Opening up disruptive ways of management in cancer pain: the concept of multimorphic pain

Lemaire, Antoine; George, Brigitte; Maindet, Caroline; Burnod, Alexis; Allano, Gilles; Minello, Christian

doi:10.1007/s00520-019-04831-z

Cited by 18 publications

(22 citation statements)

References 65 publications

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“…The management of multimorphic cancer pain is one of the fundamental pillars of supportive care in cancer and is thus part of a complementary approach to the care speci c to cancer [24,25]. Supportive care in cancer is "the prevention and management of the adverse effects of cancer and its treatment.…”

Section: Discussionmentioning

confidence: 99%

“…For our part, we retain the fact that the management of cancer pain is an integral part of supportive care as soon as the cancer diagnosis is made. As opioids are an important part of multimorphic cancer pain management with other treatments and interventional or complementary approaches [3,4,25], OIC must be taken into account as one of the factors that can decrease quality of life or unbalance our analgesic strategy. Since targeted therapies like naloxegol have proven to be safe and e cient on OIC in cancer patients, we can now bene t from new tools to help us reach the best symptoms management, for the right patient, at the right time.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of naloxegol in patients with cancer pain suffering from opioid-induced constipation

Lemaire

Pointreau

Narciso

et al. 2021

Support Care Cancer

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Naloxegol, an oral once-daily peripherally acting mu-opioid receptor antagonist, is indicated for the treatment of opioid-induced constipation (OIC) with inadequate response to laxative(s), in cancer and non-cancer patients. This study mainly aimed to assess in real-life conditions the e cacy and safety of naloxegol in cancer pain patients, and the evolution of their quality of life. MethodsA non-interventional, 4-week follow-up study was conducted in 24 French oncology and pain centers between 2018 and 2019. Eligible patients were aged ≥ 18 years, treated with opioids for cancer-pain, and started naloxegol for OIC with inadequate response to laxatives. The rate of the response to naloxegol (primary criterion) was assessed at W4. The evolution of quality of life was measured using the Patient Assessment of Constipation Quality of Life (PAC-QOL). ResultsA total of 124 patients were included (mean age: 62 ± 12 years; ECOG ≤ 2: 79%; primary cancer: lung 18%, breast 16%, prostate 11%, head and neck 9%, digestive 9%...; metastatic stage: 80%). At inclusion, the median opioid dosage was 60 mg of oral-morphine or equivalent. At W4, the response rate was 73.4% (95% CI [63.7%-83.2%]) and 62.9% (95% CI [51.5%-74.2%]) of patients had a clinically relevant change in quality of life (decrease in PAC-QOL score ≥ 0.5 point). Adverse events related to naloxegol were reported in 8% of patients (7% with gastrointestinal events; one serious diarrhea). ConclusionThis real-world study shows that naloxegol is effective and well tolerated in cancer pain patients with OIC and that their quality of life improves under treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness of naloxegol in patients with cancer pain suffering from opioid-induced constipation

Lemaire

Pointreau

Narciso

et al. 2021

Support Care Cancer

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“…Some changes in the opioid response are related to the adaptive behavior of the drug used, such as the onset of tolerance or opioid-induced hyperalgesia. In other cases, the variations of cancer pain and its multimorphic nature in the course of the disease influence the response [9]. Consequently, the clinician should evaluate all these clinical variables together at each patient visit.…”

Section: Discussionmentioning

confidence: 99%

“…Cancer pain is a singular clinical entity, defined by multimorphic characteristics, that can be modified during cancer progression by various factors. These include both cancer etiology, physiopathology, and clinical presentation, as well as disruptive elements, as concomitant treatments, pain from associated diseases, comorbidities and complications, and modifications in the environment [9]. Furthermore, the presence of neuropathic and breakthrough pain worsens pain intensity and induces a poorer response to analgesics [10,11].…”

Section: Introductionmentioning

confidence: 99%

The Complex Balance between Analgesic Efficacy, Change of Dose and Safety Profile Over Time, in Cancer Patients Treated with Opioids: Providing the Clinicians with an Evaluation Tool

Corli

Porcu

Santucci

et al. 2020

JCM

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Background: Scanty data exist on the integration between the analgesic effect of opioids, dose changes, and adverse events in cancer patients. Methods: To provide further information on this issue, we analysed data on 498 advanced-stage cancer patients treated with strong opioids. At baseline and three visits (at days 7, 14, and 21), pain intensity, oral morphine-equivalent daily dose, and the prevalence of major adverse events were measured. The proportion of responders (pain intensity decrease ≥30% from baseline) and non-responders, as well as of patients with low or high dose escalation, was calculated. Results: Pain intensity strongly decreased from baseline (pain intensity difference −4.0 at day 7 and −4.2 at day 21) in responders, while it was quite stable in non-responders (pain intensity difference −0.8 at day 7 and −0.9 at day 21). In low dose escalation patients (82.4% at final visit), daily dose changed from 52.3 to 65.3 mg; in high dose escalation patients (17.6%), it varied from 94.1 to 146.7 mg. Among responders, high dose escalation patients experienced significantly more frequent adverse events compared to low or high dose escalation patients, while no differences were observed in non-responders. Conclusions: The response to opioids results from the combination of three clinical aspects, which are strongly interrelated. These results provide some thoughts to help clinical evaluations and therapeutic decisions regarding opioid use.

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“…All our articles on the subject deplore these figures and use them as the starting point for a problem of scale that we would like to resolveonce and for all-, in our role as healthcare professionals managing cancer pain, an issue that is still widely underestimated and undertreated, including in palliative situations [1][2][3][4][5]. Although many scientific articles focus on proposing increasingly detailed and exhaustive models for understanding multimorphic cancer pain and trying to improve the situation that our cancer patients experience [6], there is still a gap between theory and real life, between scientific knowledge and its application in the field. In clinical practice, the multidisciplinary healthcare teams involved in supportive care still struggle daily to obtain early access to patients as a means of improving cancer pain management.…”

Section: Introductionmentioning

confidence: 99%

Cancer pain is over! (If you want it)

Lemaire

Rodríguez

2022

Support Care Cancer

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Opening up disruptive ways of management in cancer pain: the concept of multimorphic pain

Cited by 18 publications

References 65 publications

Effectiveness of naloxegol in patients with cancer pain suffering from opioid-induced constipation

Effectiveness of naloxegol in patients with cancer pain suffering from opioid-induced constipation

The Complex Balance between Analgesic Efficacy, Change of Dose and Safety Profile Over Time, in Cancer Patients Treated with Opioids: Providing the Clinicians with an Evaluation Tool

Cancer pain is over! (If you want it)

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