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ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 7  |  Page : 1594-1599

Standardized nursing and therapeutic effect of oxycontin on oral mucosal pain in nasopharyngeal carcinoma patients


The Departmentof Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China

Date of Web Publication19-Dec-2018

Correspondence Address:
Yuying Fan
The Department of Nasopharyngeal Carcinoma, Sun Yat.sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_551_18

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 > Abstract 


Aim: This study aims to explore the standardized nursing and therapeutic effect of OxyContin on oral mucosal pain in nasopharyngeal carcinoma (NPC) patients with concurrent chemoradiotherapy.
Materials and Methods: From March 2016 to December 2017, 60 patients with NPC were selected from the Sun Yat-Sen University Cancer Center. Patients consuming OxyContin for moderate and severe pain were divided into the experimental group and control group, respectively. All the patients were given OxyContin 10 mg orally, and the dose was adjusted according to the degree of pain relief until it was significantly relieved. At the same time, the combination of analgesic drugs with standardized nursing intervention for pain was granted, and the analgesic effect, adverse effects, and quality of life of both groups were analyzed.
Results: There was no significant difference between the total dose of radiotherapy and OxyContin. OxyContin could significantly improve the quality of life in patients with moderate pain (P < 0.05), while the effect was not significant in patients with severe pain.
Conclusion: Patients with NPC having oral mucosal pain after radiotherapy and chemotherapy need intervention at the earliest. The application of OxyContin and cancer pain standardized nursing care can improve the analgesic efficacy, reduce drug adverse effects, and improve the patient's quality of life.

Keywords: Cancer pain standardized care, nasopharyngeal carcinoma, oral mucositis, OxyContin, quality of life


How to cite this article:
Hu W, Chen L, Wang C, Guo L, Hua X, Cai Y, Fan Y. Standardized nursing and therapeutic effect of oxycontin on oral mucosal pain in nasopharyngeal carcinoma patients. J Can Res Ther 2018;14:1594-9

How to cite this URL:
Hu W, Chen L, Wang C, Guo L, Hua X, Cai Y, Fan Y. Standardized nursing and therapeutic effect of oxycontin on oral mucosal pain in nasopharyngeal carcinoma patients. J Can Res Ther [serial online] 2018 [cited 2019 Jan 24];14:1594-9. Available from: http://www.cancerjournal.net/text.asp?2018/14/7/1594/247723




 > Introduction Top


Nasopharyngeal carcinoma (NPC) or Guangdong cancer is highly prevalent in southern China. The treatment includes chemotherapy and radiotherapy surgery (radical treatment [1]). NPC patients exhibit different degrees of oral mucositis during radiotherapy, seriously affecting nutrition.[2] Severe pain can disrupt the normal physiological functions and quality of life; its causes include tumor characteristics (tumor compression and infiltration) and anti-tumor treatment-related factors (tissue damage caused by surgery, biopsy, radiotherapy, and drugs).

The World Health Organization (WHO) guidelines state that opioids are important in alleviating pain in cancer. Some studies report that standardized pain care ensures analgesia, safety and effectiveness of medication, timely detection and treatment of adverse reactions, and standardized and reasonable use of analgesics.[3] We combined OxyContin with standardized nursing to treat oral mucositis, and to observe the effect of combination therapy on the analgesia and impact on the quality of life.


 > Materials and Methods Top


Patient characteristics

From March 2016 to December 2017, 60 NPC patients initially treated with concurrent chemoradiotherapy and suffering from moderate and above level oral mucosal pain were selected. Patients consuming OxyContin for moderate and severe pain were divided into the experimental and control groups, respectively. The experimental group had 29 patients (22 males and 7 females) with a mean age of 42.3 ± 10.3 years (range: 19–65 years), while the control group had 31 patients (28 males and 3 females) with a mean age of 45.6 ± 10.7 years (range: 28–69 years). There were no significant differences in sex, age, or other general data between the two groups (P > 0.05).

Tools of pain assessment

The statistics and analysis of the pain of all patients was as per the Numerical Rating Scale (NRS). The degree of pain was indicated by a 0–10 digital scale. The scale indication was as follows, 0 points: No pain; 1–3 points: Mild pain, where although patients were in pain, they could work, function, and sleep without interference; 4–6 points: Moderate pain, patients were in intolerant pain, such that their sleep was disturbed; 7–10 points: Severe pain, patients were in severe pain and accompanied by autonomic dysfunction, leading to severely disturbed sleep.

