249P - Improving quality of life and symptom burden with opioids and adjuncts in lung cancer (IQSOL study)

Background

Pain and cough are the two commonest presenting symptoms in lung cancer, with an incidence of 51% and 65%, causing significant distress to the patient and caretakers. This study highlights the impact of opioid analgesics and adjuncts in relieving symptom burden and eventual improvement in cough specific quality of life.

Methods

This retrospective study comprises 107 lung cancer patients under JIPMER palliative registry from Jan-2019 till Oct-2021. Survival and QOL data were collected from patients and caretakers via telephone. Clinical data was collected from medical records. Symptom burden was assessed with the Visual Analog Scale and Cough VAS scale, while cough-QOL was assessed with the MCLCS (Manchester Cough in Lung Cancer Scale) at the time of clinical follow up.

Results

Comparing the data of patients who had received opioid analgesics without adjuncts (n=25), the patients who had received opioid analgesics (n=82) along with adjuncts (Gabapentin 600 mg/day and Amitriptyline 25 mg/day), had a better cough relief (19% v 45%) and improved cough QOL (20% v 32%). G+A subgroup showed a 20.7% reduction of mean baseline morphine dose at subsequent visits. Gabapentin subgroup had a 10% reduction of mean baseline dose. Reduction in mean cough VAS in opioids only group Vs Opioid + Adjunct group is 17.3% Vs 40.4%. Gabapentin subgroup has 39% reduction while G+A subgroup has 40.6% reduction in the mean cough VAS. Reduction in Mean MCLCS score in opioids only group Vs Opioid + Adjunct group is 17.8% Vs 35.5%. Per the MCLCS, in the gabapentin subgroup has 36.6% reduction while G+A subgroup has 27.3% reduction.

Conclusions

Inferring from the above data, patients with adjuncts have better mean cough VAS and QOL according to the MCLCS questionnaire, in addition to reduction in overall pain, when compared to patients who received only opioids for their pain. In addition to primary treatment with radiotherapy and chemotherapy, palliative care forms a core component in management of lung cancers and their symptom burden. Antitussive properties of opioids appear to be accentuated when given along with adjuncts. The efficacy of adjuncts, though well studied in other chronic cough conditions, need to be evaluated further in thoracic malignancies, especially lung cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.