Transdermal fentanyl for the management of cancer pain: a survey of 1005 patients

Transdermal fentanyl was released in Germany in 1995. From October 1996 to February 1998 transdermal treatment was documented for 1005 patients (506 m en and 499 women with a mean age of 60 years, range 20-92 years) with chron ic pain in an open survey including 290 physicians from hospitals and gener al practitioners throughout Germany. Most patients suffered from cancer pai n and only 11 patients had chronic pain from non-malignant disease. Physici ans were asked to complete a questionnaire for patients treated with transd ermal fentanyl on initiation of therapy (day 0), and days 3, 6, 18, 30 ther eafter, followed by monthly follow-up intervals. Patients were asked to com plete a pain diary. Transdermal therapy was documented from day 0 for 824 p atients, while 181 patients had been treated with transdermal fentanyl befo re admission in the survey. Most of the other 824 patients had been treated with other step 3 opioids (55% of the patients) or step 2 opioids (23%) be fore conversion to transdermal fentanyl, whereas 8% had been treated only w ith non-opioids and 14% had received analgesics only as required or not at ail before initiation of transdermal therapy. The most important reasons fo r switching to transdermal opioid therapy were insufficient pain relief wit h the previous medication followed by a variety of gastrointestinal symptom s impeding oral analgesic therapy, Initial fentanyl doses ranged from 0.6 t o 9.6 mg/day (25 to 400 mug/h) with a median of 1.2 mg/day (50 mug/h). Medi an doses slowly increased throughout the observation period to 2.4 mg/day ( 100 mug/h) after 4 months of treatment. Most patients continued transdermal therapy until the time of death (47% of patients). Other reasons for disco ntinuation were inadequate pain relief (10%), pain relief with other analge sic regimens (10%), other symptoms than pain (5%), rejection of transdermal therapy by the patient (6%) or miscellaneous (16%). Adverse events were do cumented as the reason for discontinuation of transdermal therapy in 49 pat ients (5%). Dyspnoea was documented for seven patients as the reason for di scontinuation. One of these patients. as well as another patient with an ep isode of apnoea, had to be treated with artificial respiration for several hours, but both patients recovered without sequelae. Transdermal therapy wi th fentanyl was safe and efficient in this national survey. Transdermal fentanyl can be recommended for treatment of moderate to severe cancer pain and probably may even be used as a first-line drug on step 3 o f the World Health Organization recommendations in selected patient groups.