New Medicine Recommendation By SMC Means Better Quality Of Life For Palliative Care Patients In Scotland

Main Category: Palliative Care / Hospice Care
Also Included In: Cancer / Oncology
Article Date: 09 Dec 2008 - 8:00 PDT

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The Scottish Medicines Consortium (SMC) has today recommended Relistor (methylnaltrexone bromide) for use by the NHS in Scotland. Relistor is a new treatment developed to help overcome opioid-induced constipation, a common problem for many end-of-life patients receiving palliative care.

Constipation is a particularly common side effect of opioid-based painkillers and can negatively impact on a patient's quality of life. Laxatives fail to work in about one third of patients with the result that intrusive methods of relief, such as enemas and manual evacuation, may be required. These methods can be distressing, uncomfortable, and undignified for a patient, further impacting on their quality of life.

"Over half of palliative care patients state they would prefer to die in their own homes1, but the problem of constipation contributes to many not being able to achieve this," said Dr Vignesh Rajah, Medical Director, Wyeth Pharmaceuticals.

"The National Audit Office's recent report, End of Life Care,2 highlights the importance of patients being able to choose where they receive their end-of-life care. Relistor's availability may allow patients to manage opioid-induced constipation at home reducing the need for hospital referrals or in-patient stays."

Dr Rajah added: "In palliative care, the key focus is to improve the patient's quality of life and preserve dignity. This is reflected in today's recommendation by the SMC, and highlights the importance given to delivering high quality palliative care services in Scotland. This was outlined recently by the Scottish Government's publications, Review of Palliative Care Services in Scotland and Living and Dying Well.3, 4"

The SMC's recommendation of Relistor means that healthcare professionals in Scotland with expertise in palliative care will be able to prescribe Relistor for end-of-life palliative care patients who do not respond adequately to usual laxative therapy. Relistor is the first palliative care treatment to be recommended following a formal health technology appraisal in the UK.

Relistor is also available in England & Wales and Northern Ireland, although there is as yet no specific guidance on its use by the National Institute for Health and Clinical Excellence (NICE).

Dr Rajah commented: "This SMC recommendation is especially welcome as it recognises the difficulties of assessing the cost-effectiveness of treatments whose purpose is solely to improve a patient's quality of life rather than to extend life. Standard cost-effectiveness measures are predominantly focused on assessing increases in length of patient survival. However, we are pleased that the SMC has been able to give due weight to the quality of life issues faced by palliative care patients."

About Relistor

Relistor was accepted for use within its licensed indication in NHS Scotland, for the treatment of opioid-induced constipation in advanced illness patients who are receiving palliative care, when response to usual laxative therapy has not been sufficient. All physicians with expertise in palliative care can prescribe Relistor.

Relistor is the first in a new class of treatments specifically designed to target the underlying cause of opioid-induced constipation. Relistor treats the constipating side effects of opioids without interfering with pain relief in the central nervous system (the brain and spinal cord).

Full details of the SMC recommendation can be found on the SMC website http://www.scottishmedicines.org.uk

About opioid-induced constipation and palliative care

Pain is a commonly reported symptom in palliative patients and a visible sign of distress when approaching end of life. Opioids are an essential and well-established treatment for pain encountered in palliative care; approximately 70 per cent of patients with advanced cancer and about 65 per cent of patients dying from non-malignant disease experience pain5. However, one of the most common and distressing side effects of opioid treatment is constipation. The majority of patients who take opioids will develop opioid-induced constipation to varying degrees, some of whom will have little or no tolerance to the condition6.

If left untreated, opioid-induced constipation can cause considerable pain, nausea and vomiting and faecal impaction7, 8.

Traditionally, laxatives have been prescribed along with opioids to treat opioid-induced constipation5. However, as laxatives are not always effective, symptoms of opioid-induced constipation can persist despite the early use of these agents7, 8. Relistor represents an important therapeutic option for palliative care patients suffering from opioid-induced constipation, when response to usual laxative therapy has not been sufficient.

It is estimated that approximately 75 per cent of the 55,000 people who die in Scotland each year could benefit from some form of palliative care3 and around one million people in Scotland have at least one long term condition3. The introduction of Relistor to NHS Scotland supports recent recommendations to improve palliative care services as outlined in Review of Palliative Care Services in Scotland and Living and Dying Well 3, 4.

The SMC's positive opinion for Relistor also supports the NHS's End of Life Care Strategy which recognises the importance of patients having the option to choose where they die. Over half of palliative care patients state they would prefer to die at home. However, only 20 per cent currently achieve this1.

The recent National Audit Office report, End of Life Care2, has also examined the current provision of end of life care services in England & Wales and Northern Ireland and identifies the potential for improving their quality. It also highlights the importance of delivering better patient care and better use of resources in implementing the Department of Health's End of Life Care Strategy.

What are Opioids?

For more information on what opioids are, and opioid-induced constipation (OIC), please see:
All About Opioids and Opioid-Induced Constipation (OIC)

About Wyeth Pharmaceuticals

Wyeth Pharmaceuticals, a division of Wyeth (NYSE:WYE), has leading products in the areas of women's health care, infectious disease, gastrointestinal health, central nervous system, inflammation, transplantation, haemophilia, oncology, vaccines and nutritional products.

Wyeth is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing and marketing of pharmaceuticals, vaccines, biotechnology products and non-prescription medicines that improve the quality of life for people worldwide. The Company's major divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort Dodge Animal Health.

References

1. NHS End of Life Care Programme progress report

2. National Audit Office. End of Life Care. London: The Stationery Office, 2008.

3. Audit Scotland, Review of palliative care services in Scotland, August 2008

4. NHS Scotland, Living and Dying Well; a national action plan for palliative and end of life care in Scotland, October 2008

5. Colvin L, Forbes K, Fallon M. Difficult pain. BMJ. 2006 May 6;332 (7549):1081-3

6. SIGN Publication Number 44; Control of Pain in Patients with Cancer: A National Clinical Guideline. June 2002

7. Panchal SJ, Muller-Schwefe P, Wurzelmann JI et al. Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract. July 2007; 61(7): 1181 - 1187

8. Miles CL, Fellowes D, Goodman ML et al. Laxatives for the management of constipation in palliative care patients (Review). The Cochrane Library. 2007; Issue 2

Scottish Medicines Consortium