Facteurs prédictifs du recours à au moins deux paliers de titration de Fentanyl d’action rapide (FAR) chez des patients avec douleurs liées au cancer

Abstract : Introduction: pain is one of the most common symptoms in cancer patients. In addition to their background pain, 50 to 80% of these patients present breakthrough pains (BTP) responsible for significant morbidity. These BTP can be treated with fast-acting fentanyl (FAR). A titration is recommended to obtain the minimum effective dosage of FAR. In patients requiring high doses, this titration can be long, making prescribing and follow-up difficult and increasing risks of discomfort, misuse or even abandonment of the treatment by the patient. The objective of this exploratory work is to identify factors predicting the need for at least two levels of titration after initiation of a FAR therapy to help the follow up organization of these patients. Methods: we performed an observational, transversal and monocentric study in the department of palliative medicine of Bordeaux teaching hospital. This study was conducted between 01/01/2013 and 31/12/2016 in patients with cancer pain already treated with opioids in background therapy and requiring a FAR titration. Results: of the 91 patients included, 84 were analyzed. The median age was at 66 years and sex ratio for men were 60.7%. ADPs mainly occurred spontaneously (69%) with an effective mean dosage of FAR at 149.6μg. In univariate analysis, a high daily dose of background opioid (≥ 300 mg / d) appears to be significantly associated with the delivery of at least two titration levels at initiation of FAR (p = 0.01). Other characteristics were not found to be statistically significant. Conclusion: patients with high dosages of opioids in the background may be at risk for longer titration. Further multivariate analyses are required to confirm this result.
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Master Thesis
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Audrey Paoletti. Facteurs prédictifs du recours à au moins deux paliers de titration de Fentanyl d’action rapide (FAR) chez des patients avec douleurs liées au cancer. Médecine humaine et pathologie. 2018. ⟨dumas-02062130⟩

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