- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00152854
Acetaminophen for Cancer Pain
A Randomised, Placebo-controlled, Crossover Trial of Acetaminophen in Cancer Patients on Strong Opioids
Study Overview
Status
Intervention / Treatment
Detailed Description
Aim:
To assess whether regular oral acetaminophen can reduce pain in cancer patients already on a strong opioid regimen.
Rationale:
It is estimated that 75% of people with advanced cancer suffer significant pain. Many of these people continue to have pain despite being on strong opioids. The rationale behind adding an additional analgesic with a different mechanism of action is to attempt to improve analgesia without increasing side effects.
Overview:
This is a double blind, randomised placebo-controlled, crossover trial to evaluate whether the addition of regular acetaminophen can reduce pain in cancer patients already on a strong opioid regimen. The study will be performed in ambulatory cancer patients who have pain that is believed to be caused by their cancer, and who have already been stabilised on an opioid regimen of > 60mg/day of morphine equivalents. Each patient will be randomly allocated to receive either acetaminophen 1g qid or an identical appearing placebo qid for a seven-day period, and then crossed over to the other arm for a further seven-day period. Patients will complete daily pain diaries and weekly questionnaires (Brief Pain Inventory) and comparison will be made between the pain scores for the two treatment periods. Patient preference for the two treatment periods will also be evaluated.
Research Question:
A randomised, double-blind, placebo controlled crossover trial to determine if the addition of regular acetaminophen (1g PO qid) leads to improved analgesic control in adult cancer patients at Princess Margaret Hospital, who are already on strong opioids (> 60mg morphine equivalents/day) as evaluated by daily pain scores measured by Numerical Rating Scales (NRS) and the Brief Pain Inventory (BPI).
Hypothesis:
Regular acetaminophen improves pain control in cancer patients who are already on strong opioid regimens.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients diagnosed with malignancy who have persistent pain which is believed by the investigator to be due to their cancer, and whose analgesic regimen has been stabilised on > 60mg of morphine equivalents/day.
- Age > 18 years
- Performance status of 0-2 by the European Co-operative Oncology Group (ECOG) Performance Scale
- Sufficient English skills to be able to complete the daily diary, BPI and to understand the consent form
- Signed informed consent
Exclusion Criteria:
- Patient has no pain (0/10 on NRS).
- Patients with severe pain are excluded, however once their pain control is optimised they are eligible.
- Patient has received radiation therapy in the six weeks prior to commencing the study or is likely to require radiotherapy during the study period.
- Patient has commenced, or had dose modifications, to either non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids in the week prior to commencing the study, or during the two-week study period.
- Patient has commenced chemotherapy or hormone therapy in the 4 weeks prior to the study or is expected to commence chemotherapy or hormonotherapy during the study period. Patients who are stable on long-term chemotherapy or hormones are eligible for this study. Patients who receive high dose steroids as antiemetics with their chemotherapy are eligible providing they are not receiving the steroids during the study period.
- Patient has a contraindication to acetaminophen.
- Use of acetaminophen in the 48 hours prior to commencement of the study period.
Abnormal laboratory values:
- Absolute neutrophil count < 1.5 X 10^9/L and white blood cell (WBC) count < 3 X 10^9/L
- Platelet count < 100 X 10^9/L
- Liver transaminases > 2.5 X upper limit of normal
- Bilirubin > 1.5 X upper limit of normal
- Creatinine > 1.5 X upper limit of normal
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: A, 1, acetaminophen
acetaminophen
|
acetaminophen 1g po qid
|
Placebo Comparator: B placebo
placebo PO qid
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Patient preference for the acetaminophen or the placebo arm as assessed by asking the patient whether he/she preferred treatment period 1 or treatment period 2
Time Frame: Post completion of period 2
|
Post completion of period 2
|
Differences in the mean pain intensity score as assessed by the daily average Numeric Rating Scale (NRS) pain score during the week given acetaminophen compared with the daily average NRS pain score during the week given placebo
Time Frame: post period 2
|
post period 2
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Symptoms possibly associated with acetaminophen use for each period using an NRS: feeling sick (nausea and vomiting)
Time Frame: post period 2
|
post period 2
|
drowsiness
Time Frame: post period 2
|
post period 2
|
constipation
Time Frame: post period 2
|
post period 2
|
cold sweats
Time Frame: post period 2
|
post period 2
|
overall sense of well being
Time Frame: post period 2
|
post period 2
|
Total analgesic consumption in each treatment period
Time Frame: post period 2
|
post period 2
|
Best and worst pain scores for each treatment period
Time Frame: post period 2
|
post period 2
|
Pain relief obtained in each treatment period
Time Frame: post period 2
|
post period 2
|
Effect of pain on functional ability
Time Frame: post period 2
|
post period 2
|
Strength of preference for acetaminophen versus placebo on a 5-point scale
Time Frame: post period 2
|
post period 2
|
Proportion of patients who had a preference for acetaminophen who perceived the improvement warranted taking the additional tablets
Time Frame: post period 2
|
post period 2
|
Proportion of patients having a clinically significant improvement in pain (defined as an improvement in mean NRS of at least 33% during the week taking acetaminophen)
Time Frame: post period 2
|
post period 2
|
Collaborators and Investigators
Investigators
- Principal Investigator: Janette Vardy, MD, University Health Network, University of Toronto
- Principal Investigator: David Warr, MD, University Health Network, University of Toronto
- Principal Investigator: Ian Tannock, MD, PhD, University Health Network, University of Toronto
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- ACETAPLAC
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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