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07-09-2011 | General practice | Article

Sublingual tablet is preferred option for breakthrough cancer pain


Free abstract

MedWire News: Study results show that taking a transmucosal fentanyl product in a sublingual rather than buccal or nasal spray form is the preferred method for patients experiencing breakthrough cancer pain.

Relative to the other forms of administration, a sublingual tablet was more easily accessible, easier to administer, and was more palatable, say the researchers.

"Cancer breakthrough pain often rapidly becomes severe and generally lasts less than 30 minutes," explain Andrew Wilcock and colleagues from the University of Nottingham in the UK in the journal BMJ Supportive and Palliative Care.

"Thus, medication given orally, for example, morphine, has the potential disadvantage of taking too long to work and causing unwanted effects beyond the duration of the pain episode," they add.

The authors remark, however, that information on how to select the most appropriate way to administer transmucosal fentanyl products is lacking. They therefore used recently available placebo versions of the drug to compare the three administration methods (sublingual, buccal/sublingual, nasal spray) and assess patient satisfaction.

A group of 30 cancer patients, aged a mean 65 years, each rated all of the products using a 1-7-point Likert scale. They expressed how far they agreed with statements relating to the products' ease with which a dose can be accessed, its ease of administration, palatability, and patients' overall satisfaction with the method compared with their usual rescue analgesic.

A separate, previous trial has established superior effectiveness of transmucosal fentanyl product over placebo, note Wilcock and co-investigators.

In terms of accessibility, patients' usual rescue analgesic was rated best (median score 3="mildly easy"), which was significantly better than the buccal/sublingual tablet and nasal spray, but not the sublingual tablet.

The nasal spray received the worst rating (median score 7="definitely difficult") and was significantly different to all other administration formats.

Patients' usual rescue analgesic and the sublingual tablet were equally rated the best format for ease of administration (median score 1="definitely easy") while the buccal/sublingual and nasal sprays were considered moderately easy to use; a significant difference.

Of note, 18 patients chose to place the tablet sublingually and 11 chose to place it buccally.

The sublingual tablet scored highest for palatability, with a median of 2 on the Likert scale, denoting it was "moderately" liked. Indeed, 12 positive comments were made relating to its lack of taste and rapid dissolution.

Overall, the sublingual tablet was rated significantly higher than the buccal tablet or nasal spray, with a median rating of 3 ("mildly liked"). A respective 27, 18, and 17 patients indicated that they would be happy to use the products, and 18, six, and two patients chose the methods as their favorite.

"The involvement of service users in this survey has provided valuable feedback which will help inform our formulatory decision-making locally and may also be of interest to other practitioners considering using these products," concludes the research team.

By Sarah Guy

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