The opioid rotation ratio of hydrocodone to strong opioids in cancer patients

Akhila Reddy; Sriram Yennurajalingam; Hem Desai; Suresh Reddy; Maxine de la Cruz; Jimin Wu; Diane Liu; Eden Mae Rodriguez; Jessica Waletich; Seong Hoon Shin; Vicki Gayle; Pritul Patel; Shalini Dalal; Marieberta Vidal; Kimberson Tanco; Joseph Arthur; Kimmie Tallie; Janet Williams; Julio Silvestre; Eduardo Bruera

doi:10.1634/theoncologist.2014-0130

The opioid rotation ratio of hydrocodone to strong opioids in cancer patients

Akhila Reddy, Sriram Yennurajalingam, Hem Desai, Suresh Reddy, Maxine de la Cruz, Jimin Wu, Diane Liu, Eden Mae Rodriguez, Jessica Waletich, Seong Hoon Shin, Vicki Gayle, Pritul Patel, Shalini Dalal, Marieberta Vidal, Kimberson Tanco, Joseph Arthur, Kimmie Tallie, Janet Williams, Julio Silvestre, Eduardo Bruera

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22 Scopus citations

Abstract

Purpose. Cancer pain management guidelines recommend initialtreatment with intermediate-strength analgesics such as hydrocodone and subsequent escalation to stronger opioids such as morphine. There are no published studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the opioid rotation ratio (ORR) of hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients.

Patients and Methods. We reviewed the records of consecutive patient visits at our supportive care center in 2011-2012 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected from patients who returned for follow-up within 6 weeks. Linear regression analysis was used to estimate the ORR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow-up.

Results. Overall, 170 patients underwent OR from hydrocodone to stronger opioid. The median age was 59 years, and 81% had advanced cancer. The median time between OR and follow-up was 21 days. We found 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow-up, the median ORR from hydrocodone to MEDD was 1.5 (quintiles 1-3: 0.9-2). The ORR was associated with hydrocodone dose (r = 2.52; p <.0001) and was lower in patients receiving >40 mg of hydrocodone per day (p <.0001).The median ORR of hydrocodone to morphine was 1.5 (n = 44) and hydrocodone to oxycodone was 0.9 (n = 24).

Conclusion. The median ORR from hydrocodone to MEDD was 1.5 and varied according to hydrocodone dose.

Original language	English (US)
Pages (from-to)	1186-1193
Number of pages	8
Journal	Oncologist
Volume	19
Issue number	11
DOIs	https://doi.org/10.1634/theoncologist.2014-0130
State	Published - 2014
Externally published	Yes

Bibliographical note

Publisher Copyright:
© AlphaMed Press 2014.

Keywords

Cancer
Hydrocodone
Opioid analgesics
Opioid-related disorders
Pain management
Palliative care

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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Reddy, A., Yennurajalingam, S., Desai, H., Reddy, S., de la Cruz, M., Wu, J., Liu, D., Rodriguez, E. M., Waletich, J., Shin, S. H., Gayle, V., Patel, P., Dalal, S., Vidal, M., Tanco, K., Arthur, J., Tallie, K., Williams, J., Silvestre, J., & Bruera, E. (2014). The opioid rotation ratio of hydrocodone to strong opioids in cancer patients. Oncologist, 19(11), 1186-1193. https://doi.org/10.1634/theoncologist.2014-0130

Reddy, A, Yennurajalingam, S, Desai, H, Reddy, S, de la Cruz, M, Wu, J, Liu, D, Rodriguez, EM, Waletich, J, Shin, SH, Gayle, V, Patel, P, Dalal, S, Vidal, M, Tanco, K, Arthur, J, Tallie, K, Williams, J, Silvestre, J & Bruera, E 2014, 'The opioid rotation ratio of hydrocodone to strong opioids in cancer patients', Oncologist, vol. 19, no. 11, pp. 1186-1193. https://doi.org/10.1634/theoncologist.2014-0130

