Significance of combined palliative care and chemotherapy for upper intestinal cancer or lung cancer

European Journal of Pain Supplements 1 (2007) 86–87 www.EuropeanJournalPain.com

Poster

Significance of combined palliative care and chemotherapy for upper intestinal cancer or lung cancer Satoshi Hara * Division of Palliative Care, Kinki University, Osaka, Japan

1. Objective

3. Results

To examine the effects and significance of combination therapy for reducing pain associated with the recurrence or progression of cancer and improving the patient’s QOL, and chemotherapy for achieving antitumor effects.

Patients with symptoms, their condition, the effects of chemotherapies, and the results of opioid therapies are presented in Table 1 below.

4. Discussion 2. Methods The patients included in the study had recurrent cancer with symptoms such as pain and a feeling of abdominal distension. Because their PS was poor, chemotherapy could not be continued. This result was likely because the treatment was aimed at intensive chemotherapy focusing on the dose intensity of drugs such as taxane anticancer agents. However, opioid treatment for alleviation of pain yielded the anticipated effects.

We studied 14 patients admitted to hospital because of recurrent esophageal cancer, gastric cancer, or lung cancer who received palliative therapy with opioids for pain and chemotherapy. Chemotherapy was initiated with concurrent opioid administration to control cancer pain. Antitumor effects were examined using the RECIST criteria, and pain was measured using the Numeric Rating Scale (NRS).

Table 1 Symptoms, condition, effects of chemotherapies and results of opioid therapies

1 2 3 4 5 6 7 8 9 10 1 2 3 4

Sex

Symptoms

M M M M M M M M F F M M F F

Feeling of abdominal Feeling of abdominal Feeling of abdominal Feeling of abdominal Feeling of abdominal Feeling of abdominal Feeling of abdominal Feeling of abdominal Feeling of abdominal Feeling of abdominal Chest pain Chest pain Chest pain Chest pain

distension distension distension distension distension distension distension distension distension distension

Condition

Chemotherapy

Effects

Opioid 1

Pleural effusion Pleural effusion Pleural effusion Pleural effusion Pleural effusion Pleural effusion Pleural effusion Pleural effusion Pleural effusion Pleural effusion Pleural effusion Bone metastasis Bone metastasis Bone metastasis

TXT TXL TXT TXL → TXT TS-1 TXT UFT TXT TXL → TXL → TXL → Iressa TXL →

NC NC NC PD PD NC PD PD PD NC NC NC NC PD

Oxycodone Oxycodone Oxycodone Oxycodone ANPE ANPE Oxycodone ANPE Oxycodone ANPE Oxycodone Oxycodone Oxycodone Oxycodone

TS-1

TS-1 CBDCA CBDCA CBDCA

Opioid 2

Oxycodone Fentanyl

Opioid 3

Best NRS

Fentanyl Fentanyl Morphine inj. Fentanyl Morphine inj

8→ 9→ 8→ 8→ 7→ 8→ 8→ 9→ 8→ 8→ 6→ 7→ 8→ 8→

Fentanyl Fentanyl Morphine inj. Oxycodone Fentanyl Morphine inj.

3 2 2 3 2 3 1 3 4 0 2 2 1 0

* Correspondence to: Satoshi Hara, Division of Palliative Care, Kinki University, Osaka, Japan. 1754-3207/$32 © 2007 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.

S. Hara / European Journal of Pain Supplements 1 (2007) 86–87

The administration route of opioids must be changed for patients with digestive tract cancer. Thus, it is desirable to use patches or the subcutaneous or intravenous route in the early stage of therapy.

5. Conclusion (1) In patients with poor PS, the antitumor effects and symptom alleviation provided by chemotherapy were poor,

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whereas opioids were effective in relieving pain, leading to improvement and enhancement of QOL. (2) Alleviation of symptoms with the coadministration of opioids likely contributes to continuation of chemotherapy for patients wishing to fight cancer. (3) A system enabling simultaneous initiation of intensive anticancer treatment and symptom control is needed.