Cancer. 2012
Zafar SY, Malin JL, Grambow SC, Abbott DH, Kolimaga JT, Zullig LL, Weeks JC, Ayanian JZ, Kahn KL, Ganz PA, Catalano PJ, West DW, Provenzale D; for the Cancer Care Outcomes Research & Surveillance (CanCORS) Consortium.
This national prospective, population-based cohort study from the USA assessed how patient preferences guide the course of palliative chemotherapy for 702 patients with metastatic colorectal cancer. Over 90% saw a medical oncologist, of whom 82% received chemotherapy. Patients over 65 or too sick to complete their own survey were less likely to visit an oncologist and patients over 75 with comorbidities were less likely to receive chemotherapy. However, of the patients that thought chemotherapy would not extend their life, would not help with cancer-related problems, or whose preferred treatment was comfort up to 90% still received chemotherapy, indicating that patient preferences were not associated with the administration of chemotherapy.
J Clin Oncol. 2012
Hardy J, Quinn S, Fazekas B, Plummer J, Eckermann S, Agar M, Spruyt O, Rowett D, Currow DC.
This multisite, double-blind RCT assessed the effect of subcutaneous ketamine (in combination with opioids and co-analgesics) over 3 to 5 days compared to with placebo, in 185 patients with chronic uncontrolled cancer pain. It showed there was no significant difference between the proportion patients responding to ketamine (31%) or placebo (27%), irrespective of pain type (nociceptive vs. neuropathic). There were however twice as many adverse events with ketamine which were more severe. The number needed to treat for one additional positive outcome from ketamine was 25. The number needed to harm was six. The authors concluded that ketamine does not have net clinical benefit when used as an adjunct to opioids and standard co-analgesics in cancer pain.
Cochrane Database Syst Rev. 2012
Combination pharmacotherapy for the treatment of neuropathic pain in adults.
Chaparro LE, Wiffen PJ, Moore RA, Gilron I.
This Cochrane review identified double-blind RCTs of drug combinations for neuropathic pain compared to a comparator (including placebo) to assess the efficacy, tolerability and safety of analgesic combinations. 21 eligible studies were identified: five (604 participants) evaluated topical medications; four (578 participants) an opioid with gabapentin or pregabalin; three (90 participants) fluphenazine with a tricyclic antidepressant; three (90 participants) of an N-methyl-D-aspartate antagonist in combination with another analgesic; two (77 participants) evaluated an opioid with a tricyclic antidepressant; one (313 participants) of tramadol with paracetamol; one (120 participants) of gabapentin and alpha-lipoic acid; one (56 participants) of gabapentin and nortriptyline; and one (44 participants) of L-365,260 (a cholecystokinin antagonist) with morphine.
Meta-analysis was only possible for gabapentin with an opioid versus gabapentin alone (two studies, 386 participants) and showed modest, yet statistically significant, superiority of a gabapentin with an opioid over gabapentin alone, but produced more frequent side effect-related trial dropouts compared to gabapentin alone.
The authors concluded that although there are many, good-quality studies showing superiority of two-drug combinations, there are few studies for any one specific combination and recommend that future combination studies include comparisons with placebo and both single-agent components.
J Pain Symptom Manage. 2012
Nguyen LM, Rhondali W, De la Cruz M, Hui D, Palmer L, Kang DH, Parsons HA, Bruera E.
This study surveyed 198 patients in the USA to evaluate self-reported opioid deviation (taking <70% or >130% of the prescribed dose) and the barriers to pain management with opioids in outpatients with advanced cancer. The median pain intensity (0-10) was 4 and morphine equivalent daily dose was 120 mg (interquartile range: 45-270 mg). Prescribed and patient-reported prescribed doses for opioids correlated, with 19 patients reporting deviation. Deviation was more frequent in males and non-whites. Low adherence was associated with higher barriers to pain management scores (as measured by the Barriers Questionnaire-II) for lower motivation and for lower knowledge. The frequency and predictors of opioid deviation need to be better characterize in this population.
by Jason Boland