PMID- 30776537
OWN - NLM
STAT- MEDLINE
DCOM- 20200909
LR  - 20200909
IS  - 1873-6513 (Electronic)
IS  - 0885-3924 (Linking)
VI  - 57
IP  - 5
DP  - 2019 May
TI  - The Burden of Opioid Adverse Events and the Influence on Cancer Patients' 
      Symptomatology.
PG  - 899-908.e6
LID - S0885-3924(19)30060-0 [pii]
LID - 10.1016/j.jpainsymman.2019.02.009 [doi]
AB  - CONTEXT: Opioids are frequently used for the treatment of moderate-to-severe pain 
      and their use may produce a number of unwanted adverse events (AEs). OBJECTIVES: 
      The objective of this study was to understand the burden of opioid-induced AEs in 
      cancer patients with pain after the introduction of strong opioids (WHO Step 
      III). METHODS: This is a cohort study derived from a randomized controlled trial 
      involving 498 cancer patients with pain who received strong opioids. During 
      28-day follow-up, we analyzed frequency, intensity, and changes over time of the 
      main opioid-induced AEs; the influence of previous pain therapy on AEs; and the 
      relationships between the presence of AEs and analgesic response. RESULTS: After 
      starting strong opioids, dry mouth, nausea, and vomiting immediately increased 
      and persisted over time, constipation continued to increase, while drowsiness and 
      confusion tended to decrease. Patients previously treated with weak opioids had 
      more frequent and severe AEs. While at all observation points the percentage of 
      patients without AEs was 37%-39%, considering all the five scheduled visits, from 
      Day 3 to Day 28, 17% of patients never experienced any AEs, while 48% of patients 
      had four or more concomitant AEs. Patients with no AEs experienced significantly 
      lower pain intensity. CONCLUSION: Opioid introduction induces various AEs that 
      persist over time and worse patients' symptomatology. Moreover, there seems to be 
      a different expression of the opioid toxicity among patients, and a possible 
      interaction between AEs and the analgesic response. The balance between the 
      opioids analgesic effect and induced toxicity is fundamental in deciding the best 
      management for pain in cancer patients.
CI  - Copyright (c) 2019 American Academy of Hospice and Palliative Medicine. Published 
      by Elsevier Inc. All rights reserved.
FAU - Corli, Oscar
AU  - Corli O
AD  - Department of Oncology, Unit of Pain and Palliative Care Research, Laboratory of 
      Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario 
      Negri IRCCS, Milan, Italy. Electronic address: oscar.corli@marionegri.it.
FAU - Santucci, Claudia
AU  - Santucci C
AD  - Department of Oncology, Unit of Cancer Epidemiology, Laboratory of Methodology 
      for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 
      Milan, Italy.
FAU - Corsi, Nicole
AU  - Corsi N
AD  - Department of Oncology, Unit of Pain and Palliative Care Research, Laboratory of 
      Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario 
      Negri IRCCS, Milan, Italy.
FAU - Radrezza, Silvia
AU  - Radrezza S
AD  - Department of Public Health, Laboratory for Public Health, Istituto di Ricerche 
      Farmacologiche Mario Negri IRCCS, Milan, Italy.
FAU - Galli, Francesca
AU  - Galli F
AD  - Department of Oncology, Unit of Statistics, Laboratory of Methodology for 
      Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, 
      Italy.
FAU - Bosetti, Cristina
AU  - Bosetti C
AD  - Department of Oncology, Unit of Cancer Epidemiology, Laboratory of Methodology 
      for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 
      Milan, Italy.
LA  - eng
PT  - Clinical Trial, Phase IV
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
DEP - 20190216
PL  - United States
TA  - J Pain Symptom Manage
JT  - Journal of pain and symptom management
JID - 8605836
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Aged
MH  - Analgesics, Opioid/*adverse effects/therapeutic use
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Neoplasms/*complications
MH  - Pain/*complications/*drug therapy
MH  - Time Factors
OTO - NOTNLM
OT  - Cancer pain
OT  - adverse events
OT  - opioids
OT  - symptoms
EDAT- 2019/02/19 06:00
MHDA- 2020/09/10 06:00
CRDT- 2019/02/19 06:00
PHST- 2018/12/19 00:00 [received]
PHST- 2019/02/07 00:00 [revised]
PHST- 2019/02/10 00:00 [accepted]
PHST- 2019/02/19 06:00 [pubmed]
PHST- 2020/09/10 06:00 [medline]
PHST- 2019/02/19 06:00 [entrez]
AID - S0885-3924(19)30060-0 [pii]
AID - 10.1016/j.jpainsymman.2019.02.009 [doi]
PST - ppublish
SO  - J Pain Symptom Manage. 2019 May;57(5):899-908.e6. doi: 
      10.1016/j.jpainsymman.2019.02.009. Epub 2019 Feb 16.