Study of Opioid Rotation Versus Opioid Escalation in Patients With Moderate to Severe Cancer Pain
Cancer, Pain
About this trial
This is an interventional supportive care trial for Cancer focused on measuring Significant cancer pain, at least numeric rating scale 4
Eligibility Criteria
Inclusion Criteria:
- age > 18 years
- patients who are being treated with one of strong opioids including oral oxycodone, oral hydromorphone, or fentanyl patch with range from 60 mg to 200 mg of oral morphine equivalent daily dose (MEDD)
- moderate to severe cancer pain (numeric rating scale more than 3) at screening
- patients without uncontrolled adverse effects associated with currently applied opioid
Exclusion Criteria:
- previous opioid rotation
- unable to take oral medication
- life expectancy less than a month
- newly started chemotherapy and/or radiotherapy within past 2 weeks of screening
- serum aspartate aminotransferase, alanine aminotransferase, or alkaline phosphatase > 2.5 times of upper normal limit
- serum total bilirubin or creatinine > 1.5 times of upper normal limit
Sites / Locations
- Gyeongsang National University Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
opioid rotation
opioid dose escalation
Patients who are randomized to opioid rotation are treated with strong opioid other than currently used strong opioid (Reduce the dose by 25%-50% to allow for incomplete cross-tolerance between different opioids). oral oxycodone : convert to oral hydromorphone or fentanyl patch oral hydromorphone : convert to oral oxycodone or fentanyl patch fentanyl patch : convert to oral oxycodone or oral hydromorphone
Patients who are randomized to opioid dose escalation will be treated cancer pain by escalation dose of same strong opioid. oral oxycodone : maintain oral oxycodone and titrate the dose oral hydromorphone : maintain oral hydromorphone and titrate the dose fentanyl patch : maintain fentanyl patch and titrate the dose