title: Factors predicting requirement of high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone in patients with cancer pain.
abstract: OBJECTIVE
  To identify predictive factors requiring high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone to transdermal fentanyl in patients with cancer pain.
  
  
  METHODS
  The participants were 76 hospitalized terminal cancer patients who underwent opioid switching from oxycodone or morphine sustained-release tablet to transdermal fentanyl at our hospital between January 2009 and June 2010. The conversion dose was calculated as transdermal fentanyl (25 μg/h)/oral morphine (60 mg) or oxycodone (40 mg)=1. The response evaluated was the dose conversion ratio [transdermal fentanyl/oral morphine or oxycodone (conversion dose to fentanyl)]=Y and was taken to be 0 for Y≤1, 1 for 1<Y≤2, 2 for 2<Y≤3, and 3 for 3<Y. Predictors evaluated were factors potentially impacting pain. Ordered logistic regression analysis was carried out to identify the predictive factors requiring high-dose transdermal fentanyl in opioid switching.
  
  
  RESULTS
  Breast cancer [odds ratio (OR)=8.218; 95% confidence interval (CI), 1.219-55.407; P=0.0305], total protein level (OR=0.630; 95% CI, 0.408-0.974; P=0.0377), alanine aminotransferase level (OR=1.017; 95% CI, 1.001-1.033; P=0.0390), advanced age (OR=3.700; 95% CI, 1.360-10.063; P=0.0104), and male sex (OR=3.702; 95% CI, 1.355-10.115; P=0.0107) were found to be significant predictive factors requiring high-dose transdermal fentanyl in opioid switching.
  
  
  CONCLUSIONS
  Our study indicates that breast cancer, total protein, alanine aminotransferase, advanced age, and male sex are significant predictors of a need for higher dose transdermal fentanyl in opioid switching. Our results are considered likely to contribute to the establishment of evidence-based medicine in pain relief and palliative care.
authors.affiliation: Departments of Pain Treatment and Palliative Care Unit, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kanbayashi
authors.forename: Toyoshi
authors.initials: T
authors.lastname: Hosokawa
authors.forename: Kousuke
authors.initials: K
authors.lastname: Okamoto
authors.forename: Sawako
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Konishi
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Takagi
authors.forename: Tsuneharu
authors.initials: T
authors.lastname: Miki
authors.forename: Masafumi
authors.initials: M
authors.lastname: Taniwaki
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects; D009369:Neoplasms / Q000150:complications; D016017:Odds Ratio; D010098:Oxycodone / Q000009:adverse effects; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D010098:Oxycodone; D005283:Fentanyl