İleri evre kanser hastalarında opioid kullanımı

Giriş: Opioidler ileri evre kanser hastalarında tümörün tipinden bağımsız olarak orta ve şiddetli ağrıların tedavisinde temel taşıdır. Opioidlerin doğru endikasyonları oluşsa bile gerektiği kadar yaygın ve yeterli dozda kullanılmamaktadır. Ülkemizdeki opiod kullanımına ışık tutmak için, opioid kullanan kanser hastalarında tanı, opioid dozu ve yan etki profilini değerlendirmek istedik.Hastalar ve Metod: Haziran–Aralık 2014 tarihleri arasında kliniğimize yatan toplam 490 hastadan retrospektif olarak tarandı ve opioidle (fentanil) ağrı palyasyonu sağlanan 173 ileri evre kanser hastası çalışmaya dahil edildi. Opioid dozları zayıf (≤ 100 mg/gün oral morfin ve eşdeğeri) ve yüksek (>100 mg/gün oral morfin ve eşdeğeri) olarak ikiye ayrılarak demografik veriler ve yan etkilerle ilişkisi incelendi.Bulgular: Toplam 173 hastanın, 115’i (%66.5) erkek ve 58’i (%33.5) kadındı ve ortalama yaş 59.9±12 olarak saptandı. Hastaların 141 (%81.5)’i metastatikken 32’si (%18.5) non-metastatik ileri evredeydi. 37 (%21.4) akciğer, 34 (%19.7) mide, 22 (%12.7) meme, 17 (%9.8) lenfoma-lösemi, 16 (%9.2) kolon, 16 (%9.2) prostat, 11 (%6.4) rektum, 10 (%5.8) pankreas ve 10 (%5.8) hastada ise diğer kanserler mevcuttu. Yüksek doz opioid kullanımı sıklığı ve tanılar (pankreas, mide, prostat, kolorektal, meme, akciğer ve lenfoma; sırasıyla %50, %44.1, %37.5, 30.7, %36.4, %32.4, ve %17.6, P = 0.62) ve yan etki profili açısından anlamlı fark yoktu (P >0.05). Sonuç: Kanser türünden bağımsız olarak, opioid kullanan üç hastanın en az birinde yüksek doz opioid ihtiyacı mevcuttur. Yüksek doz opioid kullanımı beraberinde daha yüksek oranda yan etki riskini de getirmediğinden dolayı, kanser hastalarında ağrı palyasyonu için gerek görüldüğünde opioid dozu etkin ve çok yüksek dozlara kadar artırılarak kullanılmalıdır.

Anahtar Kelimeler:

Kanser ağrısı, opioid tedavisi, düşük doz opioid, yüksek doz opioid

Opioid use in advanced stage cancer patients

Objective: We wanted to evaluate the dose intensity and the rate of opioid use in patients hospitalized with a diagnosis of cancer at Medical Oncology Department.Cancer pain, opioid therapy, low-dose opioid, high-dose opioid Patients and Methods: June to December 2014, data were retropectively analiysed from 173 patients in 490 advanced cancer patients who were admitted to our clinic and received opioid treatment. Types of opioid use divided as weak (equal to ≤100 mg/day and strong (equal to >100 mg/day morphine), and the opioid dose intensity were examined. Results: A total of 173 patients, 114 (66.3%) were male and 58 (33.7%) were female, mean age of 59.9±4.12 were found. 141 (81.5%) patients had metastases, 32 (18.5%) patients had no metastases. According to type of cancer, 37 patients were classified (21.4%) lung, 34 (19.7%) of the stomach, 22 patients (12.7%), breast, and 17 (9.8%), leukemia, lymphoma, 16 (9.2%), colon and 16 (9.2%) of the prostate, 11 patients (6.4%), the rectum, and 10 (5.8%), pancreatic cancer, and 10 patients (5.8%) present in other cancers. There were no statistically differences found among opioid side effects according to opioid dosage (P > 0.05). Conclusion: Regardless of the type of cancer, high doses of opioid are required in at least one of the three opioid-utilizing patients. Since high dose opioid use does not bring with it a higher risk of side effects, the opioid should be used in an effective and very high dose of opioid when it is needed for palliation of pain in cancer patients.

