Long Term Outcomes of Intrathecal Therapy in Patients with Refractory Cancer Related Pain
Kari Bancroft, MD, MPA; Oscar A. DeLeon-Casasola, MD; James Hitt, MD, PhD
University at Buffalo, The State University of New York
Cancer related pain remains a common problem that is often undertreated.1 Comprehensive medical management (CMM) can effectively reduce pain in a vast majority of cancer patients, but it is estimated that between 5-15% of cancer pain patients fail CMM and require some type of invasive therapy.2 Intrathecal therapy can provide some patients with chronic cancer related pain improved analgesia with fewer side effects.
This retrospective study describes the experiences of 19 cancer patients who received an implantable intrathecal drug delivery system (IDDS) for refractory cancer related pain. Patients who received an IDDS at Roswell Park Cancer Institute in Buffalo, New York between 2005 and 2010 were included in the study. Data regarding the patient’s pain and disability was extracted from the electronic medical record, including pain intensity (numeric rating scale, NRS), patient impression of pain relief, and psychosocial disability scores. Data was collected at baseline (prior to IDDS implantation) and at follow-up clinic visits spanning a four year post-implantation time period.
Pain intensity (NRS scores) and pain relief impression scores significantly improved post-implant at time points of one month to four years. Improvements in psychosocial disability were also significantly improved through four years of therapy.
Implantable intrathecal drug delivery systems provide significant pain relief in appropriately selected patients who fail CMM. Patients with refractory cancer related pain also find significant improvement in quality of life, as measured by various aspects of psychosocial disability, after implantation of an intrathecal drug delivery system.