Transdermal fentanyl (Durogesic) for pain control in patients with cancer

Introduction: Pain is common symptom for many people with cancer. Clinical experience suggests that optimal palliative care can effectively mange the symptoms of cancer patients during most of the course of the disease. TTS delivers fentanyl continuously for up to 72 h and subsequent administrations maintain constant serum levels. The aim of this retrospective study was to assess effectiveness and acceptability of Durogesic in clinical practice.
Material and methods: This retrospective audit covers the period from December 1999 to September 2000. Palliative Care Team at the Oncology Centre in Wroclaw, Poland (650.000 inhabitants, 1 200 cancer death per year) was created in the 1994. We used Durogesic in 150 cases but all cases with incomplete clinical notes and to short (less than 7 days) observing time were excluded from statistical analyses. Finally, 60 sets of clinical notes were audited. Mean patient age was 61,6.
Results: Assessment of pain was based on VAS - Visual analogue Scale (0-10) and on 5-step verbal Scale - 0 - none, 1 - weak, 2 - moderate, 3 - strong, 4 - very strong. Evaluation of other symptoms such as dyspnoea, cough, insomnia, constipation, weakness, nausea and vomiting, weight loss, dysuria, swallowing troubles, depression, diarrhea, pressure sores, hemorrhage, confusion has been performed using 4-step verbal scale. The mean duration of care was 111.8 days. The mean duration of Durogesic treatment was 69.6 days. 57% of the patients were converted from another strong opioid, 10% from buprenorphine and 33 from a weak opioid, to TTS fentanyl. The most common reason for conversion was poor pain control, nausea, vomiting and constipation. Mean starting dose of TTS Fentanyl was 32.5 J-Lg/h. The average final dose was 63.11 ug/h). The mean rescue dose of morphine was 18.5 mg. Good and very good pain control was recorded in more then 90% of patients - VAS less then 4. Patches were generally well tolerated.
Conclusion: Cancer pain responds to pharmacological measures, and successful treatment is based on simple principles that have been promoted by the World Health Organization. Fentanyl TTS seems to be a safe and efficacious tool for pain control, enabling us to administer reliable analgesic treatment in a very easy way.