Quality of life and cancer pain: satisfaction and side effects with transdermal fentanyl versus oral morphine.

TLDR

The study compared pain‑related satisfaction, side‑effect perception, functioning, and well‑being between advanced cancer patients treated with transdermal fentanyl and those receiving sustained‑release oral morphine. A cross‑sectional quality‑of‑life survey of 504 assessable cancer patients employed validated instruments (FACT‑G, BPI, MOS, MSAS) and study‑specific scales to evaluate these outcomes. Patients on fentanyl reported higher overall satisfaction and fewer, less impactful side effects than those on oral morphine, despite being older and having lower functioning, while pain intensity, sleep, and symptom scores were similar across groups.

Abstract

PURPOSE To compare pain-related treatment satisfaction, patient-perceived side effects, functioning, and well-being in patients with advanced cancer who were receiving either transdermal fentanyl (Duragesic, Janssen Pharmaceuticals, Titusville, NJ) or sustained-release oral forms of morphine (MS Contin, Perdue Frederick Co, Norwalk, CT, or Oramorph SR, Roxanne Laboratories, Columbus, OH). PATIENTS AND METHODS A total of 504 assessable cancer patients participated in this cross-sectional, quality-of-life study. Relevant elements of four validated scales were used--the Functional Assessment of Cancer Therapy-General (FACT-G) scale, the Brief Pain Inventory (BPI), the Medical Outcomes Study (MOS) questionnaire, and the Memorial Symptom Assessment Scale (MSAS)--as well as original scales that were developed and validated for this study. RESULTS The majority of patients in both treatment groups had late-stage (IV/D) cancer. Patients who received transdermal fentanyl were more satisfied overall with their pain medication than those who received sustained-release oral forms of morphine (P = .035). Fentanyl patients also experienced a significantly lower frequency (P < .002) and impact (P < .001) of pain medication side effects. These results occurred despite the fact that cancer patients who received fentanyl were significantly older (P < .001) and had significantly lower functioning and well-being scores (P = .001). Measures of pain intensity, sleep adequacy, and symptoms demonstrated no significant differences between treatment groups. CONCLUSION These data suggest that patients are more satisfied with transdermal fentanyl compared with sustained-release oral forms of morphine. A lower frequency and reduced impact of side effects with transdermal fentanyl may be one reason cancer patients who receive fentanyl are more satisfied with their pain management.