Determinants of Opioid Efficiency in Cancer Pain: a Comprehensive Multivariate Analysis from a Tertiary Cancer Centre

Background: Pain is one of the most terrifying symptoms for cancer patients. Although most patients withcancer pain need opioids, complete relief of pain is hard to achieve. This study investigated the factors influencingpersistent pain-free survival (PPFS) and opioid efficiency. Materials and
Methods: A prospective study wasconducted on 100 patients with cancer pain, hospitalized at the medical oncology clinic of Akdeniz University.Patient records were collected including patient demographics, the disease, treatment characteristics, and detailsof opioid usage. Pain intensity was measured using a patient self-reported visual analogue scale (VAS). The areaunder the curve (AUC) reflecting the pain load was calculated from daily VAS tables. PPFS, the primary measureof opioid efficacy, was described as the duration for which a patient reported a greater than or equal to two-pointdecline in their VAS for pain. Predictors of opioid efficacy were analysed using a multivariate analysis.
Results:In the multivariate analysis, PPFS was associated with the AUC for pain (Exp (B)=0.39 (0.23-0.67), P=0.001),the cumulative opioid dosage used during hospitalisation (Exp (B)=1.00(0.99-1.00), P=0.003) and changes in theopioid dosage (Exp (B)=1.01 (1.00-1.01), P=0.016). The change in VAS score over the standard dosage of opioidswas strongly associated with current cancer treatment (chemotherapy vs. others) (ß=-0.31, T=-2.81, P=0.007)and the VAS for pain at the time of hospitalisation (ß=-0.34, T=-3.07, P= 0.003).
Conclusions: The pain load,opioid dosage, concurrent usage of chemotherapy and initial pain intensity correlate with the benefit receivedfrom opioids in cancer patients.