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International Journal of Clinical Oncology

Erschienen in:

01.04.2015 | Original Article

Opioid needs of terminally ill patients with gynecologic malignancies

verfasst von: Fumi Utsumi, Hiroaki Kajiyama, Jun Sakata, Makiko Higashi, Kaoru Niimi, Ryuichiro Sekiya, Hiroko Mitsui, Shiro Suzuki, Tomokazu Umezu, Mika Mizuno, Eiko Yamamoto, Kiyosumi Shibata, Fumitaka Kikkawa

Erschienen in: International Journal of Clinical Oncology | Ausgabe 2/2015

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Abstract

Background

Little is known about patterns and predictive factors regarding opioid use for terminally ill patients with gynecologic malignancies. The aim of this study was to elucidate predictors affecting opioid requirements of end-of-life patients with gynecologic malignancies.

Methods

A retrospective study was carried out on patients with gynecological malignancies admitted to our institute and died during the years 2002 to 2012. The association between maximum opioid dose and factors affecting opioid requirements were examined. Data extracted from medical records included age, site of primary cancer, maximum total dose of opioids prescribed over 24 h, the site of recurrence and metastasis, procedures performed during the hospital stay, total number of chemotherapy courses and overall survival.

Results

The study identified 189 patients. Most patients had ovarian cancer (42.3 %) followed by cervical cancer (28.0 %) and then corpus malignancy (27.0 %). Opioid requirements decreased with increasing age, especially from the 50s onward. This was particularly marked in cervical cancer patients. In addition, pelvic metastasis was associated with the maximum dose of opioids and the average opioid use was highest in patients with cervical cancer.

Conclusion

Young age and pelvic invasion were significant predictive factors regarding opioid requirements. Additionally, cervical cancer patients may require more opioids among those with gynecologic malignancies.

Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63(1):11–30CrossRefPubMed

van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG et al (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449CrossRefPubMed

Strohbuecker B, Mayer H, Evers GC et al (2005) Pain prevalence in hospitalized patients in a German university teaching hospital. J Pain Symptom Manag 29(5):498–506CrossRef

Zoega S, Fridriksdottir N, Sigurdardottir V et al (2013) Pain and other symptoms and their relationship to quality of life in cancer patients on opioids. Qual Life Res 22(6):1273–1280CrossRefPubMed

Breivik H, Cherny N, Collett B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20(8):1420–1433CrossRefPubMed

Fisch MJ, Lee JW, Weiss M et al (2012) Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol 30(16):1980–1988CrossRefPubMedCentralPubMed

Goncalves F, Almeida A, Antunes C et al (2013) A cross-sectional survey of pain in palliative care in Portugal. Support Care Cancer 21(7):2033–2039CrossRefPubMed

Cherny N, Ripamonti C, Pereira J et al (2001) Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 19(9):2542–2554PubMed

Hanks GW, Conno F, Cherny N et al (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84(5):587–593CrossRefPubMedCentralPubMed

10.

Group EGW, Jost L (2007) Management of cancer pain: ESMO clinical recommendations. Ann Oncol 18(Suppl 2):ii92–ii94

11.

Mercadante S, Radbruch L, Caraceni A et al (2002) Episodic (breakthrough) pain: consensus conference of an expert working group of the European association for palliative care. Cancer 94(3):832–839CrossRefPubMed

12.

Rees WD (1990) Opioid needs of terminal care patients: variations with age and primary site. Clin Oncol (R Coll Radiol) 2(2):79–83CrossRef

13.

Hall S, Gallagher RM, Gracely E et al (2003) The terminal cancer patient: effects of age, gender, and primary tumor site on opioid dose. Pain Med 4(2):125–134CrossRefPubMed

14.

Bristow RE, Tomacruz RS, Armstrong DK et al (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20(5):1248–1259CrossRefPubMed

15.

Brun JL, Feyler A, Chene G et al (2000) Long-term results and prognostic factors in patients with epithelial ovarian cancer. Gynecol Oncol 78(1):21–27CrossRefPubMed

16.

Mercadante S, Dardanoni G, Salvaggio L et al (1997) Monitoring of opioid therapy in advanced cancer pain patients. J Pain Symptom Manag 13(4):204–212CrossRef

17.

Dalacorte RR, Rigo JC, Dalacorte A (2011) Pain management in the elderly at the end of life. N Am J Med Sci 3(8):348–354CrossRefPubMedCentralPubMed

18.

Mercadante S, Casuccio A, Pumo S et al (2000) Factors influencing the opioid response in advanced cancer patients with pain followed at home: the effects of age and gender. Support Care Cancer 8(2):123–130CrossRefPubMed

19.

Zerzan J, Benton K, Linnebur S et al (2010) Variation in pain medication use in end-of-life care. J Palliat Med 13(5):501–504CrossRefPubMed

20.

Quigley C, Joel S, Patel N et al (2003) Plasma concentrations of morphine, morphine-6-glucuronide and morphine-3-glucuronide and their relationship with analgesia and side effects in patients with cancer-related pain. Palliat Med 17(2):185–190CrossRefPubMed

21.

Klepstad P, Dale O, Kaasa S et al (2003) Influences on serum concentrations of morphine, M6G and M3G during routine clinical drug monitoring: a prospective survey in 300 adult cancer patients. Acta Anaesthesiol Scand 47(6):725–731CrossRefPubMed

22.

Vainio A, Auvinen A (1996) Prevalence of symptoms among patients with advanced cancer: an international collaborative study. Symptom prevalence group. J Pain Symptom Manag 12(1):3–10CrossRef

23.

Ikeda K, Ide S, Han W et al (2005) How individual sensitivity to opiates can be predicted by gene analyses. Trends Pharmacol Sci 26(6):311–317CrossRefPubMed

24.

Ikeda K, Kobayashi T, Ichikawa T et al (2001) The untranslated region of (mu)-opioid receptor mRNA contributes to reduced opioid sensitivity in CXBK mice. J Neurosci 21(4):1334–1339PubMed

Titel: Opioid needs of terminally ill patients with gynecologic malignancies
verfasst von: Fumi Utsumi
Hiroaki Kajiyama
Jun Sakata
Makiko Higashi
Kaoru Niimi
Ryuichiro Sekiya
Hiroko Mitsui
Shiro Suzuki
Tomokazu Umezu
Mika Mizuno
Eiko Yamamoto
Kiyosumi Shibata
Fumitaka Kikkawa
Publikationsdatum: 01.04.2015
Verlag: Springer Japan
Erschienen in: International Journal of Clinical Oncology / Ausgabe 2/2015
Print ISSN: 1341-9625
Elektronische ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-014-0708-0

Springer Medizin

Opioid needs of terminally ill patients with gynecologic malignancies