Cancer Cachexia May Hinder Pain Control When Using Fentanyl Patch

Abstract

The objective of this study was to evaluate the influence of cancer cachexia on pain control in cancer patients receiving a transdermal fentanyl patch (FP) and to investigate whether dry skin was a factor related to cancer cachexia and uncontrolled pain. We retrospectively reviewed the medical records of 77 patients receiving FP treatment for the first time, who were classified into cancer cachexia and non-cancer-cachexia groups, according to European Palliative Care Research Collaborative criteria. On day 7 after FP administration, the mean FP dose and morphine equivalent dose (MED) in the cancer cachexia group were significantly higher than in the non-cancer-cachexia group. Additionally, in the cancer cachexia group, there was a significantly larger degree of variation in pain intensity over 7 d than in the non-cachexia group. In patients who were switched from FP to morphine injection, the mean pain intensity and MED on day 3 after morphine injection were significantly lower than those immediately before morphine injection. Subsequently, to investigate whether dry skin was involved in poor pain control in the cancer cachexia group, transepidermal water loss (TEWL) was compared between 15 additional patients classified into cancer cachexia and noncancer cachexia groups; the mean TEWL in the cancer cachexia group was found to be significantly lower. Our data suggest that cancer cachexia may be a risk factor for poor pain control in patients receiving FP treatment, and that uncontrolled pain in FP treatment may be caused by the inhibition of fentanyl transdermal absorption due to dry skin.

Pancreas Cancer-Associated Pain Management

“…Concomitant medications including cancer treatment regimens, impairments in organ function, older age, cachexia, and genetics may substantially influence opioid metabolism, resulting in inadequate analgesia or overdosing, especially with repeated doses. Cachexia may modulate response to opioids, especially when using a fentanyl transdermal patch, and decreased analgesic efficacy has been reported [49], although this is clinically managed with appropriate titration. The metabolism of commonly prescribed opioids typically involves two major enzyme systems, cytochrome (CYP) P450 and UDP‐glucuronosyltransferases.…”

“Normal” TEWL‐how can it be defined? A systematic review

“…25 Mean TEWL values were significantly lower in cancer-cachexia patients compared with non-cancer cachexia patients. 25 In addition, Tamai et al 26 researched how TEWL values may change due to chemotherapy using a prospective cohort study. Thirteen female breast cancer patients receiving chemotherapy had their TEWL values measured at both frontal and parietal locations of the scalp at baseline, and 3 weeks and then 3 months following the initiation of chemotherapy.…”

“…There was no difference between groups in regard to gender or age. 25 The Tewameter TM300 was used to take TEWL measurements on patients after they relaxed for 10-20 min in a room from 20 to 25°C with a relative humidity between 40% and 50%. 25 Mean TEWL values were significantly lower in cancer-cachexia patients compared with non-cancer cachexia patients.…”

“…25 The Tewameter TM300 was used to take TEWL measurements on patients after they relaxed for 10-20 min in a room from 20 to 25°C with a relative humidity between 40% and 50%. 25 Mean TEWL values were significantly lower in cancer-cachexia patients compared with non-cancer cachexia patients. 25 In addition, Tamai et al 26 researched how TEWL values may change due to chemotherapy using a prospective cohort study.…”

Assoziationen von Tumorpatienten und deren Behandelnden zu den Themen Ernährung und Appetit

“…Tumorassoziierter Gewichtsverlust tritt bei etwa 60 % aller Krebspatienten auf [10] und unterscheidet sich substanziell von dem Gewichtsverlust, der während Hungerzuständen beobachtet werden kann [11]. Die Folgen einer Tumorkachexie sind vielfältig und reichen von einem verminderten Ansprechen auf eine transdermale Fentanyltherapie durch die mit der Kachexie assoziierte Hauttrockenheit [12] über eine schlechtere Prognose der Krebserkrankung [13] bis hin zu einer schlechteren Lebensqualität im palliativmedizinischen Kontext [14].…”