Does transdermal fentanyl work in patients with low BMI? Patient-reported outcomes of pain and percent pain relief in cancer patients on transdermal fentanyl

Natalie Moryl; Ali Bokhari; Yvona Griffo; Rachel Hadler; Lauren Koranteng; Alexandra Filkins; Tianyu Zheng; Susan D Horn; Charles E Inturrisi

doi:10.1002/cam4.2479

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Does transdermal fentanyl work in patients with low BMI? Patient-reported outcomes of pain and percent pain relief in cancer patients on transdermal fentanyl

Journal article

Open access

Peer reviewed

Does transdermal fentanyl work in patients with low BMI? Patient-reported outcomes of pain and percent pain relief in cancer patients on transdermal fentanyl

Natalie Moryl, Ali Bokhari, Yvona Griffo, Rachel Hadler, Lauren Koranteng, Alexandra Filkins, Tianyu Zheng, Susan D Horn and Charles E Inturrisi

Cancer medicine (Malden, MA), Vol.8(18), pp.7516-7522

12/2019

DOI: 10.1002/cam4.2479

PMCID: PMC6912029

PMID: 31568684

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Abstract

Low body mass index (BMI) is suspected of being associated with low transdermal fentanyl (TDF) blood levels and worse pain relief. Clinical pain data to support this claim are lacking. Using a Chronic Pain Registry, we identified 901 cancer patients who received TDF at outpatient pain service clinics of our cancer center from 7/1/2011 to 12/1/2016. Of these, 240 patients had a BMI measure, pain intensity, and pain relief scores documented within 30 days of a TDF order. We examined associations between BMI, TDF dose, Worst and Least pain scores, and pain relief scores using standard statistical tests. In cancer patients receiving TDF, low BMI (<18.5) was significantly associated with greater pain relief irrespective of TDF dose and borderline significantly associated with greater percent pain relief after controlling for age, cancer diagnoses, and pain etiology (P = .073), suggesting that low BMI may independently predict better pain relief in cancer patients. As there were no significant associations between BMI and TDF dose, we find no basis for BMI-dependent dose modification or avoiding TDF in cachectic and low BMI patients. When predicting percent pain relief, we conclude that there is no basis for avoiding TDF or modifying its dose in cancer patients with low BMI and cachexia.

Administration, Cutaneous

Analgesics, Opioid - administration & dosage

Body Mass Index

Cancer Pain - drug therapy

Cancer Pain - epidemiology

Cancer Pain - etiology

Female

Fentanyl - administration & dosage

Humans

Male

Neoplasms - complications

Neoplasms - epidemiology

Pain Management

Patient Reported Outcome Measures

Details

Title: Subtitle: Does transdermal fentanyl work in patients with low BMI? Patient-reported outcomes of pain and percent pain relief in cancer patients on transdermal fentanyl
Creators: Natalie Moryl - Memorial Sloan Kettering Cancer Center
Ali Bokhari - Memorial Sloan Kettering Cancer Center
Yvona Griffo - Memorial Sloan Kettering Cancer Center
Rachel Hadler - Memorial Sloan Kettering Cancer Center
Lauren Koranteng - Memorial Sloan Kettering Cancer Center
Alexandra Filkins - Memorial Sloan Kettering Cancer Center
Tianyu Zheng - University of Utah
Susan D Horn - University of Utah
Charles E Inturrisi - Cornell University
Resource Type: Journal article
Publication Details: Cancer medicine (Malden, MA), Vol.8(18), pp.7516-7522
DOI: 10.1002/cam4.2479
PMID: 31568684
PMCID: PMC6912029
NLM abbreviation: Cancer Med
ISSN: 2045-7634
eISSN: 2045-7634
Grant note: Weill Cornell Medical College Bridge Fund RC2 DA028928 / NIDA NIH HHS R25CA020449 / National Cancer Institute of the National Institutes of Health P30 CA008748 / NCI NIH HHS
Language: English
Date published: 12/2019
Academic Unit: Anesthesia
Record Identifier: 9984296142402771

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