Journal of Clinical Case Reports

The Question of Therapy Continuation in the Light of Dependence on Short-Acting Opioids in Long-Term Cancer Patient

Abstract

Zaforemska A, Olczak B and Ciałkowska-Rysz A

Introduction: The risk of addiction in cancer patients with a relatively good prognosis is a challenge for modern medicine. As the number of therapies increases, so do patient survival and, consequently, the risk of inappropriate use of opioid drugs, especially the short-acting ones. The aim of the present study is to evaluate the decision to continue therapy with a short-acting fentanyl preparation and suggest possible alterations in the treatment plan of an addicted patient.

Methods and materials: The present study concerns a 49-year-old male patient with an advanced neuroendocrine tumour in the pre-sacral region. The tumour infiltrates the rectal wall and has formed metastases to the liver, lungs and bones. The patient is under the care of the Palliative Medicine Clinic due to the reported severe pain, assessed as 7-10 on the Numeric Rating Scale (NRS). In the course of the therapy with opioid analgesics, the patient has developed an addiction to the prescribed short-acting intranasal fentanyl preparation. The attempts to modify the treatment have not produced the desired effects due to aggravation of the symptoms and a lack of compliance. The patient remains pleased with the therapy and considers the prescribed fentanyl preparation to be the only effective drug. The research method includes the medical history and physical, an analysis of the patient’s medical record and a self-designed questionnaire to assess the degree of dependence on opioid drugs. The questionnaire consists of 19 questions divided into the major and minor criteria.

Conclusion: The analysis of the results of the survey results confirmed the patient’s dependence on opioid drugs. He gave positive answers to 16 out of 19 questions in the survey. The history and physical revealed that the patient was pleased with the instituted therapy as it allowed him to remain physically fit and maintain a high quality of life. Because of the advanced stage of the neoplastic process as well as the significantly increased pain, the improvement of life quality is of the utmost importance. Therefore, it seems justified to continue the intranasal fentanyl preparation therapy since it is both well- tolerated by the patient and able to produce a highly satisfactory analgesic effect.