An Easier Way to Predict Palliative Response

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Patients with HRPC may not have to maintain daily analgesic diaries.

CHICAGO—A 24-hour analgesic score prior to palliative treatment in patients with hormone- refractory prostate cancer (HRPC) potentially could be used in place of daily average analgesic scores, according to researchers.

“We could just collect analgesic diaries the day before their treatment as opposed to collecting the information on a daily basis for patients on systemic therapy,” said lead investigator Sara Taylor, MD, a medical oncology resident at Queens University, Kingston, Ont., Canada.

“That would give us an accurate measure of what the patient's actual analgesic use was for the whole treatment cycle. That one-day snapshot can give us a picture of what the patient has used over the whole three-week cycle.”

Dr. Taylor and her colleagues conducted a secondary analysis of a double-blind, placebo-controlled phase 3 trial that examined the palliative response to mitoxantrone and prednisone with or without IV clodronate.

In this trial, 209 patients with HRPC and pain due to bone metastases recorded pain and analgesic scores at baseline and at each treatment visit by using a daily analgesic diary and the 6-point present pain intensity (PPI) index. The researchers defined palliative response as a PPI of 0 or a 2-point decrease from baseline, or a reduction by 50% in the average daily analgesic scores over two visits, without an increase in either measure.

The investigators correlated average daily analgesic scores with the analgesic scores in the 24 hours prior to systemic therapy and evaluated the relationship between analgesic scores and PPI per cycle. They also determined the agreement of palliative response when calculated using the PPI and either the average daily analgesic score or the 24-hour analgesic score.

The data, presented here at the American Society of Clinical Oncology annual meeting, showed a strong correlation between the daily average analgesic score and the 24-hour analgesic score obtained before treatment, and strong agreement of the palliative response based on the two methods.

In addition, patients with high PPI scores had higher analgesic scores, and this association remained even after adjusting for various baseline factors.

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