Opioids in pain management of mesothelioma and lung cancer patients

Figures & data

Table I. Characteristics of the patients with mesothelioma and lung cancer.

	Mesothelioma N= 22	Lung cancer N= 88
Gender: Male Female	16 (73%) 6 (23%)	64 (73%) 24 (23%)
Age	63 years, SD= 9.6 (range 41–79)	63 years, SD = 9.6 (range 37–80)
Karnofsky (Mean)	63, SD = 16.6 (range 30–90)	56, SD= 16.2 (range 20–90)
Hb level (Mean) < 120 g/l	11.6, SD= 1.6 13 (59%)	11.6, SD= 1.6 52 (59%)
Mean time (range) since diagnosis months	13.4 (range 0–95)	9.9 (range 0–106)
Mean time (range) since initiation of opioid treatments months	8.8 (0–69)	3.3 (0–48)

Table II. Key characteristics of pain in mesothelioma and lung cancer patients.

	Mesothelioma N = 22	%	Lung cancer N= 88	%	Significance@
Pain category Bone/soft-tissue pain Mixed pain Visceral pain Neuropathic pain	8 11 2 1	36 50 9 5	41 36 7 2	47 41 8 2	p = 0.765
Localization of pain (main site) Thorax front/abdomen Abdominal/pelvic	12 10	55 46	38 26	59 36	p = 0.453
Patient assessment/Have you had pain (EORTC QoL)* Not at all A little Quite a bit Very much	1 6 11 3	5 27 50 14	5 18 27 19	7 26 39 28	p= 0.619
Physician's assessment of pain** Not at all A little Quite a bit Very much	1 12 7 2	5 55 32 9	13 38 26 10	15 44 30 11	p= 0.602

*Assessed by 69/88 patients, **Assessed for 87 patients; @Fisher's exact test.

Table III. Determinants of pain in univariate analysis of lung cancer patients. Number (%).

Variables	Moderate to severe pain		Crude OR	95% CI	Significance p
	Present	Absent
Gender: Male Female	23 (36) 13 (54)	40 (64) 11 (46)	0.49	0.2–1.3	0.137
Age: Below median Above median	26 (51) 10 (28)	25 (49) 26 (72)	2.70	1.1–6.7	0.029
Karnofsky: Below median Above median	30 (50) 6 (22)	30 (50) 21 (78)	3.50	1.2–9.9	0.013
Hb: Below 120 Above 120	21 (41) 15 (42)	30 (59) 21 (58)	0.98	0.4–2.3	0.964
Fatigue: Yes No	33 (45) 3 (23)	41 (55) 10 (77)	2.68	0.7–10.6	0.134
Nausea: No Yes	12 (52) 24 (38)	11 (48) 40 (62)	1.81	0.7–4.8	0.223
Depression: Yes No	20 (39) 16 (46)	31 (61) 19 (54)	0.77	0.3–1.8	0.549
Dyspnoea: Yes No	19 (40) 17 (44)	29 (60) 22 (56)	0.85	0.4–1.9	0.706
Anxiety: Yes No	28 (46) 8 (31)	33 (54) 18 (69)	1.90	0.7–5.1	0.185
Constipation: Yes No	19 (45) 16 (36)	23 (55) 28 (64)	1.45	0.6–3.4	0.402
Sleeplessness: Yes No	23 (56) 12 (27)	18 (44) 32 (73)	3.40	1.4–8.4	0.007
Breakthrough pain: Yes No	26 (52) 10 (27)	24 (48) 27 (73)	2.92	1.2–7.3	0.018
Anorexia: Yes No	17 (40) 19 (43)	26 (60) 25 (57)	0.86	0.4–2.0	0.730

*χ²-test, Likelihood ratio statistic (two-sided).

Table IV. Determinants of pain in univariate analysis of mesothelioma patients.

Variables	Moderate to severe pain		Crude OR	95% CI	Significance p
	Present	Absent
Gender: Male Female	6 (38) 3 (50)	10 (63) 3 (50)	0.60	0.1–3.9	0.655
Age: Below median Above median	6 (46) 3 (33)	7 (54) 7 (67)	1.71	0.3–9.9	0.674
Karnofsky: Below median Above median	6 (67) 3 (30)	3 (33) 7 (70)	2.33	0.4–13.7	0.415
Hb: Below 120 Above 120	5 (39) 4 (44)	8 (62) 5 (56)	0.78	0.1–4.4	1.000
Fatigue: Yes No	9 (43) 0 (0)	12 (57) 1 (100)	0.57	0.4–0.8	1.000
Nausea: No Yes	4 (67) 5 (31)	2 (33) 11 (69)	4.40	0.6–32.5	0.178
Depression: Yes No	6 (43) 3 (38)	8 (57) 5 (63)	1.25	0.2–7.4	1.000
Dyspnoea: Yes No	5 (36) 4 (50)	9 (64) 4 (50)	0.56	0.1–3.3	0. 662
Anxiety: Yes No	9 (50) 0 (0)	9 (50) 4 (100)	0.50	0.3–0.8	0.115
Constipation: Yes No	7 (50) 2 (25)	7 (50) 6 (75)	3.00	0.4–20.3	0.380
Sleeplessness: Yes No	5 (46) 4 (36)	6 (55) 7 (64)	1.46	0.3–8.1	1.000
Breakthrough pain: Yes No	7 (54) 2 (22)	6 (46) 7 (78)	4.1	0.6–27.7	0.203
Anorexia: Yes No	7 (58) 2 (20)	5 (42) 8 (80)	5.6	0.8–38.5	0.099

*Fisher's exact test (two-sided).

Table V. Pain and other covariates associated with mesothelioma and lung cancer patients in a nested case-control setting*.

	Dependent variable: Mesothelioma (cases) or lung cancer (controls)
Covariates	Crude OR	95% CI	p	@Adjusted OR	95% CI	p
Age (at enrolment)	MV			MV
Gender	MV			MV
Karnowsky (median cut-off) (> median: reference)	1.91	0.6–6.0	p= 0.266	2.29	0.6–8.2	p= 0.203
Hb (120 cut-off) (> 120: reference)	1.00	0.4–2.7	p= 1.000	1.08	0.4–3.3	p= 0.883
Fatigue (yes: reference)	3.44	0.5–24.4	p= 0.215	5.16	0.8–31.3	p= 0.074
Nausea (yes: reference)	1.05	0.4–3.2	p= 0.920	0.70	0.2–2.4	p= 0.574
Depression (yes: reference)	1.17	0.5–2.9	p= 0.729	0.90	0.3–2.9	p= 0.869
Dyspnoea (yes: reference)	1.37	0.5–3.9	p= 0.540	1.82	0.6–5.7	p = 0.300
Anxiety (yes: reference)	1.81	0.5–6.1	p= 0.335	1.46	0.4–5.6	p= 0.581
Constipation (yes: reference)	1.72	0.6–4.8	p= 0.295	1.71	0.6–5.2	p= 0.335
Sleeplessness (yes: reference)	1.11	0.4–2.8	p= 0.822	1.28	0.5–3.3	p= 0.605
Breakthrough pain (yes: reference)	1.05	0.4–3.1	p= 0.927	1.10	0.3–3.7	p= 0.869
Anorexia (yes: reference)	1.19	0.4–3.3	p= 0.730	0.82	0.2–3.0	p= 0.768
Total opioid dose (median cut-off) (> median: reference)	1.00	0.4–2.4	p= 1.000	1.04	0.4–2.7	p= 0.931

*Analyzed by conditional logistic regression models, robust CVE; MV, matching variable; NC, not computable; @adjusted for all covariates in the model except for the matching variables.