Wednesday, July 2, 2008

2008 ASCO: methadone, genetics, modafinil

The 2008 American Society of Clinical Oncology meeting was last month. Every year the palliative care, supportive care, and end-of-life care abstracts are worth browsing (abstracts here).

I wanted to particularly point out 3:

  1. First is a case series about one center's experience with initiating and rotating to methadone in outpatients. Very little has been published about rotating to methadone in the outpatient setting despite it being a relatively common practice (that's my sense at least) - most of the publications about methadone rotations have been in inpatients. The data presented here suggest it's safe (no one falling over dead from torsades) and has salutary effects on pain.
  2. Second is one looking at genetic polymorphisms (of cytokine genes) and their associations with pain and opioid dose (certain polymorphisms in this lung cancer population were associated both with pain and opioid dose). I'm probably prematurely excited about the growing trickle of research (in actual real live humans in pain) into the genetic basis of the variable response to opioids, but there you go.
  3. Third, outcome data from a randomized, placebo controlled trial of modafinil for cancer-related fatigue was presented. Patients were all initiating chemotherapy, and those who reported severe fatigue (but not mild or moderate) seemed to benefit from modafinil over placebo. The magnitude of the benefit, while statistically significant, is unclear from the abstract. I've used modafinil occasionally, with (of course) mixed results; these are the first placebo controlled data I've seen on it in our population. I'm curious as to readers' experience with it.

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