Grouping criteria and method of administration

The NRS score of the experimental group was 4–6 points indicating moderate oral mucosal pain, while the control group scored 4–6 points indicating severe oral mucosal pain. The initial titration dose of OxyContin was 10 mg orally, once every 12 h. The dose was increased to 20 mg (orally, once 12 hourly), if the pain score was still over 4 points after 24 h. The dose was further increased to 30 mg (orally, once 12 hourly), if the pain score was still >4 points after 24 h, and continued so on. If the pain score was ≤3 points, the dose was not changed, so that patients would not have pain during activities, rest, or sleep.

Nursing method

Standardized cancer pain nursing was performed, including:

  1. Pain assessment based on NRS score [4]: The nurses evaluated the pain of NPC patients 2–3 times within 24 h, after the first dose according to the standard protocol. Following pain control, the status was evaluated every 24 h. The pain score scale, number of radiotherapy sessions, and OxyContin doses were recorded during the assessment
  2. Establish a pain care sheet and record the pain characteristics, location, time, medication, and nursing measures: The nurses would determine the pain score based on the highest pain of the patients within 24 h. When the patient had an outbreak of pain, the nurse would make an assessment and give timely feedback to the doctor, aiming to achieve a pain score goal ≤3 points and the number of pain outbreaks be ≤2 times, on the 1st day [5]
  3. Routine care was given for the oral mucositis, including antibacterial mouthwash containing bismuth, localized spray of recombinant human epidermal growth factor, and Vitamin B12.
  4. The patient maintained a pain diary prepared by the Guangdong Association of Cancer Rehabilitation and Palliative Care Committee of the Anti-Cancer Association. This was combined with illustrations to circle the pain location, record the pain score, describe the pain characteristic with the provided words, and write down the name and dosage of the painkiller and any side effects. It was convenient for the doctors and nurses to check the patient's pain, and for the patients to understand their own pain problems
  5. Pain education for patients: Our nurses distributed educative materials such as “Pain Patient Education Handbook” compiled by the China Anti-Cancer Association to NPC patients, and explained the drug-related adverse reactions to correctly understand the pain and be able to treat side effects actively. One-on-one teaching was conducted based on the different educational backgrounds of patients, videos were played about cancer pain, and pain-related lectures conducted once a month to increase compliance and improve satisfaction among patients
  6. Psychological care was given to help patients relieve their tension and anxiety caused by pain
  7. If the patient was discharged from the hospital or was on leave, the nurse was responsible for daily follow-ups, filling the registration book, and performing health education and medication guidance at the same time.


Observation index

Evaluation of pain relief rate

Pain relief rate through 24 h after the first dose, (relief rate) = (NRS before administration - NRS after 24 h of administration)/NRS before administration × 100%

The degrees of pain relief are shown in [Table 1].
Table 1: The detail information of different degrees of pain relief

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Pain relief effective rate through 24 h after the first dose = (obvious relief numbers + R numbers + PR numbers)/total numbers × 100%.

Remission time statistics

Effective remission time was defined as the duration from the 1st day of treatment to the day that the pain was effectively relieved.

Average doses of OxyContin per patient in each group

We calculated the total dose of OxyContin taken per patient, from the 15th radiotherapy session and the doses had reached 30–35 gray at the end of radiotherapy.

Life quality observation

This study was evaluated with reference to the WHO Quality of Life Measurement Scale (WHO QOL-100). Each patient was given the scale every 2 weeks. The scores of each dimension and aspect were positive, and the scores of all aspects were the cumulative scores of the following subitems (higher the score they earn and better the quality of life they had).[6]

Physiological field = (24 - pain and discomfort + energy and fatigue + sleep and rest)/3

Psychological field = (positive feeling + thought, learning, memory, attention + self-esteem + body and appearance + (24-negative feeling))/3

Independence area = (action ability + daily living ability + (24 - dependence on drugs and medical means) + workability)/3

Social relations field = (personal relationship + satisfaction of required social support + sex life)/3

Environmental field = (social security + housing environment + economic sources + medical services and social security + acquisition of new information + opportunities to participate in recreational activities and its positivity + environmental conditions + traffic conditions)/8

