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P198 Impact of Tapentadol for Cancer Pain Treatment
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Selected Abstracts
indicators. Large population studies are required to clarify the relevance of PPG.
P197 Current Practices in Monitoring Dexamethasone-Induced Hyperglycemia on an Inpatient Palliative Care Unit
Tammy Bach1,2, Jurgis Karuza1, Anna Berall1, Altaf Kassam1, Giulia-Anna Perri1,2 1 Baycrest Health Sciences, Toronto, Ontario, Canada 2 University of Toronto, Toronto, Ontario, Canada
Introduction: To minimize monitoring and concerns over iatrogenic hypoglycemia, corticosteroid-induced hyperglycemia is typically managed conservatively. However, studies show that symptomatic hyperglycemia occurs in up to 20% of patients who are on high-dose corticosteroids, suggesting that palliative care patients on corticosteroids may benefit from active glucose control. The study objective was to determine current practices in the monitoring and treatment of dexamethasone-induced hyperglycemia in an inpatient palliative care population. Methods: A retrospective chart review from January 2014 to March 2015 was completed in one inpatient geriatric palliative care unit. Patients on dexamethasone were included. Patients with pre-existing diabetes mellitus or that received dexamethasone through continuous infusion were excluded. Information was abstracted regarding glucose monitoring strategies, hyperglycemia treatment, average daily dose of dexamethasone, palliative performance scale (PPS) and incidence of delirium. Results: Of 133 patients on dexamethasone, 99 met inclusion criteria. 27 of 99 patients (27%) received glucose monitoring and 2 of 27 (7%) monitored patients received hyperglycemia treatment. Glucose monitoring frequency varied from a single check to daily checks. Duration of monitoring varied from a single check to weeks. 23 of 25 (92%) untreated patients had blood glucose levels LT 10mmol/L. Monitored patients had significantly higher average PPS scores (44.07 vs. 38.06, p?0.01) and longer lengths of stay (70.56 vs. 40.15 days, p¼0.03), but showed no difference in incidence of delirium (22.22% vs. 33.33%, p¼0.28) when compared to unmonitored patients. Conclusion: Practice patterns are highly variable in the monitoring and treatment of corticosteroidinduced hyperglycemia. Patients with a higher PPS score tend to receive more monitoring.
Vol. 52 No. 6 December 2016
P198 Impact of Tapentadol for Cancer Pain Treatment
Shoichiro Sazuka1,2, Toshiya Koitabashi2, Tatsuya Ichinohe1 1 Department of Dental Anesthesiology Tokyo Dental College, Chibacity, Chiba, Japan 2 Department of Palliative care medicine Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan Objectives: Tapentadol (TP) has two mechanisms of action: mu-opioid receptor agonism and noradrenaline reuptake inhibition. Since TP has been developed for the management of chronic pain, there is paucity of information regarding the efficacy and tolerability in cancer pain management. The present study was performed to clarify the clinical impact of TP therapy for cancer pain treatment. Methods: After obtaining IRB approval, patients with cancer pain in whom TP was prescribed within 15 months were enrolled. This study was conducted retrospectively. TP was prescribed to treat either moderate nociceptive or neuropathic pain. Pain intensity was evaluated using numerical rating scale (NRS; 010) before and after administering TP. Results: Fifty-nine patients were enrolled and TP, initial dose of 50-300 mg/day, was prescribed. Seven patients were excluded from the analysis due to oral intake failure caused by general physical health deterioration within a few days following TP prescription. Mixed pain mechanisms (nociceptive and neuropathic pain) were found in 22 patients, pure neuropathic and nociceptive pain mechanisms were observed in 19 and 11 patients, respectively. The pain relief could be achieved within 1-13 (median 4) days following TP administration in 46 patients. The median NRS scores were 8 and 2 before and after TP treatment, respectively. Additional pain relief was obtained in 31 patients by increasing doses and their median NRS was 1. There were no nausea and vomiting in opioid naive patients. TP was effective and well tolerated in the management of cancer pain. From baseline to the final assessment, individual reductions in pain intensity of at least 50%, were achieved by 88% of the patients. TP had a better gastrointestinal tolerability profile than other opioids, with a lower incidence of gastrointestinal adverse events. Conclusion: We concluded the benefit ratio of TP appears to be better compared to other opioids.
