Methadona as a first-line treatment for cancer pain in a palliative care unit in a developing country

DRAN, GRACIELA; PEIRANO, GABRIELA; RUSSO, JORGELINA; MAMMANA, G; BERTOLINO, MARIELA; VEGA, F; PASTRANA, TANIA; RUGGIERO, RAúL A.; ARMESTO, ARNALDO; VIGNAROLI, E; CAMERANO, GABRIELA V.

Viena

Congreso; 18th ECCO-40th ESMO European Cancer Congress; 2015

ABSTRACT Background: Methadone is increasingly being used to manage cancer pain in developing countries, mainly because of its low cost. However, there exists little information about its use in a palliative care setting. Preliminary data from our Palliative Care Unit (PCU) suggested that Methadone was the most frequent choice as the first- line alternative for patients requiring strong opioids. Background: Methadone is increasingly being used to manage cancer pain in developing countries, mainly because of its low cost. However, there exists little information about its use in a palliative care setting. Preliminary data from our Palliative Care Unit (PCU) suggested that Methadone was the most frequent choice as the first- line alternative for patients requiring strong opioids. Objective: To describe the characteristic of prescription of strong opioids as the initial choice to treat moderate to severe cancer pain along the first month of treatment in a Tertiary PCU in Argentina. : To describe the characteristic of prescription of strong opioids as the initial choice to treat moderate to severe cancer pain along the first month of treatment in a Tertiary PCU in Argentina. Methods: Retrospective analysis based on the records of all new opioid- naive patients with moderate to severe cancer pain referred to PC consultation during a twelve-month period, who were indicated strong opioids in the first consult. Collected data included type and dose of opioid, variations in the intensity of pain and need and reasons for opioid rotation (OR). Descriptive statistics were used to summarize the results. : Retrospective analysis based on the records of all new opioid- naive patients with moderate to severe cancer pain referred to PC consultation during a twelve-month period, who were indicated strong opioids in the first consult. Collected data included type and dose of opioid, variations in the intensity of pain and need and reasons for opioid rotation (OR). Descriptive statistics were used to summarize the results. Results: Fifty- six patients met the inclusion criteria. At baseline, most had ECOG score of 3-4, mixed pain and exhibited poor prognostic factors. Methadone was the most frequent opioid accounting for more than two thirds of prescriptions both initially and at the last assessment. The initial and final opioid dose were similar, although significant decrease in the intensity of pain was achieved (p<0.001, unpaired Students t test). Those patients on Methadone underwent significantly less opioid rotation (P<0.001; ×2 Test) and longer interval between the first day and rotation (p<0.0001, paired Students t test), than patients on opioids other that Methadone. Reason for rotation for all opioids was mostly opioid- induced neurotoxicity. Conclusions: Our results demonstrate the preference of first line Methadone in the management of cancer related pain at the PCU. In addition, Methadone provided good pain relief with low rate of OR. Several hypothesis for the high rates of use of Methadone are given. Results herein need to be confirmed in a prospective large population- based study. : Our results demonstrate the preference of first line Methadone in the management of cancer related pain at the PCU. In addition, Methadone provided good pain relief with low rate of OR. Several hypothesis for the high rates of use of Methadone are given. Results herein need to be confirmed in a prospective large population- based study. : Fifty- six patients met the inclusion criteria. At baseline, most had ECOG score of 3-4, mixed pain and exhibited poor prognostic factors. Methadone was the most frequent opioid accounting for more than two thirds of prescriptions both initially and at the last assessment. The initial and final opioid dose were similar, although significant decrease in the intensity of pain was achieved (p<0.001, unpaired Students t test). Those patients on Methadone underwent significantly less opioid rotation (P<0.001; ×2 Test) and longer interval between the first day and rotation (p<0.0001, paired Students t test), than patients on opioids other that Methadone. Reason for rotation for all opioids was mostly opioid- induced neurotoxicity. Conclusions: Our results demonstrate the preference of first line Methadone in the management of cancer related pain at the PCU. In addition, Methadone provided good pain relief with low rate of OR. Several hypothesis for the high rates of use of Methadone are given. Results herein need to be confirmed in a prospective large population- based study. : Our results demonstrate the preference of first line Methadone in the management of cancer related pain at the PCU. In addition, Methadone provided good pain relief with low rate of OR. Several hypothesis for the high rates of use of Methadone are given. Results herein need to be confirmed in a prospective large population- based study.