Effectiveness, safety, and tolerability of oral morphine in patients with cancer.

Abstract

e19527 Background: Pain is the most common symptom of cancer. Effective management of moderate to severe cancer pain in most cases requires treatment with opioid analgesics.The goal of cancer pain management is to improve the quality of life of patients. Methods: The aim of this study was to evaluate the Efficacy, Safety and Tolerability of oral morphine in cancer patients. In Indira Gandhi Regional Cancer Center, Raipur (C.G.) from Jan. 2003 to June 2006 1235 metastatic cancer patients were studied, out of which 600 patients were female of 635 patients were male. Age group of patients was 20 year to 75 year. Most of the patients included in this study presented with advanced cancer and required oral morphine for moderate to severe cancer pain (W.H.O. Step ladder 2 and 3). We use immediate release morphine because this is much cheaper, however and is as effective. A typical starting doses for immediate release oral morphine is 10 to 30mg every 3-4 hr. in patients not currently receiving opioids. When a patient is switching from another opioid (usually codeine) to morphine it is important to calculate the equianalgesic morphine dose. Results: There were 635 male patients (51.42%) and 600 female patients (48.58%). The mean age was 54 yr. The average time of use was 6.4 months. Mean initial and final pain score were 7.4 and 1.3 respectively. Severe toxicity was 0% and the most of the side effects was G.I. effects: Constipation (41.6%), Nausea/Vomiting (28.7%), C.N.S. side effects: sedation and myoclonus (21.3%), Respiratory depression (6.2%), urinary retention, Xerostomia and non-cardiogenic pulmonary edema (8.9%). Adjuvant drugs were used in 846 patients (68.50%) to control pain. Uncontrolled pain occurred in 146 patients (11.82%). Conclusions: Pain control was achieved in the majority of patients. Morphine showed a low toxicity profile with a high compliance rate. Side effects are manageable and are mainly G.I. effects (constipation). Economic reasons must be strongly considered in developing countries and immediate release morphine represents a good alternative option.