018
revised:
14
06
2019
accepted:
14
06
2019
pubmed:
1
10
2019
medline:
17
9
2020
entrez:
1
10
2019
Statut:
ppublish
Résumé
Low body mass index (BMI) is suspected of being associated with low transdermal fentanyl (TDF) blood levels and worse pain relief. Clinical pain data to support this claim are lacking. Using a Chronic Pain Registry, we identified 901 cancer patients who received TDF at outpatient pain service clinics of our cancer center from 7/1/2011 to 12/1/2016. Of these, 240 patients had a BMI measure, pain intensity, and pain relief scores documented within 30 days of a TDF order. We examined associations between BMI, TDF dose, Worst and Least pain scores, and pain relief scores using standard statistical tests. In cancer patients receiving TDF, low BMI (<18.5) was significantly associated with greater pain relief irrespective of TDF dose and borderline significantly associated with greater percent pain relief after controlling for age, cancer diagnoses, and pain etiology (P = .073), suggesting that low BMI may independently predict better pain relief in cancer patients. As there were no significant associations between BMI and TDF dose, we find no basis for BMI-dependent dose modification or avoiding TDF in cachectic and low BMI patients. When predicting percent pain relief, we conclude that there is no basis for avoiding TDF or modifying its dose in cancer patients with low BMI and cachexia.
Sections du résumé
BACKGROUND
Low body mass index (BMI) is suspected of being associated with low transdermal fentanyl (TDF) blood levels and worse pain relief. Clinical pain data to support this claim are lacking.
METHODS
Using a Chronic Pain Registry, we identified 901 cancer patients who received TDF at outpatient pain service clinics of our cancer center from 7/1/2011 to 12/1/2016. Of these, 240 patients had a BMI measure, pain intensity, and pain relief scores documented within 30 days of a TDF order. We examined associations between BMI, TDF dose, Worst and Least pain scores, and pain relief scores using standard statistical tests.
RESULTS
In cancer patients receiving TDF, low BMI (<18.5) was significantly associated with greater pain relief irrespective of TDF dose and borderline significantly associated with greater percent pain relief after controlling for age, cancer diagnoses, and pain etiology (P = .073), suggesting that low BMI may independently predict better pain relief in cancer patients. As there were no significant associations between BMI and TDF dose, we find no basis for BMI-dependent dose modification or avoiding TDF in cachectic and low BMI patients.
CONCLUSIONS
When predicting percent pain relief, we conclude that there is no basis for avoiding TDF or modifying its dose in cancer patients with low BMI and cachexia.
Identifiants
pubmed: 31568684
doi: 10.1002/cam4.2479
pmc: PMC6912029
doi:
Substances chimiques
Analgesics, Opioid
0
Fentanyl
UF599785JZ
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
7516-7522Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : National Cancer Institute of the National Institutes of Health
ID : R25CA020449
Pays : International
Organisme : NIDA NIH HHS
ID : RC2 DA028928
Pays : United States
Organisme : Weill Cornell Medical College Bridge Fund
Pays : International
Informations de copyright
© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
Lancet Oncol. 2012 Feb;13(2):e58-68
pubmed: 22300860
Drug Saf. 2003;26(13):951-73
pubmed: 14583070
Gerontology. 1994;40(1):32-7
pubmed: 8034201
J Pain. 2018 Mar;19(3):278-290
pubmed: 29154919
J Clin Oncol. 2015 Jan 1;33(1):90-9
pubmed: 25422490
J Pain Palliat Care Pharmacother. 2012 Jun;26(2):98-104
pubmed: 22764844
World Health Organ Tech Rep Ser. 1990;804:1-75
pubmed: 1702248
Pain. 2009 Jul;144(1-2):218-22
pubmed: 19442446
Clin Pharmacokinet. 1983 Sep-Oct;8(5):422-46
pubmed: 6226471
Oncol Rep. 2005 Oct;14(4):1029-36
pubmed: 16142368
Clin Pharmacokinet. 2003;42(2):107-21
pubmed: 12537512
Cancer. 2016 Jan 1;122(1):149-56
pubmed: 26451687
Br J Clin Pharmacol. 2017 Feb;83(2):294-313
pubmed: 27619152
J Pain Symptom Manage. 2002 Sep;24(3):284-6
pubmed: 12458106
Cancer Med. 2019 Dec;8(18):7516-7522
pubmed: 31568684
Anesthesiology. 1993 Jan;78(1):36-43
pubmed: 8424569
Pharmacogenet Genomics. 2014 Apr;24(4):185-94
pubmed: 24469018
J Clin Pharmacol. 2010 Jun;50(6):667-78
pubmed: 20097932