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abstract = "Purpose. Cancer pain management guidelines recommend initialtreatment with intermediate-strength analgesics such as hydrocodone and subsequent escalation to stronger opioids such as morphine. There are no published studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the opioid rotation ratio (ORR) of hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients.Patients and Methods. We reviewed the records of consecutive patient visits at our supportive care center in 2011-2012 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected from patients who returned for follow-up within 6 weeks. Linear regression analysis was used to estimate the ORR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow-up.Results. Overall, 170 patients underwent OR from hydrocodone to stronger opioid. The median age was 59 years, and 81% had advanced cancer. The median time between OR and follow-up was 21 days. We found 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow-up, the median ORR from hydrocodone to MEDD was 1.5 (quintiles 1-3: 0.9-2). The ORR was associated with hydrocodone dose (r = 2.52; p <.0001) and was lower in patients receiving >40 mg of hydrocodone per day (p <.0001).The median ORR of hydrocodone to morphine was 1.5 (n = 44) and hydrocodone to oxycodone was 0.9 (n = 24).Conclusion. The median ORR from hydrocodone to MEDD was 1.5 and varied according to hydrocodone dose.",

keywords = "Cancer, Hydrocodone, Opioid analgesics, Opioid-related disorders, Pain management, Palliative care",

author = "Akhila Reddy and Sriram Yennurajalingam and Hem Desai and Suresh Reddy and {de la Cruz}, Maxine and Jimin Wu and Diane Liu and Rodriguez, {Eden Mae} and Jessica Waletich and Shin, {Seong Hoon} and Vicki Gayle and Pritul Patel and Shalini Dalal and Marieberta Vidal and Kimberson Tanco and Joseph Arthur and Kimmie Tallie and Janet Williams and Julio Silvestre and Eduardo Bruera",

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year = "2014",

doi = "10.1634/theoncologist.2014-0130",

language = "English (US)",

volume = "19",

pages = "1186--1193",

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AU - Reddy, Akhila

AU - Yennurajalingam, Sriram

AU - Desai, Hem

AU - Reddy, Suresh

AU - de la Cruz, Maxine

AU - Wu, Jimin

AU - Liu, Diane

AU - Rodriguez, Eden Mae

AU - Waletich, Jessica

AU - Shin, Seong Hoon

AU - Gayle, Vicki

AU - Patel, Pritul

AU - Dalal, Shalini

AU - Vidal, Marieberta

AU - Tanco, Kimberson

AU - Arthur, Joseph

AU - Tallie, Kimmie

AU - Williams, Janet

AU - Silvestre, Julio

AU - Bruera, Eduardo

PY - 2014

Y1 - 2014

N2 - Purpose. Cancer pain management guidelines recommend initialtreatment with intermediate-strength analgesics such as hydrocodone and subsequent escalation to stronger opioids such as morphine. There are no published studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the opioid rotation ratio (ORR) of hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients.Patients and Methods. We reviewed the records of consecutive patient visits at our supportive care center in 2011-2012 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected from patients who returned for follow-up within 6 weeks. Linear regression analysis was used to estimate the ORR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow-up.Results. Overall, 170 patients underwent OR from hydrocodone to stronger opioid. The median age was 59 years, and 81% had advanced cancer. The median time between OR and follow-up was 21 days. We found 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow-up, the median ORR from hydrocodone to MEDD was 1.5 (quintiles 1-3: 0.9-2). The ORR was associated with hydrocodone dose (r = 2.52; p <.0001) and was lower in patients receiving >40 mg of hydrocodone per day (p <.0001).The median ORR of hydrocodone to morphine was 1.5 (n = 44) and hydrocodone to oxycodone was 0.9 (n = 24).Conclusion. The median ORR from hydrocodone to MEDD was 1.5 and varied according to hydrocodone dose.

AB - Purpose. Cancer pain management guidelines recommend initialtreatment with intermediate-strength analgesics such as hydrocodone and subsequent escalation to stronger opioids such as morphine. There are no published studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the opioid rotation ratio (ORR) of hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients.Patients and Methods. We reviewed the records of consecutive patient visits at our supportive care center in 2011-2012 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected from patients who returned for follow-up within 6 weeks. Linear regression analysis was used to estimate the ORR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow-up.Results. Overall, 170 patients underwent OR from hydrocodone to stronger opioid. The median age was 59 years, and 81% had advanced cancer. The median time between OR and follow-up was 21 days. We found 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow-up, the median ORR from hydrocodone to MEDD was 1.5 (quintiles 1-3: 0.9-2). The ORR was associated with hydrocodone dose (r = 2.52; p <.0001) and was lower in patients receiving >40 mg of hydrocodone per day (p <.0001).The median ORR of hydrocodone to morphine was 1.5 (n = 44) and hydrocodone to oxycodone was 0.9 (n = 24).Conclusion. The median ORR from hydrocodone to MEDD was 1.5 and varied according to hydrocodone dose.

KW - Cancer

KW - Hydrocodone

KW - Opioid analgesics

KW - Opioid-related disorders

KW - Pain management

KW - Palliative care

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The opioid rotation ratio of hydrocodone to strong opioids in cancer patients

Abstract

Bibliographical note

Keywords

UN SDGs

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