Adjuvants underused initially, follow up needed for cancer patients in pain

By Sarah Guy, medwireNews Reporter

Italian study results indicate that physicians underuse adjuvant therapies for treatment of pain in cancer in the first instance, and that close follow up of oncology patients is needed to improve the efficacy of analgesic therapy in this setting.

In over 200 patients who reported three pain measurements over a 3-week period, under a third were initially prescribed an adjuvant drug - defined as those with a primary indication other than pain but with analgesic properties.

Furthermore, at the 1- and 2-week follow ups, adjustments to patients' drug regimens were made in 28% and 19% of patients, respectively, indicating clinicians change regimens relatively frequently during the course of cancer pain management.

"Our data suggest not enough cancer patients receive adjuvants," said Sandro Barni (Azienda Ospedaliera Treviglio Caravaggio) in a media statement. "We'd like both doctors and patients to be better informed about the benefits of these drugs."

The findings emerge from a study presented at the European Society for Medical Oncology 2012 Congress in Vienna, Austria.

Barni and colleagues recorded visual analog scale (VAS) pain scores for 265 consecutive cancer patients treated at one of eight cancer centers. Participants were aged a median 62 years, 59% were female, and all initially recorded pain levels based on the preceding 7 days.

The majority of analgesics prescribed to patients were nonsteroidal anti-inflammatories, used by 69% of the cohort, with 34% and 39% of patients using weak and strong opioids, respectively, and 28% using adjuvants (including pregabalin). In all, 34% of patients had their treatment adjusted after reporting their initial VAS, while 57% had their treatment confirmed.

One week later, patients (n=216 of the initial cohort) reported a VAS of 2.6 - lower than the 2.9 reported at baseline, and 28% of analgesic regimens were adjusted - 55% of which were changed to adjuvant therapies. Treatment was confirmed in 72% of patients at this stage.

By the second weekly follow up, 19% of the 131 available patients' analgesic regimens were adjusted - 86% of which were changed to an adjuvant - and the remaining 81% of treatment was confirmed.

"The adjustments demonstrate that you need to follow patients very carefully. Healthcare professionals should be getting cancer patients to assess pain on visual scales every time they see them and adjusting treatments accordingly," commented Barni.

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