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Supportive Care in Cancer
Published in: Supportive Care in Cancer 8/2012

Open Access 01-08-2012 | Original Article

Efficacy of opioid rotation to continuous parenteral hydromorphone in advanced cancer patients failing on other opioids

Authors: Wendy H. Oldenmenger, Paul J Lieverse, Paul J. J. M. Janssen, Walter Taal, Carin C. D. van der Rijt, Agnes Jager

Published in: Supportive Care in Cancer | Issue 8/2012

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Abstract

Purpose

The effectiveness of an opioid rotation to parenteral hydromorphone in advanced cancer patients has never been investigated. Therefore, the purpose of this study was to investigate the analgesic efficacy and side effects of parenteral hydromorphone on serious cancer-related pain.

Methods

We included 104 consecutive advanced cancer patients who were extensively pretreated with opioids. They were rotated to parenteral hydromorphone because they failed to achieve adequate pain relief on other opioids. Pain intensity and side effects were daily assessed. The moment of adequate pain control was defined as the first of at least 2 consecutive days when the mean pain intensity at rest was ≤4 (on a 0–10 numeric rating scale) and side effects were tolerable.

Results

The reasons for rotation to parenteral hydromorphone were inadequate pain control with/without expected delivery problems due to high opioid dosages (n = 61) and intolerable side effects with persistent pain (n = 43). Adequate pain control was achieved in 86 patients (83%) within a mean of 5 days. Eight of 86 patients still had side effects, but these were scored as acceptable. The mean pain intensity at rest decreased from 5.4 [standard deviation (sd) = 2.1] to 2.4 (sd = 1.5; p < 0.001). The median failure-free treatment period was 57 days and covered a substantial part of the median survival of 78 days in the responding patients.

