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Efficacy of opioid rotation to continuous parenteral hydromorphone in advanced cancer patients failing on other opioids
Supportive Care in Cancer, 08/31/2011
Clinical Article
Oldenmenger WH et al. – 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.
Methods- 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 SE were daily assessed
- Moment of adequate pain control defined as first of at least 2 consecutive days when mean pain intensity at rest was ≤4 (on 0-10 numeric rating scale) and SE were tolerable
- Reasons for rotation to parenteral hydromorphone were inadequate pain control with/without expected delivery problems due to high opioid dosages (n=61) and intolerable SE with persistent pain (n=43)
- Adequate pain control achieved in 86 patients (83%) within mean of 5 days
- 8 of 86 patients still had SE, but these were scored as acceptable
- Mean pain intensity at rest decreased from 5.4 [standard deviation (sd)=2.1] to 2.4 (sd=1.5; p<0.001)
- Median failure-free treatment period 57 days and covered substantial part of median survival of 78 days in responding patients