Magazine article Drug Topics

Do Cancer Patients Prefer Transdermal Pain Reliever?

Magazine article Drug Topics

Do Cancer Patients Prefer Transdermal Pain Reliever?

Article excerpt

Late-stage cancer patients prefer transdermal fentanyl over sustained-release oral morphine for pain relief, according to a new study from the University of Texas M. D. Anderson Cancer Center in Houston. But other cancer pain experts caution that the results are far from conclusive.

The study involved more than 500 patients-the vast majority of whom had late-stage (IV/D) cancer-who were being treated for pain with either transdermal fentanyl (Duragesic, Janssen) or one of two sustainedrelease oral morphine medications (Oramorph SR, Roxane; or MS Contin, Purdue Frederick). Patients were asked to fill out a questionnaire about their pain medication, perceived side effects, and overall satisfaction.

According to patients' responses, 50% of fentanyl patients reported never having side effects, as opposed to 36% of morphine patients. Almost seven out of 10 fentanyl patients reported either that they had no significant side effects or that they were not bothered by their side effects, compared with fewer than half of morphine patients.

Richard Payne, M.D., chief of pain and symptom management at the cancer center and lead author of the study, suggested that morphine patients may experience more side effects because the oral morphine is absorbed through the gastrointestinal tract and is more likely to cause nausea and constipation.

While there were no significant differences in preference among the women studied, men receiving fentanyl seemed on average more satisfied with their treatment than men taking morphine. Almost 97% of male fentanyl patients said they would recommend the treatment to others, compared with just under 90% of male morphine patients. Similar numbers were reported regarding the willingness of these patients to continue the therapy.

Despite some differences in preference and side effects, patients' selfreported pain levels were about the same for all three medications, suggesting that morphine was as effective a pain reliever as fentanyl.

"They're interesting data, but we really need to see a randomized, controlled trial," said Mike Shobelock, Pharm.D., clinical research managermedical affairs, for Roxane Laboratories, maker of Oramorph SR. Before joining Roxane, Shobelock spent several years treating cancer pain at the Ohio State University Medical Centers. …

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