[Health-related quality of life in the oncology departments of the hospital of Navarra. The EORTC Quality of Life Group]

Low-dose sublingual fentanyl improves quality of life in patients with breakthrough cancer pain in palliative care

Aim: This subanalysis of the CAVIDIOPAL study evaluated the impact of individualized management of breakthrough cancer pain (BTcP) with fentanyl on the quality of life (QoL) of advanced cancer patients in Spanish palliative care units. Patients & methods: This was a prospective, observational, multicenter study. The European Organization for Research and Treatment of Cancer's QLQ-C30 questionnaire was used at baseline (V0) and visit 28 (V28). Results: Ninety-five patients were mainly treated with 67-133 μg fentanyl, showing a notable reduction in intensity (visual analog scale: 8.0 [V0] to 4.6 [V28]), frequency and duration of BTcP episodes shortly after the first 1-2 weeks of treatment, with significantly improved QoL (global health status: 31.1 [V0] to 53.1 [V28]). Conclusion: Low-dose sublingual fentanyl effectively reduced BTcP in advanced cancer patients in palliative care units, significantly improving QoL. Clinical trial registration: NCT02840500 (ClinicalTrials.gov).

Impact of individualized management of breakthrough cancer pain on quality of life in advanced cancer patients: CAVIDIOPAL study

PURPOSE

The main aim of the study was to assess the impact of individualized management of breakthrough cancer pain (BTcP) on quality of life (QoL) of patients with advanced cancer in clinical practice.

METHODS

A prospective, observational, multicenter study was conducted in patients with advanced cancer that were assisted by palliative care units. QoL was assessed with the EORTC QLQ-C30 questionnaire at baseline (V0) and after 28 days (V28) of individualized BTcP therapy. Data on background pain, BTcP, comorbidities, and frailty were also recorded.

RESULTS

Ninety-three patients completed the study. Intensity, duration, and number of BTcP episodes were reduced (p < 0.001) at V28 with individualized therapy. Transmucosal fentanyl was used in 93.8% of patients, mainly by sublingual route. Fentanyl titration was initiated at low doses (78.3% of patients received doses of 67 μg, 100 μg, or 133 μg) according to physician evaluation. At V28, mean perception of global health status had increased from 31.1 to 53.1 (p < 0.001). All scales of EORTC QLQ-C30 significantly improved (p < 0.001) except physical functioning, diarrhea, and financial difficulties. Pain scale improved from 73.6 ± 22.6 to 35.7 ± 22.3 (p < 0.001). Moreover, 85.9% of patients reported pain improvement. Probability of no ≥ 25% improvement in QoL was significantly higher in patients ≥ 65 years old (OR 1.39; 95% CI 1.001-1.079) and patients hospitalized at baseline (OR 4.126; 95% CI 1.227-13.873).

CONCLUSION

Individualized BTcP therapy improved QoL of patients with advanced cancer. Transmucosal fentanyl at low doses was the most used drug.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov database (NCT02840500) on July 19, 2016.

Evaluación de la calidad de vida como predictor de supervivencia en el cáncer

La calidad de vida y la supervivencia son variables a tener en cuenta en ensayos clínicos de pacientes oncológicos. Es importante investigar la relación que existe entre ellas para los distintos tipos de cáncer. Se unieron las bases de datos de todos los pacientes oncológicos incluidos en los ensayos clínicos que se ejecutaron en el país, en el período 2000-2020. La calidad de vida se evaluó a través de las encuestas utilizadas en cada protocolo de investigación. Se realizó un análisis del tiempo transcurrido entre la inclusión del paciente y el fallecimiento para determinar el tiempo de supervivencia. Se comprobó que las variables de supervivencia de los pacientes incluidos en ensayos clínicos, mostraron valores superiores a los reportados para los pacientes con similares localizaciones del tumor no incluidos en estas investigaciones. Las localizaciones de mayor supervivencia fueron: pulmón (14.03 meses), cabeza y cuello (19.63 meses) y esófago (16.85 meses). En el caso de la calidad de vida se obtuvo que, globalmente, los pacientes mantuvieron un excelente estado general y la mayoría se incorporó a las actividades domésticas y laborales. Los pacientes incluidos en ensayos clínicos mostraron un incremento de la supervivencia y calidad de vida.

Quality of life in patients with metastatic breast cancer treated with metronomic chemotherapy

AIM

The objective of the study was to detect changes in quality of life (QoL) in metastatic breast cancer patients treated with metronomic chemotherapy with daily low doses of cyclophosphamide and celecoxib.

MATERIAL & METHODS

Patients included in a Phase II trial, treated with metronomic cyclophosphamide and celecoxib were included in the QoL study. Assessment of QoL was carried out every 2 months by the Functional Assessment of Cancer Therapy Breast (FACT-B) questionnaire, Brief Pain Inventory and Eastern Cooperative Oncologic Group scale. Data were analyzed at three time points: baseline (BL); middle of treatment (MT); and end of treatment (ET).

RESULTS

A total of 20 patients were included. All patients were heavily pretreated. Treatment showed a good and safe therapeutic profile. With FACT-B questionnaire, no significant differences were observed during the response period (BL-MT). However, a significant increase was observed in the Emotional well-being and Additional concerns axes, when the last time point was included in the analysis (BL-MT-ET). A significant decrease in the proportion of patients with pain was found when comparing BL with ET (p = 0.046). The assessment with Eastern Cooperative Oncologic Group scale showed that 26.7% (4/15) of the patients improved their functional status and 40% (6/15) showed no changes, while 33.3% (5/10) worsened it.

CONCLUSION

Patients treated metronomically for several months did not worsen their QoL. A high proportion of patients showed improvement or no changes and there were less patients with pain at the end of the treatment.