Prevalencia de la adherencia terapéutica a opioides mayores en una muestra de pacientes oncológicos avanzados. Estudio piloto / Prevalence of the therapeutic adherence to strong opioids analgesics in a sample of advanced cancer patients. A pilot study

OBJETIVO: Determinar la prevalencia de adherencia terapéutica a opioides mayores de la escala analgésica de la Organización Mundial de la Salud (OMS) medida con el test 4-ítem Morisky Medication Adherence Scale (MMAS-4), en una muestra de pacientes oncológicos avanzados. Conocer los factores asociados a adherencia terapéutica en este tipo de paciente. MATERIAL Y MÉTODO: Estudio observacional prospectivo realizado en la Región Sanitaria de Lleida entre septiembre de 2013 y marzo de 2014. Se incluyeron 89 pacientes oncológicos avanzados consecutivamente, atendidos por equipos específicos de fin de vida, ya sea en el domicilio (PADES) o bien en la consulta externa de ámbito hospitalario (UFISS). Se utilizó el test autoadministrado MMAS-4. RESULTADOS: Se incluyeron un total de 89 pacientes de los cuales 48 (54 %) fueron atendidos por PADES y 41 (46 %) por UFISS. Media de edad (70,3 ± 14,1 años). Pacientes varones 64 (72 %). La dosis equivalente de morfina diaria (MEDD) fue de 76,26 ± 74,73 mg. Un total de 47 pacientes (52,8 %) presentaron adherencia al tratamiento. Haber recibido analgésicos por vía transdérmica es un factor que contribuye a la mala adherencia terapéutica (p = 0,006) y fallar la pregunta D del MMAS-4 junto con género femenino contribuye a la mala adherencia terapéutica (p = 0,027). DISCUSIÓN: Se detecta un 52,8 % de adherencia terapéutica a opioides del tercer escalón de la OMS en la muestra estudiada

AIM: To determine the prevalence of the therapeutic adherence to strong opioids analgesics (third step of the analgesic ladder of the World Health Organization [WHO]) in a sample of advanced cancer patients using the Morisky-Green-Levine tool (MMAS-4) and to know the factors associated. METHODS: Observational and prospective study carried out in the Sanitary Region of Lleida between September 2013 and March 2014. A total of 89 advanced cancer patients consecutively attended by end-of-life specific teams both at home (PADES) and at the hospital (UFISS) were included. The self-administered 4-items Morisky-Green-Levine test was used. RESULTS: Mean of age (70, 3 ± 14, 1 years). Man 64 (72 %). Patients attended by the Home care Team 48 patients (54 %). The Morphine Equivalent Daily Dose (MEDD) was 76.26 ± 74.73 mg. The therapeutic adherence was detected in 47 patients (52.8 %). Factors related to the route of administration of the analgesic (transdermal, p = 0,006) and between female genre and to fail to question D of the MMAS-4 (p = 0,027) were detected in the multivariate analysis. DISCUSSION: We detected a prevalence of therapeutic adherence to the analgesics of the third ladder of the WHO of 52,8 % in the sample studied

Prevalence and characteristics of breakthrough cancer pain in an outpatient clinic in a Catalan teaching hospital: incorporation of the Edmonton Classification System for Cancer pain into the diagnostic algorithm.

BACKGROUND: Breakthrough cancer pain (BTcP) is defined according to its principal characteristics: high intensity, short time interval between onset and peak intensity, short duration, potential recurrence over 24 h and non-responsiveness to standard analgesic regimes. The Edmonton Classification System for Cancer Pain (ECS-CP) is a classification tool that evaluates different dimensions of pain. The aim of this study was to measure prevalence and the main characteristics of BTcP in a sample of advanced cancer patients and to explore the complexity observed when ECS-CP is incorporated into BTcP diagnostics algorithm. METHODS: Descriptive prevalence study (Retrospective chart review). Davies' algorithm was used to identify BTcP and ECS-CP was used to recognize appropriate dimensions of pain. The study was conducted in a sample of advanced cancer patients attending hospital outpatient clinic in Lleida, Spain. 277 patients were included from 01/01/2014 to 31/12/2015. No direct contact was made with participants. The following information was extracted from the palliative care outpatient clinic database: age, gender, civil status, cognitive impairment status, functional performance status and variables related to tumour. Only BTcP cases were included. RESULTS: Prevalence of BTcP was 39.34% (63.9% men). Mean of age was 68.2 years. Main diagnosis was lung cancer (n = 154; 31.6%). Metastases were diagnosed in 83% of the sample. 138 patients (49.8%) were diagnosed with 1 type of BTcP and 139 (50.2%) were diagnosed with more than one type of BTcP. In total, 488 different types of BTcP were recorded (mean 1.75 ± 0, 9), 244 of these types (50%) presented a component of neuropathic pain. Addictive behaviour, measured through CAGE test, was present in 29.2% (N = 81) of the patients and psychological distress was present in 40.8% (n = 113). CONCLUSIONS: Prevalence of BTcP (39.34%) is similar to the one reflected in the existing literature. Study results indicate that the routine use of ECS-CP in a clinical setting allows us to detect more than one type of BTcP as well as additional complexity associated with pain (neuropathic, addictive behavior and psychological distress).