Conclusions

In advanced cancer patients with serious unstable cancer-related pain refractory to other opioids, continuous parenteral administration of hydromorphone often results in long-lasting adequate pain control and should be considered even after extensive pretreatment with opioids.
Literature
1.
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449PubMedCrossRef
2.
WHO (1990) Cancer pain relief and palliative care. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 804:1–75
3.
Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA (1995) Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain 63(1):65–76PubMedCrossRef
4.
Fine PG, Portenoy RK, Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation (2009) Establishing “best practices” for opioid rotation: conclusions of an expert panel. J Pain Symptom Manage 38(3):418–425PubMedCrossRef
5.
Enting RH, Oldenmenger WH, van der Rijt CC, Wilms EB, Elfrink EJ, Elswijk I, Sillevis Smitt PA (2002) A prospective study evaluating the response of patients with unrelieved cancer pain to parenteral opioids. Cancer 94(11):3049–3056PubMedCrossRef
6.
Enting RH, Oldenmenger WH, Van Gool AR, van der Rijt CC, Sillevis Smitt PA (2007) The effects of analgesic prescription and patient adherence on pain in a Dutch outpatient cancer population. J Pain Symptom Manage 34(5):523–531PubMedCrossRef
7.
Kumar MG, Lin S (2007) Hydromorphone in the management of cancer-related pain: an update on routes of administration and dosage forms. J Pharm Pharm Sci 10(4):504–518PubMed
8.
Hanks GW, Conno F, Cherny N, Hanna M, Kalso E, McQuay HJ, Mercadante S, Meynadier J, Poulain P, Ripamonti C, Radbruch L, Casas JR, Sawe J, Twycross RG, Ventafridda V, Expert Working Group of the Research Network of the European Association for Palliative Care (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84(5):587–593PubMedCrossRef
9.
Mercadante S (1999) Problems of long-term spinal opioid treatment in advanced cancer patients. Pain 79(1):1–13PubMedCrossRef
10.
11.
Quigley C, Wiffen P (2003) A systematic review of hydromorphone in acute and chronic pain. J Pain Symptom Manage 25(2):169–178PubMedCrossRef
12.
Bruera E, MacEachern T, Macmillan K, Miller MJ, Hanson J (1993) Local tolerance to subcutaneous infusions of high concentrations of hydromorphone: a prospective study. J Pain Symptom Manage 8(4):201–204PubMedCrossRef
13.
14.
15.
CBO, VIKC (2008) Diagnostiek en behandeling van pijn bij patiënten met kanker. Van Zuiden Communications B.V., Alphen a/d/Rijn
16.
Turk DC, Okifuji A (1999) Assessment of patients’ reporting of pain: an integrated perspective. Lancet 353(9166):1784–1788PubMedCrossRef
17.
Lawlor P, Turner K, Hanson J, Bruera E (1997) Dose ratio between morphine and hydromorphone in patients with cancer pain: a retrospective study. Pain 72(1–2):79–85PubMedCrossRef
18.
Bruera E, Pereira J, Watanabe S, Belzile M, Kuehn N, Hanson J (1996) Opioid rotation in patients with cancer pain. A retrospective comparison of dose ratios between methadone, hydromorphone, and morphine. Cancer 78(4):852–857PubMedCrossRef
19.
Ashby MA, Martin P, Jackson KA (1999) Opioid substitution to reduce adverse effects in cancer pain management. Med J Aust 170(2):68–71PubMed
20.
Benitez-Rosario MA, Feria M, Salinas-Martin A, Martinez-Castillo LP, Martin-Ortega JJ (2004) Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain. Cancer 101(12):2866–2873PubMedCrossRef
21.
Maddocks I, Somogyi A, Abbott F, Hayball P, Parker D (1996) Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone. J Pain Symptom Manage 12(3):182–189PubMedCrossRef
22.
Tse DM, Sham MM, Ng DK, Ma HM (2003) An ad libitum schedule for conversion of morphine to methadone in advanced cancer patients: an open uncontrolled prospective study in a Chinese population. Palliat Med 17(2):206–211PubMedCrossRef
23.
Muller-Busch HC, Lindena G, Tietze K, Woskanjan S (2005) Opioid switch in palliative care, opioid choice by clinical need and opioid availability. Eur J Pain 9(5):571–579PubMedCrossRef
24.
Hanks GW, Conno F, Cherny N, Hanna M, Kalso E, McQuay HJ, Mercadante S, Meynadier J, Poulain P, Ripamonti C, Radbruch L, Casas JR, Sawe J, Twycross RG, Ventafridda V (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84(5):587–593PubMedCrossRef
25.
Tong D, Gillick L, Hendrickson FR (1982) The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group. Cancer 50(5):893–899PubMedCrossRef
26.
van der Linden YM, Steenland E, van Houwelingen HC, Post WJ, Oei B, Marijnen CA, Leer JW, Dutch Bone Metastasis Study Group (2006) Patients with a favourable prognosis are equally palliated with single and multiple fraction radiotherapy: results on survival in the Dutch Bone Metastasis Study. Radiother Oncol 78(3):245–253PubMedCrossRef
27.
Sawe J, Hansen J, Ginman C, Hartvig P, Jakobsson PA, Nilsson MI, Rane A, Anggard E (1981) Patient-controlled dose regimen of methadone for chronic cancer pain. Br Med J Clin Res Ed 282(6266):771–773PubMedCrossRef
