Opioid Switch Dosing in Chronic Cancer Pain: A Prospective Longitudinal Study

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dc.contributor.authorWong, A.K.
dc.contributor.authorKlepstad, P.
dc.contributor.authorRubio, J.P.
dc.contributor.authorSomogyi, A.A.
dc.contributor.authorVogrin, S.
dc.contributor.authorLe, B.
dc.contributor.authorPhilip, J.
dc.date.issued2024
dc.description.abstractBackground: Opioid switching is common, however, conversion tables have limitations. Guidelines suggest postswitch dose reduction, yet, observations show opioid doses may increase postswitch. Objectives: To document the opioid conversion factor postswitch in cancer, and whether pain and adverse effect outcomes differ between switched opioid groups. Design/Setting: This multicenter prospective longitudinal study included people with advanced cancer in Australia. Clinical data (demographics, opioids) and validated instruments (pain, adverse effects) were collected twice, seven days apart. Results: Opioid switch resulted in dose increase (median oral morphine equivalent daily dose 90 mg [interquartile range {IQR} 45–184] to 150 mg [IQR 79–270]), reduced average pain (5.1 [standard deviation {SD} 1.7] to 3.8 [SD 1.6]), and reduced adverse effects. Hydromorphone dose increased 2.5 times (IQR 1.0–3.6) above the original conversion factor used. Conclusions: Opioid switching resulted in overall dose increase, particularly when switching to hydromorphone. Higher preswitch dosing may require higher dose conversion ratios. Dose reduction postswitch risks undertreatment and may not be always appropriate.
dc.description.statementofresponsibilityAaron K. Wong, Pal Klepstad, Justin P. Rubio, Andrew A. Somogyi, Sara Vogrin, Brian Le, and Jennifer Philip
dc.identifier.citationJournal of Palliative Medicine, 2024; 27(3):388-393
dc.identifier.doi10.1089/jpm.2023.0541
dc.identifier.issn1096-6218
dc.identifier.issn1557-7740
dc.identifier.orcidSomogyi, A.A. [0000-0003-4779-0380]
dc.identifier.urihttps://hdl.handle.net/2440/142065
dc.language.isoen
dc.publisherMary Ann Liebert
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2014035
dc.rights© Mary Ann Liebert, Inc.
dc.source.urihttp://dx.doi.org/10.1089/jpm.2023.0541
dc.subjectadvanced cancer
dc.subjectanalgesics
dc.subjectopioid
dc.subjectpalliative care
dc.subject.meshHumans
dc.subject.meshNeoplasms
dc.subject.meshHydromorphone
dc.subject.meshAnalgesics, Opioid
dc.subject.meshLongitudinal Studies
dc.subject.meshProspective Studies
dc.subject.meshChronic Pain
dc.subject.meshCancer Pain
dc.titleOpioid Switch Dosing in Chronic Cancer Pain: A Prospective Longitudinal Study
dc.typeJournal article
pubs.publication-statusPublished

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