Outcome of opioid switching 4 weeks after discharge from a palliative care unit

Abstract

Despite the favorable effects reported with opioid switching performed in a specialized unit in the short term, data on long-term basis are poor, particularly after discharging patients home or in other settings.

Research design and methods:

The aim of this prospective study was to evaluate the long-term outcome of patients who were switched in an acute palliative care unit at a high volume of opioid switching. A consecutive sample of patients who underwent opioid substitution during admission in an acute palliative care unit were assessed for a period of 1 year. Patients were followed-up for 4 weeks after being discharged. Patients were contacted by phone or visited at the outpatient clinic 4 weeks after discharge. Epidemiological data, pain mechanisms, reason for switching, number of opioid substitutions during admission, drugs, doses and routes of administration, opioid treatment at discharge, pain intensity, distress score (DS) calculated as a sum of symptom intensity, were recorded after 2 weeks (T2) and 4 weeks (T4).

A total of 76 patients underwent an opioid substitution in the period taken into consideration. Seventeen patients were excluded as they died in the unit or underwent an alternative procedure after unsuccessful opioid trials. A total of 50 patients were consecutively assessed and discharged after performing an opioid switching. The mean age was 63 (±11) years, and 29 were males. Of the 31 patients, 29 patients were switched during admission once and twice or more, respectively. In all, 32 patients had a complete assessment at T2 and T4. In 13 patients the switching was definitive, as they maintained the same drug and the same dose. Other patients required the same changes to opioid therapy, including doses and drugs. Only a minority of patients worsened their pain and/or symptom control in the subsequent assessments after discharge.

Conclusions:

Opioid switching performed in acute pain relief and palliative care is an effective method of improving the balance between analgesia and adverse effects, even for prolonged periods of time, following discharge to another setting of care. However, for different reasons, some of patients may lose this benefit. Additional studies using different models of care should be performed in order to gather further information about the long-term outcome of opioid switching.

Key words::

• Cancer pain
• Long-term therapy
• Opioid switching

Transparency

Declaration of funding

S.M. declares no conflict of interest and has received no payment in preparation of this manuscript.

Declaration of financial/other relationships

The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.