Transdermal Fentanyl for Pain Management in Cancer Patients

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Author(s)
Primary Supervisor
Haywood, Alison
Other Supervisors
Norris, Ross
Hardy, Janet
Year published
2015
Metadata
Show full item recordAbstract
Moderate to severe pain is common among cancer patients and affects 70–80 % of patients with advanced cancer. We have the means and the knowledge to relieve pain in many patients, but evidence from surveys and observational studies shows that many patients have troublesome or severe pain and do not get adequate relief. Although opioids remain the only class of drug with the ability to ameliorate severe pain, even in developed countries with access to a range of opioids, opioid formulations and adjuvant therapies, pain management is still a major problem in cancer care. As there is a narrow therapeutic window between pain ...
View more >Moderate to severe pain is common among cancer patients and affects 70–80 % of patients with advanced cancer. We have the means and the knowledge to relieve pain in many patients, but evidence from surveys and observational studies shows that many patients have troublesome or severe pain and do not get adequate relief. Although opioids remain the only class of drug with the ability to ameliorate severe pain, even in developed countries with access to a range of opioids, opioid formulations and adjuvant therapies, pain management is still a major problem in cancer care. As there is a narrow therapeutic window between pain control and toxicity, there is also substantial potential for side-effects, and, therefore, current practice when starting patients on fentanyl (an opioid class of drug) is to begin with a low dose and titrate the dose up slowly according to pain response and adverse events. As a consequence, it is often several days before a patient’s pain is controlled. Little is known about how factors such as patient demographics, organ function, effect of enzyme inhibitor/inducer, or the drug delivery system itself influence the pharmacokinetics (PK) of fentanyl in cancer patients. Better methods are required to monitor, individualise and improve opioid dosing.
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View more >Moderate to severe pain is common among cancer patients and affects 70–80 % of patients with advanced cancer. We have the means and the knowledge to relieve pain in many patients, but evidence from surveys and observational studies shows that many patients have troublesome or severe pain and do not get adequate relief. Although opioids remain the only class of drug with the ability to ameliorate severe pain, even in developed countries with access to a range of opioids, opioid formulations and adjuvant therapies, pain management is still a major problem in cancer care. As there is a narrow therapeutic window between pain control and toxicity, there is also substantial potential for side-effects, and, therefore, current practice when starting patients on fentanyl (an opioid class of drug) is to begin with a low dose and titrate the dose up slowly according to pain response and adverse events. As a consequence, it is often several days before a patient’s pain is controlled. Little is known about how factors such as patient demographics, organ function, effect of enzyme inhibitor/inducer, or the drug delivery system itself influence the pharmacokinetics (PK) of fentanyl in cancer patients. Better methods are required to monitor, individualise and improve opioid dosing.
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Thesis Type
Thesis (PhD Doctorate)
Degree Program
Doctor of Philosophy (PhD)
School
School of Pharmacy
Copyright Statement
The author owns the copyright in this thesis, unless stated otherwise.
Item Access Status
Public
Subject
Transdermal Fentanyl
Opioids
Cancer pain medication
Pharmacokinetics (PK) of fentanyl
Cancer patients