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Use of parecoxib by continuous subcutaneous infusion for cancer pain in a hospice population
  1. Peter Armstrong1,
  2. Pauline Wilkinson2 and
  3. Noleen K McCorry3
  1. 1 Pharmacy Department, Belfast Health and Social Care Trust, Belfast, UK
  2. 2 Consultant in Palliative Medicine, Marie Curie Hospice, Belfast, UK
  3. 3 Centre of Excellence for Public Health (NI), Queen’s University Belfast, Belfast, UK
  1. Correspondence to Mr Peter Armstrong, Pharmacy Department, Belfast Health and Social Care Trust, Belfast, UK; peter.armstrong{at}belfasttrust.hscni.net

Abstract

Objectives To characterise the use of the parenteral non-steroidal anti-inflammatory drug parecoxib when given by continuous subcutaneous infusion (CSCI) in a hospice population. Clinical experience suggests parecoxib CSCI may be of benefit in this population, but empirical evidence in relation to its safety and efficacy is lacking.

Methods Retrospective chart review of patients with a cancer diagnosis receiving parecoxib CSCI from 2008 to 2013 at the Marie Curie Hospice, Belfast. Data were collected on treatment regime, tolerability and, in patients receiving at least 7 days treatment, baseline opioid dose and changes in pain scores or opioid rescue medication requirements.

Results Parecoxib CSCI was initiated in 80 patients with a mean administration of 17.9 days (median 11, range 1–94). When used for a period of 7 days, there was a statistically significant reduction in pain scores (p=0.002) and in the number of rescue opioid doses required (p=0.001), but no statistically significant opioid-sparing effect (p=0.222). It was generally well tolerated, although gastrointestinal, renal adverse effects and local site irritation were reported.

Conclusions Parecoxib may have a valuable place in the management of cancer pain, especially towards the end of life when oral administration is no longer possible and CSCI administration is relied on. Further studies into the efficacy and tolerability of parecoxib CSCI are merited.

  • cancer
  • pain
  • symptoms and symptom management

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Handling editor Declan Walsh

  • Contributors All authors were involved in the design of the study, data analysis and interpretation. PA collected the data and drafted the article. PW and NKM critically revised the article. All authors gave final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The original anonymised data for the 80 patients is available on request from the main author. This includes patient demographics, diagnosis, baseline medicines, parecoxib dosing regime, pain scores (if recorded), side effects, oral morphine equivalent doses, breakthrough opioids given and duration of treatment.

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