Spiritual pillar/Religion/Personal belief = F24.1 + F24.2 + F24.3 + F24.4

Quality of life = G1 + G2 + G3 + G4

Weight loss rate = (weight before treatment – weight after treatment)/weight before treatment × 100%

Adverse reactions

Common adverse reactions included constipation, nausea, vomiting, dizziness, headache, excessive sweating, lethargy, fatigue, and difficulty in urination. Moreover, Xu et al. believed that high-doses (beli mg) of OxyContin were safe and effective, and would not cause adverse reactions such as respiratory depression, cognitive impairment, or severe organ damage.[7]

Statistical analyses

The data were analyzed using IBM SPSS Statistics for Windows version 22.0; (IBM Corporation, Armonk, New York), and the experimental and control groups were compared. The total dose and quality of life of OxyContin during the treatments were analyzed by independent sample t-test. Paired t-test was used to analyze the quality of life before and after treatment in the same group. Statistical significance was set at P < 0.05.


 > Results Top


Pain remission rate

We compared the pain relief rates after OxyContin administration in both groups [Table 2]. The average pain relief rate of the group as a whole was 78.3%. The pain relief rates were 72.4% and 83.9% in the experimental and control groups, respectively (P = 0.335). There was no statistically significant difference in pain relief between the two groups.
Table 2: The comparison of pain relief after taking OxyContin in both groups

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Dose of OxyContin

The average doses of OxyContin in the experiment group and control group were 579.31 ± 34.56 mg and 808.71 ± 56.81 mg, respectively. The dose of the experimental group was significantly higher than that of the control group with a statistical difference (P = 0.001).

Quality of life measures before and after treatment (World Health Organization Quality of Life Measurement Scale-100)

We compared the quality of life and functional scales before and after treatment between the two groups and found that there was no significant difference between them before and after treatment (P < 0.05) [Table 3]. At the same time, the quality of life and the scales before and after treatment in each group were compared, and we found that the quality of life after treatment in the experimental group had significantly improved as compared to before treatment. In the control group, there was a decrease in the independent field after treatment (P < 0.05) [Table 4], and there was no significant change in each subitem of the remaining scales.
Table 3: Comparison of quality of life measurement scales before and after treatment between the two groups (World Health Organization Quality of Life-100)

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Table 4: Comparison of quality of life measurement scales before and after treatment between the two groups (World Health Organization Quality of Life-100)

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Weight loss and adverse reactions

We compared the body weights before and after treatment between the two groups and found that there was no significant change in the body weight before and after treatment (P > 0.05). We also analyzed the side effects of the two groups after drug administration and found that constipation and vomiting were the most common adverse reactions [Table 5].
Table 5: Comparison of weight loss and adverse reactions between the two groups

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Nursing

Standardized and strengthened drug management, and guided correct medication: OxyContin, a morphine-type opioid agonist, was administered in accordance with the regulations of the management of narcotic drugs.[8] There are strict regulations on the medications for NPC patients in our hospital during the hospitalization period. The dose of OxyContin was prescribed depending on temporary or long-term medical advice. The drug was administered after double-checking the time of previous consumption of the drug. For timely administration of drugs, they were placed in the anesthesia cabinet and managed by a special person, with well-planned duty shifts. The medication time of each enrolled patients was registered in the nursing record sheets and the patients' pain diary, and an alarm clock was used to remind patients to take their medication on time. OxyContin, a sustained-release tablet, is the first choice for oral administration. It should not be crushed or opened before it enters the enteral nutrition tube. Patients were instructed not to reduce or discontinue the OxyContin.[9]

Discover drug-related adverse reactions in time, and strengthen standardized care

In response to the adverse reactions of OxyContin, the time, method, and common adverse reactions of the drug were explained in detail to the patient. We also informed the patients that in case of occurrence of those adverse reactions, they should inform the doctors in time so that they can be given appropriate treatment.

Care of nausea and vomiting

The most common adverse reactions of OxyContin are nausea and vomiting. In this study, 11 and 14 patients of the experimental group and control group, respectively, had nausea and vomiting reactions.

