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

• Published in: Supportive care in cancer Vol. 20; no. 8; pp. 1639 - 1647
• Main Authors: Oldenmenger, Wendy H., Lieverse, Paul J, Janssen, Paul J. J. M., Taal, Walter, van der Rijt, Carin C. D., Jager, Agnes
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-08-2012; Springer; Springer Nature B.V
• Subjects: Analgesics; Analgesics, Opioid - administration & dosage; Cancer; Cancer patients; Care and treatment; Drug delivery systems; Drug therapy; Female; Humans; Hydromorphone - administration & dosage; Infusions, Parenteral; Male; Medicine; Medicine & Public Health; Middle Aged; Narcotics; Neoplasms - complications; Nursing; Nursing Research; Oncology; Original; Original Article; Pain management; Pain Management - methods; Pain Measurement; Pain Medicine; Pain, Intractable - drug therapy; Pain, Intractable - etiology; Rehabilitation Medicine; Retrospective Studies; Treatment Failure; Treatment Outcome; Hydromorphone; Neoplasm; Parenteral infusions; Pain; Analgesics; Opioids
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-011-1254-1

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.