Effectiveness of opioid rotation in the control of cancer pain: The ROTODOL Study

Jesús González-Barboteo, MD; Xavier Gómez-Batiste Alentorn, MD, PhD; Felipe A. Calvo Manuel, MD, PhD; Vicente Alberola Candel, MD; M. Amalia Palacios Eito, MD; Isabel Sánchez-Magro, MD, PhD; F. Javier Pérez Martín, PhD; Josep Porta-Sales, MD, PhD

doi:10.5055/jom.2014.0236

Authors

Jesús González-Barboteo, MD
Xavier Gómez-Batiste Alentorn, MD, PhD
Felipe A. Calvo Manuel, MD, PhD
Vicente Alberola Candel, MD
M. Amalia Palacios Eito, MD
Isabel Sánchez-Magro, MD, PhD
F. Javier Pérez Martín, PhD
Josep Porta-Sales, MD, PhD

DOI:

https://doi.org/10.5055/jom.2014.0236

Keywords:

analgesics, opioid/administration and dosage, pain, neoplasms

Abstract

Objective: To assess the effectiveness of opioid rotation (OR) to manage cancer pain. To describe the adverse events (AEs) associated with OR.

Setting: Thirty-nine tertiary hospital services.

Patients: Sixty-seven oncological patients with cancer-related pain treated at outpatient clinics.

Intervention: Prospective multicenter study. Pain intensity was scored using a Numerical Rating Scale (NRS) of 0-10. Average pain (AP) intensity in the last 24 hours, breakthrough pain (BTP), and the number of episodes of BTP on the days before and 1 week after OR were assessed. The pre-OR and post-OR opioid were recorded. The presence and intensity of any AEs occurring after OR were also recorded.

Results: In the 67 patients evaluated, 75 ORs were recorded. In all cases, the main reason for OR was poor pain control. Pain intensity decreased by ≥2 points after OR in 75.4 percent and 57.8 percent of cases for AP and BTP, respectively. If the initial NRS score was ≥4, a decrease below <4 accounted for 50.9 percent and 32.3 percent of cases for AP and BTP, respectively. The number of episodes of BTP also decreased significantly (p < 0.001). A total of 107 AEs were reported, most of which were mild in intensity, with gastrointestinal symptoms predominating.

Conclusions: Opioid rotation appears to be both safe and effective in the management of basal and breakthrough cancer pain.

Author Biographies

Jesús González-Barboteo, MD

Palliative Care Service, Hospital Duran I Reynals, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain; Chair of Palliative Care, Center for Health and Social Studies, University of Vic., Barcelona, Spain; Palliative Care Research Group, IDIBELL, Universitary Bellvitge Hospital, L’Hospitalet de Llobregat, Barcelona, Spain.

Xavier Gómez-Batiste Alentorn, MD, PhD

Director of World Health Organization Collaborating Centre for Public Health Palliative Care Programmes, Hospital Duran I Reynals, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain; Director of Chair of Palliative Care, Center for Health and Social Studies, University of Vic., Barcelona, Spain; Palliative Care Research Group, IDIBELL, Universitary Bellvitge Hospital, L’Hospitalet de Llobregat, Barcelona, Spain.

Felipe A. Calvo Manuel, MD, PhD

Chief of Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Professor of Complutense, University of Madrid, Madrid, Spain.

Vicente Alberola Candel, MD

Chief of Medical Oncology Service, Hospital Arnau de Vilanova, Valencia, Spain; Professor of Medical Oncology, Medical Oncology Service, Hospital Arnau de Vilanova, Universitat de Valencia, Valencia, Spain.

M. Amalia Palacios Eito, MD

Chief of Radiotherapy Oncology Service, Hospital Universitario Provincial Reina Sofía, Córdoba, Spain.

Isabel Sánchez-Magro, MD, PhD

Medical Director of Medical Department, Grünenthal Iberia, Madrid, Spain. Marta Neira Álvarez, MD, PhD, Medical Department, Grünenthal Iberia, Madrid, Spain.

F. Javier Pérez Martín, PhD

Clinical Research Unit, Hospital Duran I Reynals, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain

Josep Porta-Sales, MD, PhD

Chief of Palliative Care Service Research Unit, Hospital Duran I Reynals, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain; Palliative Care Research Group, IDIBELL, Universitary Bellvitge Hospital, L’Hospitalet de Llobregat, Barcelona, Spain.

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