Effectiveness of Opioid Switching in Advanced Cancer Pain: A Prospective Observational Cohort Study.
Aaron Kee Yee WongAndrew Alexander SomogyiJustin RubioTien Dung PhamBrian H LePal KlepstadJennifer PhilipPublished in: Cancers (2023)
Opioid switching is a common practice of substituting one opioid for another to improve analgesia or adverse effects; however, it has limited evidence. This study aimed to examine the effectiveness of opioid switching in advanced cancer. This multi-center prospective cohort study recruited patients assessed to switch opioids (opioid switch group) or to continue ongoing opioid treatment (control group). Clinical data (demographics, opioids) and validated instruments (pain and adverse effects) were collected over two timepoints seven days apart. Descriptive analyses were utilized. Non-parametric tests were used to determine differences. Fifty-four participants were recruited (23 control group, 31 switch group). At the follow-up, opioid switching reduced pain (worst, average, and now) ( p < 0.05), uncontrolled breakthrough pain (3-fold reduction, p = 0.008), and psychological distress (48% to 16%, p < 0.005). The switch group had a ≥25% reduction in the reported frequency of seven moderate-to-severe adverse effects (score ≥ 4), compared to a reduction in only one adverse effect in the control group. The control group experienced no significant pain differences at the follow-up. Opioid switching is effective at reducing pain, adverse effects, and psychological distress in a population with advanced cancer pain, to levels of satisfactory symptom control in most patients within 1 week.
Keyphrases
- chronic pain
- pain management
- advanced cancer
- palliative care
- end stage renal disease
- systematic review
- ejection fraction
- randomized controlled trial
- newly diagnosed
- chronic kidney disease
- clinical trial
- primary care
- neuropathic pain
- prognostic factors
- healthcare
- peritoneal dialysis
- patient reported
- physical activity
- high intensity
- artificial intelligence
- study protocol