The symptoms are easy to detect, but each person has a different tolerance for early detection to be possible. If those symptoms appeared, patients should have to inform the nurses in time. The nurse would temporarily forbid them from consumption of food and water, inform doctors of the time, degree, and traits of vomitus, and administer oral or intravenous antiemetic drugs specific to the conditions. The symptoms could be effectively improved with antiemetic drugs, such as metoclopramide, tropisetron, and dolasetron. In addition, attention should be paid to electrolyte imbalance caused by stubborn vomiting and intravenous rehydration, and electrolyte supplementation may be given if necessary. At the same time, nurses need to advise patients or their families to buy citrus fruits such as lemon or orange and place them in the bedside or ward to provide freshness of air and smell. The diet was kept light and healthy. The pork was replaced by chicken and fish, and patients were advised to consume more vegetables and fruits to reduce vomiting. The number of meals was increased with reduced portion sizes.

Care for constipation

Constipation is another common adverse reaction, that obviously affects patients' quality of life. Unlike constipation, other adverse reactions gradually reduce with the extension of medication time. Around 72% and 74% of patients developed constipation in the experimental group and the control group, respectively, and the symptoms effectively improved after treatment. The prevention and treatment of constipation should be done in time. Recording the daily defecation times and the exhaustion of anus is necessary. To relieve constipation, increased daily water consumption or drinking honey water in the morning, and consumption of vitamin and fiber-rich foods (celery, whole-grain biscuits, oatmeal, cucumber, and tomatoes) was recommended. Patients were motivated to exercise and massage their lower abdomen clockwise to promote gastrointestinal motility. Patients with no relief of constipation were advised laxatives such as Kailuo and lactulose. For patients with severe constipation or intractable constipation, the dose of laxatives was increased according to the doctor's advice, and if necessary, and clyster could be used.

Improve patient compliance

Patients enrolled needed to take timely and full doses of OxyContin. The drug was not to be stopped without permission. Some patients, who had concerns about drug addiction, were advised to take the drug only when in pain. Some patients were reluctant to take the medicine when the adverse reactions such as dizziness, nausea, vomiting, severe constipation, and urine retention occurred. Few patients had pain even though they were taking medicine and hence did not cooperate with titration. Notably, some patients left the ward without carrying OxyContin with them, and thus failed to take medicine on time or discontinued it altogether. Nurses need to instruct the patients to maintain their pain diary and check the diary every day, thus teaching them self-assessment method of pain control. Patients who were not in the hospital could be followed up by telephone, and once they returned to the hospital, they were told to find primary nurses to fill in and supplement blank records in time. For patients having doubts, the focus was on giving health knowledge lectures and personalized knowledge education every week to relieve their medication concerns and psychological pressure. Their comprehension of the knowledge was tested orally or in writing to improve their medication compliance and to ensure the effects of treatment.

Strengthening the psychological care

Pain is a disease, and all pain is malignant.[10] Pain is a personal subjective experience with feelings that are unpleasant and affect the patient's mood and psychology.

For all of the patients in our study, especially those with adverse reactions, psychological care, and guidance were given on time. This included using different methods such as face-to-face chats, patient forums, video, and voice or telephone calls with family members. Patients were suggested to listen to music, watch TV, read books, watch entertainment videos and audios to distract them and to reduce physical discomfort and bad symptoms. For those with pain score <3 points, patients would not have pain during activities, rest, or sleep.


 > Discussion Top


NPC was deemed sensitive to radiation. In recent times, radiotherapy has been recognized as a radical treatment. Radiotherapy alone was commonly used in the early stage, and radiotherapy-based radiotherapy and chemotherapy were the main methods employed in the advanced stage.[11] Radiotherapy could effectively improve the prognosis of patients, but adverse reactions such as dry mouth, nausea, vomiting, sore throat, oral ulceration, and skin pigmentation of the neck, occurred easily during treatment. Radioactive oral mucositis usually appeared around 1–2 weeks following radiation therapy, often accompanied by changes in taste, dry mouth, saliva, and pain.[12]

OxyContin has a good analgesic effect on patients with NPC. The analgesic effect of OxyContin is rapid, long-lasting, stable [13] and has a good tolerance in patients with different degrees of pain. Our study found that patients with moderate pain had consumed an overall lower dose of OxyContin, as compared to the control group having severe pain who had consumed a higher total dose of OxyContin. Thus, the degree of pain was proportional to the dose of OxyContin. Besides, for patients with moderate pain, OxyContin could effectively improve the quality of life; however, for patients with severe pain, it did not significantly improve the quality of life, which could be related to the overall impact of tumor-induced pain in patients. In addition, OxyContin could alleviate the pain in patients but caused some adverse reactions, such as vomiting, constipation, dizziness, and dysuria.[14] However, the standardized pain care can effectively improve these symptoms.


