Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
J Pain Symptom Manage. 2013 Feb;45(2):298-304. doi: 10.1016/j.jpainsymman.2012.02.025. Epub 2012 Oct 25.
Opioid switching has been found to improve opioid responsiveness in different conditions. However, data on opioid switching performed at home are almost nonexistent, despite the fact that most patients are followed at home.
The aim of this retrospective survey was to determine frequency, indications, usefulness, and safety of opioid switching when treating advanced cancer-related pain in patients followed at home.
A retrospective review of data from patients with advanced cancer followed at home by three home care teams for a period of two years was performed. Patients who had their opioids switched were selected. Reasons for switching opioid doses and routes of administration and outcomes were collected.
Two hundred one (17%) of 1141 patients receiving "strong" opioids were switched. The mean Karnofsky Performance Status score was 35.6, and the median survival was 30 days. The most frequent reason to switch was for convenience, and the most frequent switch was to parenteral morphine. In most patients, a better analgesic response was observed. Patients who were switched to parenteral morphine had a shorter survival in comparison with other opioid sequences (P<0.0005). After switching, opioid doses were increased by 23% and 41%, after a week and at time of death, respectively.
Opioid switching was useful for most patients in the home environment, at least in less complex circumstances, when done by experienced home care teams. Prospective studies are needed to provide information about the decision to admit to hospital for this purpose and the predictive factors that may relatively contraindicate transportation to a facility in severely ill patients.
在不同情况下，已发现阿片类药物转换可改善阿片类药物的反应性。然而，在家中进行阿片类药物转换的数据几乎不存在，尽管大多数患者都是在家中接受治疗。
本回顾性调查的目的是确定在家中治疗晚期癌症相关疼痛时，对患者进行阿片类药物转换的频率、适应证、有效性和安全性。
对三个家庭护理团队在两年时间内随访的 1141 名接受“强”阿片类药物治疗的晚期癌症患者的数据进行了回顾性分析。选择了阿片类药物剂量和给药途径发生转换的患者。收集了转换阿片类药物剂量和给药途径的原因和结果。
1141 名接受“强”阿片类药物治疗的患者中，有 201 名（17%）发生了转换。平均 Karnofsky 表现状态评分为 35.6，中位生存期为 30 天。转换的最常见原因是为了方便，最常见的转换是使用吗啡的注射剂型。在大多数患者中，观察到了更好的镇痛效果。与其他阿片类药物序列相比，转换为吗啡注射剂型的患者的生存期更短（P<0.0005）。转换后，阿片类药物剂量在一周和死亡时分别增加了 23%和 41%。
在家环境中，经验丰富的家庭护理团队对大多数患者进行阿片类药物转换是有用的，至少在不太复杂的情况下是如此。需要前瞻性研究提供有关为此目的住院的决策信息，以及在病情严重的患者中可能相对禁忌转运到医疗机构的预测因素。
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