A Brief Information Sheet On Opioid Effects Improves Quality Of Life In Cancer Patients On Opioids

摘要

Opioids are commonly employed in the treatment of severe pain in cancer patients. In an attempt to augment the benefit of quality of life obtained from the opioids, we prospectively evaluated the efficacy of a brief information sheet on opioid effects in 13 consecutive hospitalized cancer patients. They were randomized to receive (n=7) or not to recieve (n=6) this information sheet which shortly explained the likely side effects of and the indications for the opioids. EORTC QLQ-C30 was completed by each subject both at admission and discharge. Patients that received the information sheet had more improvement in fatigue, dyspnea, physical functioning and emotional functioning subscales (P=0.000, 0.043, 0.025 and 0.006, respectively). Our results suggest that increased awareness about the opioids, perhaps obtained from a written source, can better certain aspects of quality of life in cancer patients treated with these agents. This work was conducted by the departments of Medical Oncology and Internal Medicine at Akdeniz University Medical Faculty, in Antalya, Turkey. No support was recieved for this work. Introduction Pain is a common symptom for patients with advanced cancer[1, 2]. Control of pain in this group has been shown to improve quality of life[3]. One of the ways of quantifying various dimensions of quality of life in cancer patients is EORTC's quality of life questionnaire (EORTC QLQ-C30) that has previously been suggested[4]. However, it is not clear if awareness of various issues contributes to various aspects of quality of life, as determined by EORTC QLQ-C30 or other questionnaires or scales, in patients with advanced cancer in general and those on opioids in particular. Awareness of diagnosis in patients with advanced disease, for example, has been shown not to worsen quality of life[5], but to the best of our knowledge, no studies in the literature have addresses so far how, if any, awareness of other factors would influence quality of life in cancer patients using opioids. Thus, in this study, we aimed to investigate whether awareness of opioid effects (therapeutic or toxic) presented to cancer patients in written format would contribute to quality of life as assessed by EORTC QLQ-C30 in those treated with opioids. Patients And Methods PatientsThirteen consecutive cancer patients with either Eastern Cooperative Oncology Group (ECOG) performance status of 3 or 4, and with moderate or severe pain were recruited in the study. Prior to the study, these patients had had standard analgesics, non-opioids and opioids, on an outpatient basis, in compliance with the World Health Organisation's (WHO) analgesic ladder[6], but with no apparent treatment effect and were hospitalized mainly with the aim of better pain relief. Some of these patients had themselves requested hospitalization for faster pain control. MethodsAll patients at the time of admission were verbally and shortly informed about the opioid side effects and why an opioid at that stage was indicated. Patients were then randomized to receive or not to receive an information sheet that included the same details with oral explanation that was previously made. Additionally, it mentioned about the aim of opioid medication. This information sheet was half a page long and, in short, stated that the aim of the opioid treatment was the total disappearance of pain, and to reach this goal, frequent dose titrations, each at every few days, might be needed. Also, the common side effects were summarized. Patients had either oral morphine sulphate or transdermal fentanyl patch. In order to standardize the opioid dose, fentanyl doses were converted into corresponding equivalent morphine doses along with the previous suggestions of Payne et al[7 ]. Dose modifications were made at every 3 days, if needed. Patients were discharged when the degree of pain relief enabled outpatient follow-up and less intensive monitoring of the analgesic therapy. In order to assess quality of li