SHEFFIELD, UK-What should the research question be when investigating
a new approach to cancer pain? The most obvious answer is, Does
it relieve pain? But David Brooks, MB, of the University of Sheffield,
argues that this is not enough. Researchers must also ask about
side effects, quality of life, and patient preference.
Speaking at a symposium held in association with the 8th World
Congress on Pain, Dr. Brooks described a multicenter, open, randomized,
crossover trial comparing transdermal fentanyl (Duragesic) with
sustained-release oral morphine. The subjects were 202 patients
with cancer pain who were previously receiving stable doses of
No significant difference in pain relief was seen between the
two drugs among the 110 patients who completed the trial. "This
was no surprise since the trial was designed so that only patients
who had stable opioid responsive pain were included," Dr.
Brooks said. "So for this kind of trial, pain assessment
alone is inadequate as a single outcome measure."
However, in this study, researchers also included questions about
patient preference; 90% of the study subjects did, in fact, have
a preference, with 36% preferring morphine and 54% fentanyl. "Patient
preference gives an overall assessment of the therapy from the
patient's point of view," he said. "It gets patients
to weigh various effects individually."
As an example, he said, for one patient a bad-tasting medication
means the whole day is taken up with anticipatory nausea thinking
about it, whereas another patient may simply take the bad taste
The point, Dr. Brook believes, is that physicians must individualize
pain treatment. "No one therapy is likely to be universally
superior on every symptom subscale," he said.
In the fentanyl study, for some quality of life issues, fentanyl
was generally preferable to morphine; it caused less interruption
of daily activities and was more convenient to take. But interestingly,
for no single quality of life item was fentanyl or morphine universally