ASCOA one-year retrospective study of 111 hospice
patients with progressive cancer and chronic pain showed that the
average daily narcotic requirement for pain control was very
high, with a wide range of required dosages, Hossam A. Abdel-Rahman,
MD, said at an ASCO poster session on symptom management.
The daily dosing range of oral controlled-release oxycodone
(OxyContin) was 20 mg to 1,020 mg (mean, 93.6 mg) and for oral
controlled-release morphine (MS Contin), 30 mg to 7,800 mg (mean,
692.4 mg). One patient receiving 7,800 mg/day of MS Contin was
still able to drive, Dr. Abdel-Rahman said in an interview.
The researchers from Louisiana State University Medical Center,
Shreveport, also measured the prevalence of different primary cancers
in a population of 1,400 fully staged cancer patients who were
treated in the community setting and in these 111 patients with
chronic cancer pain treated in a hospital-affiliated hospice program.
The incidence of lung cancer was almost twice as high among the
terminally ill hospice patients as in the all-stage community-treated
cancer patients (29.7% vs 17.1%, respectively), as was the incidence
of rectal cancer (8.1% vs 4.5%, respectively). On the other hand,
breast cancer was more prevalent in the all-stage patients (34.5% vs
11.7% in the hospice patients) as was colon cancer (14.3% vs 9.9%,
The point of this study is that the treatment must be individualized,
Dr. Abdel-Rahman said. Not everybody would have satisfactory
pain relief in the dosage range we usually give, and we have to be
more liberal, because at some point in their illness, patients may
need a higher dose. He noted that no significant side effects
were seen in the study patients and urged physicians not to be
reluctant to order these big doses for fear of addiction or
serious side effects.
Another interesting aspect of the study, he said, was the use of
electronic medical records. You have the patient ID, the
diagnosis, the prescription theyre getting, and everything goes
into a database, so you can retrieve all the information really
quickly, he said. This allows you to adjust dosages in
individual patients, as well as analyze treatment patterns in your
practice or hospital.
Dr. Abdel-Rahmans colleagues in the study were Dr. Richard P.
Mansour (lead investigator) and Dr. Howard G. Wold.