Could Switching Opioids in Cancer Patients Provide Relief?

November 12, 2018

We spoke with Erin McMenamin, CRNP, of Penn Medicine, about the recent study on opioid switching in cancer patients.

Side effects and inadequate pain relief with the use of opioids in cancer patients is a challenge for healthcare providers to manage and can cause considerable problems for these patients. While the topic is still debated within the medical community, opioid switching in cancer patients may provide relief of pain and alleviation of opioid-related side effects, according to the results of a recent Italian study.

Erin McMenamin, CRNP, radiation oncology nurse practitioner at the Abramson Cancer Center of Penn Medicine in Philadelphia, who was not involved with the research, spoke with Cancer Network about these results. “Opioids are an effective and accepted method to treat cancer pain. However, unmanaged pain and/or side effects are likely to lead to lack of adherence by patients. For example, a patient experiencing severe, unrelieved constipation may prefer to stop the opioid rather than experience the side effects associated with them.”

The study researchers conducted a post-hoc analysis from a multicenter, four-arm, phase IV randomized controlled trial, evaluating 498 patients. What they found was that switching pain relief methods improved pain or opioid toxicity in half of the 79 (15.9%) patients who switched opioids.

“When inadequate pain relief or intolerable side effects interfere with the ability to obtain adequate pain relief for patients, switching opioids is an option. Switching opioids decreases the opioid requirement,as the body does not perceive them as the same. Additionally, the “new” opioid may provide improved relief with fewer side effects,” noted McMenamin.

The researchers reported that the primary reason for opioid switching was due to uncontrolled pain in the 79 patients who switched (52.3%). Other reasons for switching were adverse opioid reactions (22.1%), a combination of uncontrolled pain and reaction (4.8%), and dysphagia (20.8%). Researchers noted that pain reduction and controlled side effects were reported in 51.45% and 43.5% of medication switches, respectively.

The researchers also reported that there was variability in relief of opioid-induced toxicity among adverse events and on a patient-by-patient basis, with daily doses of oral opioids being higher and transdermal therapy doses being lower after switching.

“Everyone does not respond the same to each of the opioids. This is in part due to the chemical structure of the medication, as well as the metabolism of the medication. Some patients don’t respond to certain medications, or require a much higher dose than others in order to obtain pain relief. Others experience side effects that limit the ability to escalate the dose to obtain adequate pain control,” explained McMenamin.

“Opioids are an effective way to manage pain related to cancer. It is important to discuss expected side effects, as well as alternative methods to manage cancer pain [with patients],” she concluded.