Feasibility study of direct fentanyl patch introduction without prior opioid titration

Abstract

Opioids are key drugs for cancer pain relief, but some patients, especially those who have gastroenterological cancers, suffer from severe opioid-induced bowel dysfunction (OBD), which reduces their quality of life. In order to achieve better pain relief, efforts to minimize OBD are required. Between September 2006 and December 2007, 18 patients were enrolled in this feasibility study. All patients had gastroenterological cancer pain. The patients received direct fentanyl patch introduction starting from 12.5 microg/h, with additional opioid treatment for the first 12 h. Adverse events, changes of medications, pain scale, and patients' satisfaction scores were recorded for 9 days after fentanyl patch introduction. All patients completed the protocol treatment without interruption by adverse events. Eight patients (44%) showed adverse events that were presumed to be related to the treatment. However, all events were grade 1 and had a minimal effect on patients' quality of life. According to subjective evaluation on day 9, only 4 patients (22%) mentioned that they had felt adverse events during the treatment course. Seventeen patients (94%) had pain score scale improvements evaluated on day 9. Satisfaction scores on days 9 and day 27 were excellent or good for all but one of the patients. This prospective study showed the safety and efficacy of direct fentanyl patch introduction in Japanese gastroenterological cancer patients, and the treatment had good feasibility. This model should help cancer pain management for patients with a high risk of features of OBD such as constipation, subileus, or postabdominal surgery.