Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer Hospital
<b>Background</b>: Our aim was to examine the frequency and prescription pattern of breakthrough (BTO) and scheduled (SCH) opioids and their ratio (BTO/SCH ratio) of use, prior to and after referral to an inpatient supportive care consult (SCC) for cancer pain management (CPM). <b>...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-03-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/31/3/101 |
| _version_ | 1797241490488950784 |
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| author | Aline Rozman de Moraes Elif Erdogan Ahsan Azhar Suresh K. Reddy Zhanni Lu Joshua A. Geller David Mill Graves Michal J. Kubiak Janet L. Williams Jimin Wu Eduardo Bruera Sriram Yennurajalingam |
| author_facet | Aline Rozman de Moraes Elif Erdogan Ahsan Azhar Suresh K. Reddy Zhanni Lu Joshua A. Geller David Mill Graves Michal J. Kubiak Janet L. Williams Jimin Wu Eduardo Bruera Sriram Yennurajalingam |
| author_sort | Aline Rozman de Moraes |
| collection | DOAJ |
| description | <b>Background</b>: Our aim was to examine the frequency and prescription pattern of breakthrough (BTO) and scheduled (SCH) opioids and their ratio (BTO/SCH ratio) of use, prior to and after referral to an inpatient supportive care consult (SCC) for cancer pain management (CPM). <b>Methods and Materials</b>: Patients admitted at the MD Anderson Cancer Center and referred to a SCC were retrospectively reviewed. Cancer patients receiving SCH and BTO opioids for ≥24 h were eligible for inclusion. Patient demographics and clinical characteristics, including the type and route of SCH and BTO opioids, daily opioid doses (MEDDs) of SCH and BTO, and BTO/SCH ratios were reviewed in patients seen prior to a SCC (pre-SCC) and during a SCC. A normal BTO ratio was defined as 0.5–0.2. <b>Results</b>: A total of 665/728 (91%) patients were evaluable. Median pain scores (<i>p</i> < 0.001), BTO MEDDs (<i>p</i> < 0.001), scheduled opioid MEDDs (<i>p</i> < 0.0001), and total MEDDs (<i>p</i> < 0.0001) were higher, but the median number of BTO doses was fewer (2 vs. 4, <i>p</i> < 0.001), among patients seen at SCC compared to pre-SCC. A BTO/SCH ratio over the recommended ratio (>0.2) was seen in 37.5% of patients. The BTO/SCH ratios in the pre-SCC and SCC groups were 0.10 (0.04, 0.21) and 0.17 (0.10, 0.30), respectively, <i>p</i> < 0.001. Hydromorphone and Morphine were the most common BTO and SCH opioids prescribed, respectively. Patients in the early supportive care group had higher pain scores and MEDDs. <b>Conclusions</b>: BTO/SCH ratios are frequently prescribed higher than the recommended dose. Daily pain scores, BTO MEDDs, scheduled opioid MEDDs, and total MEDDs were higher among the SCC group than the pre-SCC group, but the number of BTO doses/day was lower. |
| first_indexed | 2024-04-24T18:24:09Z |
| format | Article |
| id | doaj.art-07cd7d71e6214cd6b28d2ba74b6788c7 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-04-24T18:24:09Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-07cd7d71e6214cd6b28d2ba74b6788c72024-03-27T13:32:43ZengMDPI AGCurrent Oncology1198-00521718-77292024-03-013131335134710.3390/curroncol31030101Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer HospitalAline Rozman de Moraes0Elif Erdogan1Ahsan Azhar2Suresh K. Reddy3Zhanni Lu4Joshua A. Geller5David Mill Graves6Michal J. Kubiak7Janet L. Williams8Jimin Wu9Eduardo Bruera10Sriram Yennurajalingam11Department of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Biostatistics, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USA<b>Background</b>: Our aim was to examine the frequency and prescription pattern of breakthrough (BTO) and scheduled (SCH) opioids and their ratio (BTO/SCH ratio) of use, prior to and after referral to an inpatient supportive care consult (SCC) for cancer pain management (CPM). <b>Methods and Materials</b>: Patients admitted at the MD Anderson Cancer Center and referred to a SCC were retrospectively reviewed. Cancer patients receiving SCH and BTO opioids for ≥24 h were eligible for inclusion. Patient demographics and clinical characteristics, including the type and route of SCH and BTO opioids, daily opioid doses (MEDDs) of SCH and BTO, and BTO/SCH ratios were reviewed in patients seen prior to a SCC (pre-SCC) and during a SCC. A normal BTO ratio was defined as 0.5–0.2. <b>Results</b>: A total of 665/728 (91%) patients were evaluable. Median pain scores (<i>p</i> < 0.001), BTO MEDDs (<i>p</i> < 0.001), scheduled opioid MEDDs (<i>p</i> < 0.0001), and total MEDDs (<i>p</i> < 0.0001) were higher, but the median number of BTO doses was fewer (2 vs. 4, <i>p</i> < 0.001), among patients seen at SCC compared to pre-SCC. A BTO/SCH ratio over the recommended ratio (>0.2) was seen in 37.5% of patients. The BTO/SCH ratios in the pre-SCC and SCC groups were 0.10 (0.04, 0.21) and 0.17 (0.10, 0.30), respectively, <i>p</i> < 0.001. Hydromorphone and Morphine were the most common BTO and SCH opioids prescribed, respectively. Patients in the early supportive care group had higher pain scores and MEDDs. <b>Conclusions</b>: BTO/SCH ratios are frequently prescribed higher than the recommended dose. Daily pain scores, BTO MEDDs, scheduled opioid MEDDs, and total MEDDs were higher among the SCC group than the pre-SCC group, but the number of BTO doses/day was lower.https://www.mdpi.com/1718-7729/31/3/101cancer painhospitalized patientsbreakthrough opioidsdaily opioid dose |
| spellingShingle | Aline Rozman de Moraes Elif Erdogan Ahsan Azhar Suresh K. Reddy Zhanni Lu Joshua A. Geller David Mill Graves Michal J. Kubiak Janet L. Williams Jimin Wu Eduardo Bruera Sriram Yennurajalingam Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer Hospital Current Oncology cancer pain hospitalized patients breakthrough opioids daily opioid dose |
| title | Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer Hospital |
| title_full | Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer Hospital |
| title_fullStr | Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer Hospital |
| title_full_unstemmed | Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer Hospital |
| title_short | Scheduled and Breakthrough Opioid Use for Cancer Pain in an Inpatient Setting at a Tertiary Cancer Hospital |
| title_sort | scheduled and breakthrough opioid use for cancer pain in an inpatient setting at a tertiary cancer hospital |
| topic | cancer pain hospitalized patients breakthrough opioids daily opioid dose |
| url | https://www.mdpi.com/1718-7729/31/3/101 |
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