Corli, O, Roberto, A, Bennett, MI orcid.org/0000-0002-8369-8349 et al. (4 more authors) (2018) Nonresponsiveness and Susceptibility of Opioid Side Effects Related to Cancer Patients’ Clinical Characteristics: A Post‐Hoc Analysis. Pain Practice, 18 (6). pp. 748-757. ISSN 1530-7085
Abstract
Background: The response to opioids is not always positive in cancer patients. A considerable proportion of patients do not respond (nonresponders [NRs]) or experience severe toxicity. The aim of this analysis was to assess the role of demographic characteristics, pain features, comorbidities, and ongoing therapy on the lack of efficacy and on the occurrence of severe adverse drug reactions (ADRs).
Methods: This is a post‐hoc analysis of a randomized controlled trial that involved 520 patients and aimed to evaluate the efficacy and safety of 4 strong opioids. Patients who presented with unchanged or worsened pain compared to the first visit were considered to be NRs. As for toxicity, severe ADRs with an incidence of greater than 10% were evaluated. Univariate and multivariate logistic models were used.
Results: 498 patients were analyzed. Liver metastases and breakthrough pain (BTP) were found to increase the risk for nonresponse. Conversely, a high basal pain intensity significantly decreased the same risk. Constipation risk was worsened by previous weak opioid therapy but decreased with aging and with the use of transdermal opioids. Risk for drowsiness was aggravated by bone metastases and concomitant treatment with anticoagulant, antidiabetic, and central nervous system drugs. Risk for confusion increased with antidiabetics, antibiotics, and previous weak opioid therapy but decreased when fentanyl was used. Occurrence of nausea increased in patients with a high rating on the Karnofsky Performance Status Index. Risk for xerostomia was higher in women and in patients treated with antidiabetic or long‐term opioids.
Conclusions: Several clinical variables are correlated with opioid response in cancer patients. In particular, the presence of BTP is associated with nonresponse. Additionally, patients who receive polypharmacological therapy are more likely to experience opioid adverse events.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 World Institute of Pain. This is the peer reviewed version of the following article: Corli, O. , Roberto, A. , Bennett, M. I., Galli, F. , Corsi, N. , Rulli, E. and Antonione, R. (2018), Nonresponsiveness and Susceptibility of Opioid Side Effects Related to Cancer Patients’ Clinical Characteristics: A Post‐Hoc Analysis. Pain Pract, 18: 748-757. doi:10.1111/papr.12669, which has been published in final form at https://doi.org/10.1111/papr.12669. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | cancer pain; opioids; nonresponders; toxicity |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 27 Nov 2017 15:19 |
Last Modified: | 08 Dec 2018 01:38 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/papr.12669 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:124511 |