28.
Slover R (1992) Transdermal fentanyl: clinical trial at the University of Colorado Health Sciences Center. J Pain Symptom Manage 7(3 Suppl):S45–S47PubMedCrossRef
29.
Morley JS, Watt JW, Wells JC, Miles JB, Finnegan MJ, Leng G (1993) Methadone in pain uncontrolled by morphine. Lancet 342(8881):1243PubMedCrossRef
30.
Bruera E, Watanabe S, Fainsinger RL, Spachynski K, Suarez-Almazor M, Inturrisi C (1995) Custom-made capsules and suppositories of methadone for patients on high-dose opioids for cancer pain. Pain 62(2):141–146PubMedCrossRef
31.
Cherny NJ, Chang V, Frager G, Ingham JM, Tiseo PJ, Popp B, Portenoy RK, Foley KM (1995) Opioid pharmacotherapy in the management of cancer pain: a survey of strategies used by pain physicians for the selection of analgesic drugs and routes of administration. Cancer 76(7):1283–1293PubMedCrossRef
32.
Paix A, Coleman A, Lees J, Grigson J, Brooksbank M, Thorne D, Ashby M (1995) Subcutaneous fentanyl and sufentanil infusion substitution for morphine intolerance in cancer pain management. Pain 63(2):263–269PubMedCrossRef
33.
de Stoutz ND, Bruera E, Suarez-Almazor M (1995) Opioid rotation for toxicity reduction in terminal cancer patients. J Pain Symptom Manage 10(5):378–384PubMedCrossRef
34.
De Conno F, Groff L, Brunelli C, Zecca E, Ventafridda V, Ripamonti C (1996) Clinical experience with oral methadone administration in the treatment of pain in 196 advanced cancer patients. J Clin Oncol 14(10):2836–2842PubMed
35.
Hagen NA, Babul N (1997) Comparative clinical efficacy and safety of a novel controlled-release oxycodone formulation and controlled-release hydromorphone in the treatment of cancer pain. Cancer 79(7):1428–1437PubMedCrossRef
36.
Ripamonti C, Groff L, Brunelli C, Polastri D, Stavrakis A, De Conno F (1998) Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio? J Clin Oncol 16(10):3216–3221PubMed
37.
Gagnon B, Bielech M, Watanabe S, Walker P, Hanson J, Bruera E (1999) The use of intermittent subcutaneous injections of oxycodone for opioid rotation in patients with cancer pain. Supp Care Cancer 7(4):265–270CrossRef
38.
Mercadante S, Casuccio A, Calderone L (1999) Rapid switching from morphine to methadone in cancer patients with poor response to morphine. J Clin Oncol 17(10):3307–3312PubMed
39.
Kloke M, Rapp M, Bosse B, Kloke O (2000) Toxicity and/or insufficient analgesia by opioid therapy: risk factors and the impact of changing the opioid. A retrospective analysis of 273 patients observed at a single center. Supp Care Cancer 8(6):479–486CrossRef
40.
Lee MA, Leng ME, Tiernan EJ (2001) Retrospective study of the use of hydromorphone in palliative care patients with normal and abnormal urea and creatinine. Palliat Med 15(1):26–34PubMedCrossRef
41.
Mercadante S, Casuccio A, Fulfaro F, Groff L, Boffi R, Villari P, Gebbia V, Ripamonti C (2001) Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study. J Clin Oncol 19(11):2898–2904PubMed
42.
Santiago-Palma J, Khojainova N, Kornick C, Fischberg DJ, Primavera LH, Payne R, Manfredi P (2001) Intravenous methadone in the management of chronic cancer pain: safe and effective starting doses when substituting methadone for fentanyl. Cancer 92(7):1919–1925PubMedCrossRef
43.
McNamara P (2002) Opioid switching from morphine to transdermal fentanyl for toxicity reduction in palliative care. Palliat Med 16(5):425–434PubMedCrossRef
44.
Moryl N, Santiago-Palma J, Kornick C, Derby S, Fischberg D, Payne R, Manfredi PL (2002) Pitfalls of opioid rotation: substituting another opioid for methadone in patients with cancer pain. Pain 96(3):325–328PubMedCrossRef
45.
Mercadante S, Ferrera P, Villari P, Casuccio A (2005) Rapid switching between transdermal fentanyl and methadone in cancer patients. J Clin Oncol 23(22):5229–5234PubMedCrossRef
46.
Morita T, Takigawa C, Onishi H, Tajima T, Tani K, Matsubara T, Miyoshi I, Ikenaga M, Akechi T, Uchitomi Y, Japan Pain RPMaP-OSG (2005) Opioid rotation from morphine to fentanyl in delirious cancer patients: an open-label trial. J Pain Symptom Manage 30(1):96–103PubMedCrossRef
47.
Narabayashi M, Saijo Y, Takenoshita S, Chida M, Shimoyama N, Miura T, Tani K, Nishimura K, Onozawa Y, Hosokawa T, Kamoto T, Tsushima T, Advisory Committee for Oxycodone Study (2008) Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable adverse effects: an open-label trial. Jpn J Clin Oncol 38(4):296–304PubMedCrossRef
Metadata
Title
Efficacy of opioid rotation to continuous parenteral hydromorphone in advanced cancer patients failing on other opioids
Authors
Wendy H. Oldenmenger
Paul J Lieverse
Paul J. J. M. Janssen
Walter Taal
Carin C. D. van der Rijt
Agnes Jager
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 8/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-011-1254-1

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