According to the results of a landmark study published
in a recent issue of the Journal of Clinical Oncology (20:4040-4049,
2002), how painkillers are delivered can make a major difference in patient
outcome. The trial, supported by Medtronics Inc, was the first to compare routes
of administering opioids for intractable cancer pain. Results showed that opioids
delivered via an implantable infusion system provided better relief from moderate
to severe cancer pain with smaller doses and significantly fewer side effects.
Intrathecal infusion also improved the quality of life of patients and caregivers.
The data suggest, moreover, that the programmable drug pump may have helped
patients live longerby about 2 months, on average. This finding requires further
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"Opioids such as morphine are extremely effective for treating severe
pain," said cancer pain specialist Peter S. Staats, MD, associate professor
of anesthesiology and critical care medicine at Johns Hopkins University School
of Medicine in Baltimore, and one of the study investigators.
"Unfortunately, in high doses they can also cause sedation, clouded
thinking, constipation, and fatiguea constellation of side effects that lead
many physicians to underprescribe these drugs and many patients to underuse
them. With this study, we’ve shown that by altering how we deliver the
medications, we can provide better pain relief, minimize the side effects, and
perhaps even help patients to live longer."
According to the American Cancer Society, about one-third of cancer patients
and two-thirds of patients with advanced or metastatic disease experience pain,
but up to 15% fail to get relief from oral opioids. For a subset of these
patientsapproximately 50,000intrathecal therapy with a programmable drug
pump represents a viable option.
"As an oncologist, I’ve seen firsthand how a patient’s pain can
hamper our efforts to treat the cancer itself and adversely affect the entire
family," said Thomas J. Smith, MD, chairman of hematology and oncology at
Virginia Commonwealth University’s Massey Cancer Center in Richmond, a study
investigator, and the lead author of the manuscript. "By using the pump, we
can deliver medication directly into the patient’s spinal fluid, where small
doses can have a big impact on pain. Put simply, less medication means fewer
side effects, which makes life better not only for the patient but for the
patient’s family, too. And with the pain under control, we can focus on
treating the cancer."
Worldwide, 202 patients from 21 medical centers participated in the study.
The primary end points were pain control and change of drug toxicity.
Researchers defined clinical success as a greater than or equal to 20% reduction
in visual analog scale (VAS) pain scores or equal pain scores with a greater
than or equal to 20% reduction in toxicity.