Journal of Clinical Oncology, Vol 16, 1588-1593, Copyright © 1998 by American Society of Clinical Oncology
Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine
R Payne, SD Mathias, DJ Pasta, LA Wanke, R Williams and R Mahmoud
University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. rp@mdanderson.com
PURPOSE: To compare pain-related treatment satisfaction, patient- perceived
side effects, functioning, and well-being in patients with advanced cancer
who were receiving either transdermal fentanyl (Duragesic, Janssen
Pharmaceuticals, Titusville, NJ) or sustained- release oral forms of
morphine (MS Contin, Perdue Frederick Co, Norwalk, CT, or Oramorph SR,
Roxanne Laboratories, Columbus, OH). PATIENTS AND METHODS: A total of 504
assessable cancer patients participated in this cross-sectional,
quality-of-life study. Relevant elements of four validated scales were
used--the Functional Assessment of Cancer Therapy-General (FACT-G) scale,
the Brief Pain Inventory (BPI), the Medical Outcomes Study (MOS)
questionnaire, and the Memorial Symptom Assessment Scale (MSAS)--as well as
original scales that were developed and validated for this study. RESULTS:
The majority of patients in both treatment groups had late-stage (IV/D)
cancer. Patients who received transdermal fentanyl were more satisfied
overall with their pain medication than those who received
sustained-release oral forms of morphine (P = .035). Fentanyl patients also
experienced a significantly lower frequency (P < .002) and impact (P
< .001) of pain medication side effects. These results occurred despite
the fact that cancer patients who received fentanyl were significantly
older (P < .001) and had significantly lower functioning and well-being
scores (P = .001). Measures of pain intensity, sleep adequacy, and symptoms
demonstrated no significant differences between treatment groups.
CONCLUSION: These data suggest that patients are more satisfied with
transdermal fentanyl compared with sustained-release oral forms of
morphine. A lower frequency and reduced impact of side effects with
transdermal fentanyl may be one reason cancer patients who receive fentanyl
are more satisfied with their pain management.
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