Keywords:

Cancer pain, opioid therapy, low-dose opioid, high-dose opioid,

PDF

___

1. Foley KM. The treatment of cancer pain. New England Journal of Medicine. 1985;313(2):84-95. 2. Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, et al. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. Journal of clinical oncology. 2014;32(36):4149-54. 3. Schug SA, Zech D, Dörr U. Cancer pain management according to WHO analgesic guidelines. Journal of pain and symptom management. 1990;5(1):27-32. 4. Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. Physician attitudes and practice in cancer pain management: a survey from the Eastern Cooperative Oncology Group. Annals of Internal medicine. 1993;119(2):121-6. 5. Ferrell BR, Wisdom C, Wenzl C. Quality of life as an outcome variable in the management of cancer pain. Cancer. 1989;63(11):2321-7. 6. Forsythe LP, Alfano CM, George SM, McTiernan A, Baumgartner KB, Bernstein L, et al. Pain in long-term breast cancer survivors: the role of body mass index, physical activity, and sedentary behavior. Breast cancer research and treatment. 2013;137(2):617-30. 7. Vardy J, Agar M. Nonopioid drugs in the treatment of cancer pain. Journal of Clinical Oncology. 2014;32(16):1677-90. 8. Cepeda MS, Farrar JT, Baumgarten M, Boston R, Carr DB, Strom BL. Side effects of opioids during short‐term administration: Effect of age, gender, and race. Clinical Pharmacology & Therapeutics. 2003;74(2):102-12. 9. Ricardo Buenaventura M, Rajive Adlaka M, Nalini Sehgal M. Opioid complications and side effects. Pain physician. 2008;11:S105-S20. 10. Trescot AM, Datta S, Lee M, Hansen H. Opioid pharmacology. Pain physician. 2008;11(2 Suppl):S133-53. 11. Lawlor PG, Bruera E. Side-effects of opioids in chronic pain treatment. Current Opinion in Anesthesiology. 1998;11(5):539-45. 12. Payne R, Mathias SD, Pasta DJ, Wanke LA, Williams R, Mahmoud R. Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine. Journal of Clinical Oncology. 1998;16(4):1588-93. 13. Jeal W, Benfield P. Transdermal fentanyl. Drugs. 1997;53(1):109-38. 14. Colak S, Erdogan MO, Afacan MA, Kosargelir M, Aktas S, Tayfur İ, et al. Neuropsychiatric side effects due to a transdermal fentanyl patch: hallucinations. The American journal of emergency medicine. 2015;33(3):477. e1-. e2. 15. University of Wisconsin- Madison, Pain and Policy Study Group website[online], http://www.painpolicy.wisc.edu/countryprofiles/euro, 05.10.2017. . 16. Vieweg WVR, Lipps WFC, Fernandez A. Opioids and methadone equivalents for clinicians. Primary care companion to the Journal of clinical psychiatry. 2005;7(3):86. 17. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Archives of internal medicine. 2011;171(7):686-91. 18. Mercadante S, Guccione C, Di Fatta S, Alaimo V, Prestia G, Bellingardo R, et al. Cancer pain management in an oncological ward in a comprehensive cancer center with an established palliative care unit. Supportive Care in Cancer. 2013;21(12):3287-92. 19. Mantyh PW. Bone cancer pain: from mechanism to therapy. Current opinion in supportive and palliative care. 2014;8(2):83. 20. Deandrea S, Corli O, Consonni D, Villani W, Greco MT, Apolone G. Prevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature. Journal of pain and symptom management. 2014;47(1):57-76.