Incidence of Adverse Effects Associated with Strong Opioids Treatment for Oncological Pain
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Abstract
Background: Opioids are the most commonly drugs used in oncological pain treatment due to its potency and availability and the mechanism underlying their adverse effects is secondary to the activation of the subtypes of opioids receptors. The incidence of adverse effects due opioid treatment varies according on the population, drug dosage and individual comorbidities, being the most common ones: Constipation, nausea and vomiting, dyspnea, drowsiness and opioid use disorder. The presence of adverse effects may be crucial in the context of treatment failure, the goal of this research is to report the incidence of adverse effects associated with the use of strong opioids in diagnosed cancer population.
Materials and methods: This research is conducted with outpatients from the “Instituto nacional de cancerología”, the national reference center of oncology in Mexico, from march to september 2023. From the total of 1230 cases that were reviewed, 467 of them met the inclusion criteria. We consider as strong opioids: Morphine, Buprenorphine, Tapentadol, Oxycodone, Fentanyl and Methadone. For the assessment of the incidence of adverse effects, we employ the Edmonton Symptom Assessment Scale, which is standardized on a numerical scale ranging from 0 to 10 points based on the intensity of the adverse effects.
Results: In the studied sample, 59,1% are women. The mean age is 57,6 ± 13,7 years with a mean BMI of 26,5 ± 5,8 kg/m2. The most common adverse effect associated with the use of opioids in cancer patients is constipation, occurring in 25,9% of the cases, followed by nausea and vomiting at 19,1%, respiratory depression at 1,7%, erythema at 1,3% and drowsiness at 1,3%. Fentanil shows the highest incidence of adverse effects, with constipation occurring in 46,7% of cases and nausea and vomiting at 26,7%. Oxycodone follows closely behind with a 41,7% incidence rate for both variables.
Conclusion: The adverse effects in order or frequency were: Constipation, nausea and vomiting, respiratory depression, erythema and drowsiness, exhibiting a minor incidence compared to other reviews. This enables us to understand the influence of our treatments and the precautions to consider in order to prevent an adverse effect from being the cause of opioid treatment failure, especially in oncologic patients with refractory pain.
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