title: The opioid rotation ratio of hydrocodone to strong opioids in cancer patients.
abstract: OBJECTIVE
  Cancer pain management guidelines recommend initial treatment with intermediate-strength analgesics such as hydrocodone and subsequent escalation to stronger opioids such as morphine. There are no published studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the opioid rotation ratio (ORR) of hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients.
  
  
  METHODS
  We reviewed the records of consecutive patient visits at our supportive care center in 2011-2012 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected from patients who returned for follow-up within 6 weeks. Linear regression analysis was used to estimate the ORR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow-up.
  
  
  RESULTS
  Overall, 170 patients underwent OR from hydrocodone to stronger opioid. The median age was 59 years, and 81% had advanced cancer. The median time between OR and follow-up was 21 days. We found 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow-up, the median ORR from hydrocodone to MEDD was 1.5 (quintiles 1-3: 0.9-2). The ORR was associated with hydrocodone dose (r = -.52; p < .0001) and was lower in patients receiving ≥40 mg of hydrocodone per day (p < .0001). The median ORR of hydrocodone to morphine was 1.5 (n = 44) and hydrocodone to oxycodone was 0.9 (n = 24).
  
  
  CONCLUSIONS
  The median ORR from hydrocodone to MEDD was 1.5 and varied according to hydrocodone dose.
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea asreddy@mdanderson.org.
authors.forename: Akhila
authors.initials: A
authors.lastname: Reddy
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Hem
authors.initials: H
authors.lastname: Desai
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Suresh
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Maxine
authors.initials: M
authors.lastname: de la Cruz
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Jimin
authors.initials: J
authors.lastname: Wu
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Diane
authors.initials: D
authors.lastname: Liu
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Eden Mae
authors.initials: EM
authors.lastname: Rodriguez
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Jessica
authors.initials: J
authors.lastname: Waletich
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Vicki
authors.initials: V
authors.lastname: Gayle
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Pritul
authors.initials: P
authors.lastname: Patel
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Shalini
authors.initials: S
authors.lastname: Dalal
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Marieberta
authors.initials: M
authors.lastname: Vidal
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Kimberson
authors.initials: K
authors.lastname: Tanco
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Joseph
authors.initials: J
authors.lastname: Arthur
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Kimmie
authors.initials: K
authors.lastname: Tallie
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Janet
authors.initials: J
authors.lastname: Williams
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Julio
authors.initials: J
authors.lastname: Silvestre
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use*; D007052:Ibuprofen / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D010045:Outpatients; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D006853:Hydrocodone; D009020:Morphine; D007052:Ibuprofen
keywords: Cancer; Hydrocodone; Opioid analgesics; Opioid-related disorders; Pain management; Palliative care