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Revista de Oncología

, Volume 2, Issue 3, pp 159–163 | Cite as

Prospective clinical evaluation of transdermal fentanyl for the treatment of cancer pain

  • Laura Cerezo
  • Alicia Marin
  • Almudena Zapatero
  • Carmen Martín de Vidales
  • Mario López
  • Armando Pérez-Torrubia
Originales
  • 22 Downloads

Abstract

Background

Transdermal therapeutic systems offer potential advantages over oral or intravenous routes of drug administration. The purpose of this prospective study was to evaluate the analgesic efficacy of the new drug formulation transdermal fentanyl (TTS Fen) in the treatment of cancer pain, as well as its safety and patient acceptability.

Methods

Forty patients were included over a 12-month period. The dose of TTS Fen was titrated individually, increasing 25 μg/h every 72 hours, until analgesic control was adequate.

Results

Pain intensity, determined by means of a numeric analog scale going from 0 to 10, decreased from a mean of 7.14 on day 1 of treatment to 3.96 on day 15, 2.40 on day 60 and 2.07 on day 90, with significant differences (p = 0.002). Treatment satisfaction was high in 89% of patients. Rescue medication with short-acting oral morphine was needed in 30% of patients during the first week of treatment with TTS Fen, but only in 26% and 15% of patients by days 15 and 60, respectively. The most frequent side effects were constipation, which occurred in 39% of patients, drowsiness in 21% and fatigue in 13%.

Conclusions

TTS Fen is effective in the treatment of cancer pain and patient satisfaction is high, mainly because of ease of use. The frequency of side effects is low.

Key words

Cancer pain Transdermal fentanyl Opioid analgesics 

Evaluacion clinica prospectiva del fentanilo transdérmico en el tratamiento del dolor oncológico

Resumen

Fundamento

La vía transdérmica de administración de fármacos presenta ventajas potenciales sobre las vías oral o parenteral. El objetivo de este estudio prospectivo fue evaluar la eficacia analgésica del nuevo fármaco fentanilo transdérmico (Fen TTS) en el control del dolor neoplásico, su seguridad y la satisfacción global del paciente.

Métodos

En un período de 12 meses se incluyeron 40 pacientes. La dosis de Fen TTS fue ajustada individualmente, aumentando 25 μg/h cada 3 días hasta lograr un control analgésico adecuado.

Resultados

La intensidad del dolor, según una escala analógica numérica de 0 a 10, descendió de una media de 7.14 el día 1 del tratamiento a 3.96 el día 15, 2.40 el día 60 y 2.07 el día 90, siendo significativas las diferencias (p = 0,002). La satisfacción con el tratamiento fue alta en el 89% de los pacientes. El 30% de los pacientes precisó analgesia de rescate con morfina oral de liberación rápida la primera semana de tratamiento, disminuyendo al 26 y al 15% los días 15 y 60, respectivamente. Los efectos secundarios más frecuentes fueron estreñimiento, 39%, somnolencia, 21% y astenia, 13%.

Conclusiones

El Fen TTS es eficaz en el tratamiento del dolor neoplásico y su aceptación por el paciente es alta, principalmente por la comodidad de administración. Los efectos secundarios son leves.

