ANAHEIM, CALIFORNIA—Among oropharyngeal patients receiving radiotherapy, gabapentin improved pain management and reduced weight loss, which potentially prevents the need for placement of a gastrostomy tube, according to a study presented at the Oncology Nursing Society (ONS) 39th Annual Congress.
Mucositis, dysphagia, odynophagia, and weight loss are experienced by patients undergoing radiotherapy for oropharyngeal cancer. According to recent evidence, gabapentin has a novel role in blocking synaptogenesis after injury, so it is effective in controlling painful mucositis.
Sarah Afonso, MS, RN, of the Johns Hopkins Hospital in Baltimore, Maryland, and colleagues conducted a retrospective study to gabapentin’s efficacy in patients undergoing radiation therapy for oropharyngeal cancer.
The researchers included three cohorts in their study. One cohort (n=24) had gastrostomy tubes and did not receive gabapentin; the second cohort (n=25) had gastrostomy tubes and received gabapentin; and the third cohort (n=19) did not have gastrostomy tubes and received gabapentin.
The mean percentage of weight loss was lowest (6.36%) among patients in the third cohort, as compared with the second cohort (8.02%). Those with gastrostomy tubes who received gabapentin lost 7.99% of their weight.
The earliest incidence of grade 2 mucositis occurred at day 19 among patients who received gabapentin. However, patients without a gastrostomy tube who received gabapentin initiated narcotic use at a mean of 28 days and those with a gastrostomy tube initiated narcotic use at a mean of 33 days. In contrast, patients who did not receive gabapentin initiated narcotic use after 19 days.
“Results of this study support avoiding prophylactic [gastrostomy tube] placement,” Afonso said during a podium session. “Although not statistically significant, the results demonstrate clinically significant outcomes, including reducing the likelihood of [gastrostomy tube] placement in the long term.”
In addition to avoiding the risks associated with unnecessary gastrostomy tube placement, gabapentin use may alleviate some patients’ concerns regarding addiction after initiating opioid use. This is an especially important concern in patients with oropharyngeal cancer as many have experienced problems with addiction, according to Afonso.
In terms of future studies, Afonso said it would be interesting to look more closely at patient demographic data to identify patterns. Also, longitudinally monitoring patients to see if long-term gastrostomy tube dependence was higher in those not receiving gabapentin could yield important data.
Researchers could investigate the financial implications for patients and organizations as well by evaluating whether gabapentin reduced hospital stays, complications, removals and supplies, and home care associated with gastrostomy tubes. Further analysis of quality of life is also warranted.
Most importantly, the data suggest the need for a randomized, controlled, clinical trial so the findings can be generalized, according to Afonso.
Afonso S. A retrospective analysis of gabapentin therapy in the management and prevention of pain in oropharyngeal cancer patients treated with radiation therapy. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-4, 2014; Anaheim, CA.