Methadone initiation and rotation in the outpatient setting for patients with cancer pain

Cancer - Tập 116 Số 2 - Trang 520-528 - 2010
Henrique A. Parsons1, Maxine de la Cruz1, Badi El Osta1, Zhijun Li1, Bianca Calderon1, J. Lynn Palmer1, Éduardo Bruera1
1Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Tóm tắt

AbstractBACKGROUND:Methadone is an effective and inexpensive opioid for cancer pain treatment. It has been reported as difficult to use in the outpatient setting because of its variable relative potency and long half‐life. The purpose of this study was to determine the outcome of methadone initiation or rotation for cancer pain treatment in outpatient settings.METHODS:Chart review was done of 189 consecutive patients who underwent methadone initiation or rotation at the authors' palliative care outpatient center. Data were collected regarding demographic and clinical characteristics, symptoms, and opioid side effects at baseline and for 2 follow‐up visits (F1, F2). Failure was defined as methadone discontinuation by the palliative care physician or patient's hospitalization for uncontrolled pain or methadone‐related side effects at F1.RESULTS:One hundred (53%) initiations and 89 (47%) rotations were conducted. Success rates for methadone initiation and rotation were 82 of 89 (92%) and 85 of 100 (84%), respectively. Mean (standard deviation) age was 60 (11) years. One hundred (53%) patients were women, 138 (73%) were white, and 182 (96%) had solid cancers. The main reason for rotation was pain (65 of 89 patients, 47%). Median (interquartile range, IQR) pain scores (Edmonton Symptom Assessment Scale/0‐10) were 6 (5‐8), 4 (3‐6), and 3 (2‐5) at baseline, F1, and F2, respectively (P < .0001). Median (IQR) daily methadone dose for initiation and rotation was 10 (5‐15) mg and 15 (10‐30) mg at F1 (P < .0001) and 10 (8‐15) mg and 18 (10‐30) mg at F2 (P < .0001), respectively. Constipation and nausea improved (P < .005) after initiation/rotation to methadone. Frequency of sedation, hallucinations, myoclonus, and delirium did not increase after initiation/rotation to methadone.CONCLUSIONS:Outpatient methadone initiation and rotation for cancer pain treatment were safe, with high success rates and low side effect profiles. Cancer 2010. © 2010 American Cancer Society.

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Tài liệu tham khảo

10.1081/CNV-50482

1986, Cancer Pain Relief

10.1016/S0885-3924(05)80002-8

10.1016/j.jpainsymman.2005.01.004

10.1007/s005200000180

10.1200/JCO.1999.17.10.3307

10.1016/0304-3959(96)03112-0

10.1200/JCO.2001.19.11.2898

10.1017/S1478951508000254

10.1200/JCO.2004.03.172

10.1016/j.ejpain.2008.01.013

10.1016/j.clpt.2004.05.003

10.1097/00000542-200005000-00030

10.1592/phco.2005.25.11.1523

10.1016/j.amjcard.2004.11.055

10.1016/S0885-3924(99)00083-4

10.1016/j.jpainsymman.2005.12.005

10.1089/10966210252785097

10.1007/s00520-008-0423-3

10.1177/082585979100700202

10.1002/(SICI)1097-0142(20000501)88:9<2164::AID-CNCR24>3.0.CO;2-5

Reddy SK, 2004, The M. D. Anderson Symptom Control and Palliative Care Handbook, 38

10.1023/A:1008263910494

10.1089/jpm.2007.0285

10.1016/S0885-3924(01)00294-9

10.1002/(SICI)1097-0142(19980315)82:6<1167::AID-CNCR23>3.0.CO;2-3

10.1177/082585970001600209

10.1200/JCO.2002.20.9.2409

Quigley C, 2004, Opioid switching to improve pain relief and drug tolerability, Cochrane Database Syst Rev, CD004847

10.1097/00001622-200007000-00006

10.1016/0304-3959(94)00257-F

10.1016/0140-6736(93)92228-L

10.1200/JCO.1998.16.10.3216

10.1191/0269216303pm696oa

10.1200/JCO.1998.16.11.3656

10.1200/JCO.1996.14.10.2836

10.1016/S0885-3924(99)00086-X

10.1038/clpt.2008.104

10.1097/ALN.0b013e3181986a9a

10.1016/j.phrs.2004.05.002

10.1007/s00520-006-0127-5

10.1016/S0140-6736(99)02107-8

10.1016/j.jpainsymman.2006.02.010

10.1001/jama.289.16.2120

10.1016/j.jpainsymman.2008.05.016

10.1016/S0305-7372(96)90075-4

10.1007/s005200100266

10.1089/jpm.2008.0155

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Cancer

Tập 116 Số 2

520-528

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