Palabras clave

Dolor oncológico Fentanilo transdérmico Analgésicos opiáceos 

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References

  1. 1.
    Díaz-Rubio E. Dolor en el paciente canceroso. Madrid: ELA Editorial Libro del Año S.L., 1996; 9–30.Google Scholar
  2. 2.
    Torres LM, Calderón E, Rey RM. Fentanilo transdérmico (Durogesic): características farmacológicas y aplicación clínica. Rev Soc Esp Dolor 1999; 6: 121–131.Google Scholar
  3. 3.
    Payne R. Experience with transdermal fentanyl in advanced cancer pain. Eur J Pain 1990; 11: 98–101.Google Scholar
  4. 4.
    Yeo W, Lam KK, Chan A, Leung T, Wu Nip S, Johnson P. Transdemal fentanyl for severe cancer-related pain. Palliat Med 1997; 11: 233–239.CrossRefPubMedGoogle Scholar
  5. 5.
    Zech D, Grond S, LynchJ Dauer H, Stollenwerk B, Lehmann K. Transdermal fentanyl and initial dose-finding with patient-controlled analgesia in cancer pain. A pilot study with 20 terminally ill cancer patients. Pain 1992; 50: 293–301.CrossRefPubMedGoogle Scholar
  6. 6.
    Donner B, Zenz M, Tryba M, Strumpf M. Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain. Pain 1996; 64: 527–534.CrossRefPubMedGoogle Scholar
  7. 7.
    Ventafridda V, Tamburini M, Caraceni A, Conno F, Naldi F. A Validation Study of the WHO Method for Cancer Pain Relief. Cancer 1987; 59: 850–856.CrossRefPubMedGoogle Scholar
  8. 8.
    Bloor K, Leese B, Maynard A. The costs of managing severe cancer pain and potential savings from transdermal administration. Eur J Cancer 1994; 30: 463–468.CrossRefGoogle Scholar
  9. 9.
    Varvel JR, Shafer SL, Hwang SS, Coen PA, Stanski DR. Absorption characteristics of transdermally administered fentanyl. Anesthesiology 1989; 70: 928–934.CrossRefPubMedGoogle Scholar
  10. 10.
    Portenoy R, Southam M, Gupta S, Lapin J, Layman M, Inturrisi C et al. Transdermal fentanyl for cancer pain. Repeated dose pharmacokinetics. Anaesthesiology 1993; 78: 36–43.CrossRefGoogle Scholar
  11. 11.
    Grond S, Zech D, Lehmann K, Radbruch L, Breitenbach H, Hertel D. Transdermal fentanyl in the long-term treatment of cancer pain: a prospective study of 50 patients with advanced cancer of the gastrointestinal tract or the head and neck region. Pain 1997; 69: 191–198.CrossRefPubMedGoogle Scholar
  12. 12.
    Donner B, Zenz M, Strumpf M, Raber M. Long-term treatment of cancer pain with transdermal fentanyl. J Pain Symptom Manage 1998; 15: 168–175.CrossRefPubMedGoogle Scholar
  13. 13.
    Korte W, Morant R. Transdermal fentanyl in uncontrolled cancer pain: titration on a day-to-day basis as a procedure for safe and effective dose finding. A pilot study in 20 patients. Support Care Cancer 1994; 2: 123–127.CrossRefPubMedGoogle Scholar
  14. 14.
    Sloan P, Moulin D, Hays H. A clinical evaluation of transdermal therapeutic system fentanyl for the treatment of cacer pain. J Pain Symptom Manage 1998; 16: 102–111.CrossRefPubMedGoogle Scholar
  15. 15.
    Zech D, Grond S, Lynch J, Hertel D, Lehmann K. Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain 1995; 63: 65–76.CrossRefPubMedGoogle Scholar
  16. 16.
    Christie J, Simmonds M, Patt R. Coluzzi P, Busch M, Nordbrock E et al. Dose-titration, multicenter study of breakthrough pain in cancer patients using transdermal fentanyl for persistent pain. J Clin Oncol 1998; 16: 3238–3245.PubMedGoogle Scholar
  17. 17.
    Sevarino F, Paige D, Sinatra R, Silverman D. Postoperative analgesia with parenteral opioids: does continous delivery utilizing a transdermal opioid preparation affect analgesic efficacy or patient safety? J Clin Anesth 1997; 9: 173–178.CrossRefPubMedGoogle Scholar
  18. 18.
    Sandler A, Baxter A, Katz J, Samson B, Friedlander M, Norman P et al. A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy. Analgesic, respiratory and pharmacokinetic effects. Anesthesiology 1994; 81: 1169–1180.CrossRefPubMedGoogle Scholar
  19. 19.
    Payne R. Factors influencing quality of life in cancer patients: the role of transdermal fentanyl in the management of pain. Semin Oncol 1998; 25: 47–53.PubMedGoogle Scholar
  20. 20.
    Ahmedzai S, Brooks D. Transdermal Fentanyl versus sustained-release oral morphine in cancer pain: preference, efficacy, and quality of life. J Pain Symptom Manage 1997; 13: 254–261.CrossRefPubMedGoogle Scholar
  21. 21.
    Wong J, Chiu G, Tsao C, Chang C. Comparison of oral controlled-release morphine with transdermal fentanyl in terminal cancer pain. Acta Anaesthesiol Sin 1997; 35: 25–32.PubMedGoogle Scholar
  22. 22.
    Payne R, Mathias S, Pasta D, Wanke L, Williams R, Mahmoud R. Quality of life and cancer pain: Satisfaction and side effects with transdermal fentanyl versus oral morphine. J Clin Oncol 1998; 16: 1588–1593.PubMedGoogle Scholar

Copyright information

© FESEO 2000

Authors and Affiliations

  • Laura Cerezo
    • 1
  • Alicia Marin
    • 1
  • Almudena Zapatero
    • 1
  • Carmen Martín de Vidales
    • 1
  • Mario López
    • 1
  • Armando Pérez-Torrubia
    • 1
  1. 1.Department of Radiation OncologyHospital Universitario de la PrincesaMadrid

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