Selected Abstracts
indicators. Large population studies are required to clarify the relevance of PPG.
P197 Current Practices in Monitoring Dexamethasone-Induced Hyperglycemia on an Inpatient Palliative Care Unit
Tammy Bach1,2, Jurgis Karuza1, Anna Berall1, Altaf Kassam1, Giulia-Anna Perri1,2 1 Baycrest Health Sciences, Toronto, Ontario, Canada 2 University of Toronto, Toronto, Ontario, Canada
Introduction: To minimize monitoring and concerns over iatrogenic hypoglycemia, corticosteroid-induced hyperglycemia is typically managed conservatively. However, studies show that symptomatic hyperglycemia occurs in up to 20% of patients who are on high-dose corticosteroids, suggesting that palliative care patients on corticosteroids may benefit from active glucose control. The study objective was to determine current practices in the monitoring and treatment of dexamethasone-induced hyperglycemia in an inpatient palliative care population. Methods: A retrospective chart review from January 2014 to March 2015 was completed in one inpatient geriatric palliative care unit. Patients on dexamethasone were included. Patients with pre-existing diabetes mellitus or that received dexamethasone through continuous infusion were excluded. Information was abstracted regarding glucose monitoring strategies, hyperglycemia treatment, average daily dose of dexamethasone, palliative performance scale (PPS) and incidence of delirium. Results: Of 133 patients on dexamethasone, 99 met inclusion criteria. 27 of 99 patients (27%) received glucose monitoring and 2 of 27 (7%) monitored patients received hyperglycemia treatment. Glucose monitoring frequency varied from a single check to daily checks. Duration of monitoring varied from a single check to weeks. 23 of 25 (92%) untreated patients had blood glucose levels LT 10mmol/L. Monitored patients had significantly higher average PPS scores (44.07 vs. 38.06, p?0.01) and longer lengths of stay (70.56 vs. 40.15 days, p¼0.03), but showed no difference in incidence of delirium (22.22% vs. 33.33%, p¼0.28) when compared to unmonitored patients. Conclusion: Practice patterns are highly variable in the monitoring and treatment of corticosteroidinduced hyperglycemia. Patients with a higher PPS score tend to receive more monitoring.
Vol. 52 No. 6 December 2016
P198 Impact of Tapentadol for Cancer Pain Treatment
Shoichiro Sazuka1,2, Toshiya Koitabashi2, Tatsuya Ichinohe1 1 Department of Dental Anesthesiology Tokyo Dental College, Chibacity, Chiba, Japan 2 Department of Palliative care medicine Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan Objectives: Tapentadol (TP) has two mechanisms of action: mu-opioid receptor agonism and noradrenaline reuptake inhibition. Since TP has been developed for the management of chronic pain, there is paucity of information regarding the efficacy and tolerability in cancer pain management. The present study was performed to clarify the clinical impact of TP therapy for cancer pain treatment. Methods: After obtaining IRB approval, patients with cancer pain in whom TP was prescribed within 15 months were enrolled. This study was conducted retrospectively. TP was prescribed to treat either moderate nociceptive or neuropathic pain. Pain intensity was evaluated using numerical rating scale (NRS; 010) before and after administering TP. Results: Fifty-nine patients were enrolled and TP, initial dose of 50-300 mg/day, was prescribed. Seven patients were excluded from the analysis due to oral intake failure caused by general physical health deterioration within a few days following TP prescription. Mixed pain mechanisms (nociceptive and neuropathic pain) were found in 22 patients, pure neuropathic and nociceptive pain mechanisms were observed in 19 and 11 patients, respectively. The pain relief could be achieved within 1-13 (median 4) days following TP administration in 46 patients. The median NRS scores were 8 and 2 before and after TP treatment, respectively. Additional pain relief was obtained in 31 patients by increasing doses and their median NRS was 1. There were no nausea and vomiting in opioid naive patients. TP was effective and well tolerated in the management of cancer pain. From baseline to the final assessment, individual reductions in pain intensity of at least 50%, were achieved by 88% of the patients. TP had a better gastrointestinal tolerability profile than other opioids, with a lower incidence of gastrointestinal adverse events. Conclusion: We concluded the benefit ratio of TP appears to be better compared to other opioids.