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Journal of Pain & Palliative Care Pharmacotherapy Volume 37, 2023 - Issue 1
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Articles

Differences in Fentanyl Requirements in Terminally Ill Cancer Patients

Aya WatanabeAya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.Correspondence[email protected]
ORCID Iconhttps://orcid.org/0000-0003-3123-489X
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Naoki ShimadaAya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.ORCID Iconhttps://orcid.org/0000-0003-0722-0076
ORCID Icon,
Hiroto IshikiAya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.ORCID Iconhttps://orcid.org/0000-0002-0800-2161
ORCID Icon,
Noriko FujiwaraAya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.ORCID Iconhttps://orcid.org/0000-0001-8201-9490
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Masanori NojimaAya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.ORCID Iconhttps://orcid.org/0000-0002-8788-2522
ORCID Icon &
Arinobu TojoAya Watanabe, MSc, Naoki Shimada, PhD and Noriko Fujiwara, MSc, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Hiroto Ishiki, MD, Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan. Masanori Nojima, PhD, Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. Arinobu Tojo, PhD, Department of Palliative Medicine, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.ORCID Iconhttps://orcid.org/0000-0001-9016-1948
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Pages 26-33 | Received 05 Apr 2021, Accepted 09 Nov 2022, Published online: 13 Dec 2022
 
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Abstract

Cancer pain is a significant issue in terminally ill cancer patients (TICPs). The fentanyl patch (FP) is used extensively for treating cancer pain, but FP requirements vary between patients. We aimed to identify determinants of FP requirements in TICPs and propose effective pain relief using a FP. In a retrospective chart review, we investigated cancer patients admitted to our hospital from April 2012 to July 2015 and used FP until death. The time course of FP use in TICPs until death was examined. The primary endpoint was the final dose of FP use (FDFP). In total, 79 patients were included the analysis. FDFP was inversely correlated with age (R= −0.262, p = 0.20; Spearman test). FDFP tended to be higher in males than in females and was significantly higher in patients with pancreatic cancer than in patients without pancreatic cancer (p = 0.017; Welch’s test). FP adjustments were more frequent in the last 60 days of life in patients with pancreatic cancer than in patients with other malignancies (P for interaction = 0.002; mixed effect model). In conclusion, younger age, and pancreatic cancer were associated with higher FP requirements in TICPs. TICPs with pancreatic cancer required more frequent FP adjustment near death.

Declaration of interest

The authors have no conflicts of interest in relation to this article.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

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