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Diamorphine or Alfentanil for Subcutaneous Use in Hospice In-patients?

Information source: Gloucestershire Hospitals NHS Foundation Trust
ClinicalTrials.gov processed this data on August 20, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Cancer

Intervention: Alfentanil (Drug); Diamorphine (Drug)

Phase: N/A

Status: Completed

Sponsored by: Gloucestershire Hospitals NHS Foundation Trust

Official(s) and/or principal investigator(s):
Paul Perkins, MBBCh FRCP, Principal Investigator, Affiliation: Gloucestershire Hospitals NHS Foundation Trust

Summary

OBJECTIVES: How does Alfentanil compare with the standard drug Diamorphine for subcutaneous analgesia in the palliative care setting? STUDY DESIGN: An open-label pilot comparison between alfentanil and diamorphine for palliative care patients who require subcutaneous opioids.

Clinical Details

Official title: An Open-label Pilot Comparison Between Alfentanil and Diamorphine for Palliative Care Patients Who Require Subcutaneous Opioids

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care

Primary outcome: The change in MDAS will be calculated from day 0 to day 3 and compared between the two groups using a t-test if the data are sufficiently normally distributed, or the Mann-Whitney U test otherwise.

Secondary outcome:

Change in MDAS between Days 0 and 7

The change in the BPI-SF

The change in BPI-SF

The difference in proportion of patients taking laxatives

The change in nausea visual analogue scale

Change in the number of vomits

Change in nausea visual analogue scale

Change in the number of vomits

Change in the total dosage of breakthrough medication (number of doses x dosage)

Change in the total dosage of breakthrough medication (number of doses x dosage)

Detailed description: STUDY DESIGN

Study 1 - Open Label Pilot Day - 1 Hospice in-patients who are thought by a clinician to

need subcutaneous strong opioids will be asked if they wish to take part in the study. They will be given a patient information leaflet and a 'cooling off period' (a minimum of 1 day) to think about it. If the clinician feels that strong parenteral opioids are needed diamorphine will be commenced immediately (as standard practice). Day 0 If the patient agrees to take part in the trial they will be asked to complete a consent form and this will be stored with the patient's notes. The following assessments will be performed: 1. McGill Pain Questionnaire Short Form(MPQ-SF) 2. Brief Pain Inventory Short Form (BPI-SF)These measures were recommended by an EAPC Expert Working Group for pain syndrome characterization 3. Memorial Delirium Assessment Scale (MDAS). This has been validated in an advanced cancer population and used recently with hospice in-patients. 4. Nausea Visual Analogue Scale (VAS) 5. Nausea Duration over last 24 hours 6. Number of vomits in previous 24 hours Randomisation Once baseline measures are completed the participant will be randomised using the next available of a series of numbered, opaque, sealed envelopes. These will be prepared remotely. Blocking will be used to prevent an imbalance in terms of the number allocated to each group. Block size will be appropriate to the size of the study and not be divulged to the investigators responsible for consent and revealing the allocation. This will reduce the risk of investigators anticipating the allocation for particular patients. A study log will be kept on site where participant details will be completed before the envelope is opened. Subsequent Days On each subsequent day the following assessments will be performed: 1. BPI-SF 2. MDAS 3. Nausea VAS 4. Number of vomits in previous 24 hours In addition the following measurements will be taken: 5. Stool chart for previous 24 hours 6. Breakthrough medication (number of doses and dosage) used 7. Laxatives taken 8. Other changes to medication Patients will cease participation after assessment on day 7.

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria: 1. To be thought by a hospice doctor to require parenteral strong opioids. 2. To have an estimated prognosis of less than 1 year. Exclusion Criteria: 1. Inability to read English sufficiently to be able to complete assessment questionnaires. 2. Confusion sufficient so that patient is unable to complete questionnaires. 3. Weakness or fatigue sufficient so that patient is unable to complete questionnaires. 4. Radiotherapy to source of pain in last 4 weeks. 5. Change in corticosteroid dose in last week.

Locations and Contacts

Sue Ryder Care Leckhampton Court Hospice, Cheltenham, Gloucestershire GL53 0QJ, United Kingdom
Additional Information

Starting date: September 2010
Last updated: March 15, 2015

Page last updated: August 20, 2015

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