As Population Ages And Need For Palliative Care Grows, Experts Tackle New Challenge For The First Time At European Meeting

Main Category: Pain / Anesthetics
Also Included In: GastroIntestinal / Gastroenterology;  Caregivers / Homecare
Article Date: 29 May 2008 - 3:00 PDT

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Experts from across Europe are gathering at a scientific symposium held at the fifth European Association for Palliative Care (EAPC) congress in Trondheim, Norway, on the 29th May, to discuss the challenges of managing an overlooked and distressing symptom that affects large numbers of patients receiving opioids as part of palliative care management for advanced illness: opioid-induced constipation (OIC). It is a condition that is often under-diagnosed in patients in the palliative care setting.

As Europe's population ages, so the number of patients living with advanced illness is likely to increase.1 Pain relief is often a key part of palliative care and opioids are routinely used to relieve the pain.2 However, the effective pain relief provided by opioids is often accompanied with a less welcome side-effect and OIC is a near universal occurrence in patients receiving opioid analgesics in the palliative care setting.3,4 OIC can be so severe, that it may result in patients choosing to sacrifice their pain medication, to mitigate the problem.

"OIC usually goes under-diagnosed", says Professor Kaasa, St Olave's University Hospital, Norway. "Clinicians don't ask about it and patients don't talk about it, which means it is often poorly managed. The discomfort and distress of OIC can affect the quality of life of patients receiving palliative care for advanced illness."

"OIC is a significant cause of distress", concurs Dr Philip Larkin, Senior Lecturer in Nursing, National University of Ireland. "A recent survey showed that a third of patients in Europe with moderate to severe symptoms receive no treatment.5 We need to put in place a European-wide consensus on how to diagnose and manage this problem now, as the demand for palliative care is growing and is predicted to continue to grow as the population of Europe ages."

"For too long OIC has been a burden for our patients despite our current treatments", notes Dr Jay Thomas, Center for Palliative Studies at San Diego Hospice and The Institute for Palliative Medicine, United States. "As clinicians, we have to be vigilant to diagnose it and aggressively treat it. Having new tools that enable OIC to be treated without interfering with pain management is a welcome addition that can help relieve suffering and give patients back some control and quality of life."

Each year, more than 1.5 million Americans receive palliative care due to an advanced illness, such as incurable cancer, end-stage heart and lung disease, or AIDS.6,7 Similar figures are not available for Europe, which may be considered indicative of the fact that this is an overlooked condition and an area of unmet medical need. However, despite this problem and the limitations of laxative therapies experts concluded that with the introduction of novel targeted therapies, the outlook for patients suffering from the distressing condition looks more positive.

The clinical impact of OIC was discussed at a scientific symposium sponsored by Wyeth, which convened a wide range of experts in palliative care including geriatricians, oncologists, nurses, researchers, palliative care physicians and general physicians. The experts will discuss the challenges in diagnosing and managing the condition in patients in the palliative care setting. They will also be discussing the limitations of laxative therapies and insights into the future with novel targeted therapies which convey a bright outlook for the distressing condition.

About Wyeth Pharmaceuticals

Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the areas of women's health care, infectious disease, gastrointestinal health, central nervous system, inflammation, transplantation, hemophilia, oncology, vaccines and nutritional products. Wyeth is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing and marketing of pharmaceuticals, vaccines, biotechnology products, nutritionals and non-prescription medicines that improve the quality of life for people worldwide. The Company's major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health.

Additional information on Wyeth is available at http://www.wyeth.eu

The EAPC Research Forum addresses researchers and clinicians from all disciplines specialised in palliative care.

Wyeth is developing methylnaltrexone bromide, a peripherally acting mu-opioid receptor antagonists (PAMORA) that reverses the constipating effects of opioid pain medications in the gastrointestinal tract without affecting their ability to relieve pain. In April 2008 it was approved for use in the US by the FDA and received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) in Europe.

References

1. Davies E, Higginson I. Better Palliative Care for Older People. WHO, 2004. See here.

2. Gutstein HB, Akil H. Opioid Analgesics. In: Brunton LL, Lazo JS, Parker KL, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11th Ed. New York, NY: McGraw-Hill; 2006: 547-590

3. Fallon MT. Constipation in cancer patients: prevalence, pathogenesis, and cost-related issues. Eur J Pain. 1999;3(suppl A):3-7

4. Emanuel EJ, Emanuel LL. Palliative and end-of-life care. In: Kasper DL, Braunwald E, Fauci AS, et al, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:53-66

5. Laugsand EA, EAPC et al. Unpublished findings

6. Miniño AM, Heron M, Murphy SL, et al. Deaths: final data for 2004. Health E-Stats. Released November 24, 2006. Available here. Accessed March 9, 2007

7. National Hospice and Palliative Care Organization. NHPCO's Facts and Figures - 2005 Findings. Available here. Accessed May 30, 2007

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