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Refractory cachexia is associated with increased plasma concentrations of fentanyl in cancer patients

Overview of attention for article published in Therapeutics and Clinical Risk Management, May 2015
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Title
Refractory cachexia is associated with increased plasma concentrations of fentanyl in cancer patients
Published in
Therapeutics and Clinical Risk Management, May 2015
DOI 10.2147/tcrm.s79374
Pubmed ID
Authors

Manabu Suno, Yuriko Endo, Hiroyuki Nishie, Makoto Kajizono, Toshiaki Sendo, Junji Matsuoka

Abstract

An appropriate plasma concentration of fentanyl is the key to achieving good pain control in cancer patients. Cachexia, a multifactorial syndrome, is known to affect drug-metabolizing enzymes. However, the fentanyl concentrations in the blood of patients with cachexia have not been analyzed. The aim of this study was to evaluate the influence of cancer cachexia on dose-adjusted plasma fentanyl concentrations in cancer patients. Blood was collected from 21 Japanese cancer patients treated with a 24-hour trans-dermal fentanyl patch during the steady state of fentanyl plasma concentration. Plasma fentanyl concentrations were analyzed using liquid chromatography with tandem mass spectrometry (LC-MS/MS), and the levels were adjusted with the dose of fentanyl. Laboratory data were collected, and the cachexia stage was determined, based on study by Fearon et al. Multiple regression analysis was performed to identify the factors that affected fentanyl plasma concentrations. Eight patients were classified as precachexia, nine as cachexia, and four as refractory cachexia, and the median dose-adjusted fentanyl concentrations (ng/mL per mg/kg/day) were 27.5, 34.4, and 44.5, respectively. The dose-adjusted fentanyl concentration in patients with refractory cachexia was higher than that in patients with precachexia (Kruskal-Wallis test and post hoc Mann-Whitney U-test, P<0.01). The factors that were found to possibly affect the dose-adjusted concentration of fentanyl included aspartate aminotransferase, C-reactive protein, and estimated glomerular filtration rate, when analyzed as six independent variables (multiple regression analysis, P<0.05). The dose-adjusted plasma concentrations of fentanyl increased with progression of cancer cachexia. Such an increase is associated with a multifactorial and systemic syndrome in cancer cachexia patients, including lower albumin, higher C-reactive protein, and impaired kidney function. In patients with cancer cachexia, we suggest that evaluation of cancer cachexia might help pain management when using a transdermal fentanyl patch in palliative care.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 30 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 30 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 6 20%
Student > Bachelor 3 10%
Student > Postgraduate 3 10%
Researcher 3 10%
Student > Ph. D. Student 3 10%
Other 5 17%
Unknown 7 23%
Readers by discipline Count As %
Medicine and Dentistry 8 27%
Nursing and Health Professions 3 10%
Biochemistry, Genetics and Molecular Biology 2 7%
Pharmacology, Toxicology and Pharmaceutical Science 2 7%
Neuroscience 2 7%
Other 5 17%
Unknown 8 27%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 11 May 2015.
All research outputs
#20,655,488
of 25,371,288 outputs
Outputs from Therapeutics and Clinical Risk Management
#1,070
of 1,323 outputs
Outputs of similar age
#206,507
of 278,911 outputs
Outputs of similar age from Therapeutics and Clinical Risk Management
#36
of 42 outputs
Altmetric has tracked 25,371,288 research outputs across all sources so far. This one is in the 10th percentile – i.e., 10% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,323 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.6. This one is in the 9th percentile – i.e., 9% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 278,911 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 14th percentile – i.e., 14% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 42 others from the same source and published within six weeks on either side of this one. This one is in the 4th percentile – i.e., 4% of its contemporaries scored the same or lower than it.