Efficacy and safety of fentanyl buccal for cancer pain management by administration through a soluble film: an update

More than half of patients receiving prescription medicine for cancer pain have been reported to experience inadequate pain relief or breakthrough pain. Buccal administration can deliver lipophilic opioids rapidly to the systemic circulation through the buccal mucosa, limiting gastrointestinal motility and first-pass metabolism. This review updates the safety and efficacy of fentanyl buccal soluble film (FBSF) in patients with cancer pain. Literature was identified through searches of Medline (PubMed). Search terms included combinations of the following: cancer pain, fentanyl, fentanyl buccal soluble film, pharmacology, kinetics, safety, efficacy and toxicity. FBSF is an oral transmucosal form of fentanyl citrate developed as a treatment of breakthrough pain in opioid-tolerant patients with cancer. Studies have shown that it is well tolerated in the oral cavity, with adequate bioavailability and safety in cancer patients. Further studies are warranted to evaluate, in comparison with other short-acting opioids, its efficacy in the management of breakthrough cancer pain, its addictive potential and its economic impact in cancer patients

Characteristics and outcomes of advanced cancer patients who miss outpatient supportive care consult appointments

Background: Missed appointments (MA) are frequent, but there are no studies on the effects of the first MA at supportive care outpatient clinics on clinical outcomes.Methods: We determined the frequency of MA among all patients referred to our clinic from January\ue2\u80\u93December 2011 and recorded the clinical and demographic data and outcomes of 218 MA patients and 217 consecutive patients who kept their first appointments (KA).Results: Of 1,352 advanced-cancer patients referred to our clinic, 218 (16\uc2 %) had an MA. The MA patients\ue2\u80\u99 median age was 57\uc2 years (interquartile range, 49\ue2\u80\u9367). The mean time between referral and appointment was 7.4\uc2 days (range, 0\ue2\u80\u9371) for KA patients vs. 9.1\uc2 days (range, 0\ue2\u80\u9389) for MA patients (P = 0.006). Reasons for missing included admission to the hospital (17/218 [8\uc2 %]), death (4/218 [2\uc2 %]), appointments with primary oncologists (37/218 [18\uc2 %]), other appointments (19/218 [9\uc2 %]), visits to the emergency room (ER) (9/218 [9\uc2 %]), and unknown (111/218 [54\uc2 %]). MA patients visited the ER more at 2\uc2 weeks (16/214 [7\uc2 %] vs. 5/217 [2\uc2 %], P = 0.010) and 4\uc2 weeks (17/205 [8\uc2 %] vs. 8/217 [4\uc2 %], P = 0.060). Median-survival duration for MA patients was 177\uc2 days (range, 127\ue2\u80\u93215) vs. 253\uc2 days (range, 192\ue2\u80\u93347) for KA patients (P = 0.013). Multivariate analysis showed that MAs were associated with longer time between referral and scheduled appointment (odds ratio [OR], 1.026/day, P = 0.030), referral from targeted therapy services (OR, 2.177, P = 0.004), living in Texas/Louisiana regions (OR, 2.345, P = 0.002), having an advanced directive (OR, 0.154, P < 0.0001), and being referred for symptom control (OR, 0.024, P = 0.0003).Conclusion: MA patients with advanced cancer have worse survival and increased ER utilization than KA patients. Patients at higher risk for MA should undergo more aggressive follow-up. More research is needed