 > Conclusion Top


We found that the pain relief rate of moderate and severe pain was higher, and OxyContin had a good therapeutic effect on oral mucosal pain in NPC, by analyzing 60 patients with different degrees of pain treated with OxyContin, and integrated nursing intervention. Early intervention for pain in NPC patients (moderate pain), timely identification of adverse reactions to OxyContin, and standardized treatment of pain can effectively improve the quality of life.

Acknowledgment

This project was supported by Medical Research Foundation of Guangdong in 2014 (Grand No. A2014252 and A2014253).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

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Li G, Gao J, Liu ZG, Tao YL, Xu BQ, Tu ZW, et al. Influence of pretreatment ideal body weight percentile and albumin on prognosis of nasopharyngeal carcinoma: Long-term outcomes of 512 patients from a single institution. Head Neck 2014;36:660-6.  Back to cited text no. 1
    
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Wu WY, Yang FY, Wu Y, Ye CX, Li WY, Zhou HJ, et al. Longitudinal study on the changes of symptom clusters among nasopharyngeal carcinoma patients undergoing radiation therapy. Chinese Journal of Modern Nursing 2016;(13):1804-8.  Back to cited text no. 2
    
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ZhuY, Yang L. Application of programmed pain care in nasopharyngeal carcinoma patients with radiotherapy. Guangxi Medical Journal 2015;(8):1196-9.  Back to cited text no. 3
    
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Diagnosis and treatment of cancer pain (2011 edition). Chin J Nurs 2012;47:192.  Back to cited text no. 4
    
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Liu J T, Chen K. Questionnaire of quality of life in the evaluation of the quality of life. Chinese Journal of Clinical Rehabilitation 2006;(26):113-6.  Back to cited text no. 6
    
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Xu JL, Yuan B, Chen XQ, Shi CB. The safety assessment of high does of oxycontin in treatment of cancer pain. J Mod Oncol 2015;23:3513-5.  Back to cited text no. 7
    
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Kapil R, Nolting A, Roy P, Fiske W, Benedek I, Abramowitz W, et al. Pharmacokinetic properties of combination oxycodone plus racemic ibuprofen: Two randomized, open-label, crossover studies in healthy adult volunteers. Clin Ther 2004;26:2015-25.  Back to cited text no. 8
    
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Fan ZY, Lin JX, Wu DC. Effect of whole-process pain management on medication compliance and breakthrough pain for patients with cancer-related pain. J Nurs Sci 2017;32:33-6.  Back to cited text no. 9
    
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Yan M. Interpretation on standardized treatment of cancer pain and 2010 NCCN clinical practice guideines for adult cancer pain (Chinese Version). Mod Pract Med 2012;24:127-9.  Back to cited text no. 10
    
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Zhang L, Zhao C, Ghimire B, Hong MH, Liu Q, Zhang Y, et al. The role of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma among endemic population: A meta-analysis of the phase III randomized trials. BMC Cancer 2010;10:558.  Back to cited text no. 11
    
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Agulnik M, Epstein JB. Nasopharyngeal carcinoma: Current management, future directions and dental implications. Oral Oncol 2008;44:617-27.  Back to cited text no. 12
    
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Sun Y, Li L, Zhang MH, Jing XR, Zhong GC, Jiang H, et al. Comparison of the efficacy and safety of super high dose of oxycodone hydrochloride prolonged-release tablets and morphine sulfate sustained-release tablets in the treatment of serious cancer pain. Journal of Modern Oncology 2017;25:3683-7.  Back to cited text no. 13
    
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Duensing L, Eksterowicz N, Macario A, Brown M, Stern L, Ogbonnaya A, et al. Patient and physician perceptions of treatment of moderate-to-severe chronic pain with oral opioids. Curr Med Res Opin 2010;26:1579-85.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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