Patient-Controlled Subcutaneous Analgesia with Hydromorphone versus Oral Oxycontin for Opioid Titration of Cancer Pain: A Prospective Multicenter Randomized Trial

Abstract

Background

Studies have shown that oral oxycontin tablets can be used for opioid titration. The European Society for Medical Oncology (ESMO) guidelines for adult cancer pain recommend opioid titration through the parenteral route, usually the intravenous or subcutaneous route. Patient-controlled subcutaneous analgesia (PCSA) with hydromorphone needs further evaluation for opioid titration. This prospective multicenter study was designed to compare the efficacy and safety of hydromorphone PCSA with oral oxycontin tablets for opioid titration of cancer pain.

Patients and Methods

Eligible patients with cancer pain were randomly assigned in a 1:1 ratio to the PCSA group or the oxycontin group for dose titration. Different titration methods were given in both groups depending on whether the patient had an opioid tolerance. The primary endpoint of this study was time to successful titration (TST).

Results

A total of 256 patients completed this study. The PCSA group had a significantly lower TST compared with the oxycontin group (median [95% confidence interval (CI)], 5.5[95% CI:2.5–11.5] hours vs.16.0 [95% CI:11.5–22.5] hours; p<0.001). The frequency (median; interquartile) of breakthrough pain (Btp) over 24 hours was significantly lower in the PCSA group (2.5;2.0–3.5) than in the oxycontin group.(3.0; 2.5–4.5) (p=0.04). The pain was evaluated by numeric rating scale (NRS) score at 12 hours after the start of titration. The pain score (median; interquartile) was significantly lower in the PCSA versus the oxycontin group (2.5;1.5–3.0) vs 4.5;3.0–6.0) (p=0.02). The equivalent dose of oral morphine (EDOM) for a successful titration was similar in both groups (p=0.29), but there was a significant improvement in quality of life (QoL) in both groups (p=0.03). No between-group difference in the incidence of opioid-related adverse effects was observed (p=0.32).

Conclusion

Compared with oral oxycontin tablet, the use of PCSA with hydromorphone achieved a shorter titration duration for patients with cancer pain (p<0.001), without significantly increasing adverse events (p=0.32).

Keywords:

• cancer pain
• opioid titration
• oxycontin tablets
• hydromorphone
• patient-controlled subcutaneous analgesia

Data Sharing Statement

The original data is saved by excel spreadsheet and shared at the Chinese Clinical Trial Registration Center. The authors are willing to share these data and the data can be downloaded at https://www.chictr.org.cn/showproj.html?proj=60437 permanently.

Acknowledgments

We appreciate Medjaden Bioscience Limited for polishing the language of the manuscript. The abstract of this paper was presented at the 20203 ASCO Conference with

Patient-controlled subcutaneous analgesia with hydromorphone versus oral oxycodone for opioid titration of cancer pain: A prospective multicenter randomized trial

as a poster presentation (Abstract:404398;Poster:492). The poster’s abstract was published in ”Poster Abstracts” in Journal of Clinical Oncology. https://ascopubs.org/doi/10.1200/JCO.2023.41.16_suppl.12124.

Disclosure

The authors report no conflicts of interest in this work.