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 study.
Benefits of Direct Deposit
"Opioids such as morphine(Drug information on 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.