Data Review Shows a Wide Range of Oral Opioid Dosing

 ASCO—A one-year retrospective study of 111 hospice patients with progressive cancer and chronic pain showed that the average daily narcotic requirement for pain control was “very high,” with a wide range of required dosages, Hossam A. Abdel-Rahman, MD, said at an ASCO poster session on symptom management.

The daily dosing range of oral controlled-release oxycodone (OxyContin) was 20 mg to 1,020 mg (mean, 93.6 mg) and for oral controlled-release morphine (MS Contin), 30 mg to 7,800 mg (mean, 692.4 mg). “One patient receiving 7,800 mg/day of MS Contin was still able to drive,” Dr. Abdel-Rahman said in an interview.

The researchers from Louisiana State University Medical Center, Shreveport, also measured the prevalence of different primary cancers in a population of 1,400 fully staged cancer patients who were treated in the community setting and in these 111 patients with chronic cancer pain treated in a hospital-affiliated hospice program.

The incidence of lung cancer was almost twice as high among the terminally ill hospice patients as in the all-stage community-treated cancer patients (29.7% vs 17.1%, respectively), as was the incidence of rectal cancer (8.1% vs 4.5%, respectively). On the other hand, breast cancer was more prevalent in the all-stage patients (34.5% vs 11.7% in the hospice patients) as was colon cancer (14.3% vs 9.9%, respectively).

The point of this study is that the treatment must be individualized, Dr. Abdel-Rahman said. “Not everybody would have satisfactory pain relief in the dosage range we usually give, and we have to be more liberal, because at some point in their illness, patients may need a higher dose.” He noted that no significant side effects were seen in the study patients and urged physicians not to be reluctant to “order these big doses for fear of addiction or serious side effects.”

Another interesting aspect of the study, he said, was the use of electronic medical records. “You have the patient ID, the diagnosis, the prescription they’re getting, and everything goes into a database, so you can retrieve all the information really quickly,” he said. “This allows you to adjust dosages in individual patients, as well as analyze treatment patterns in your practice or hospital.”

Dr. Abdel-Rahman’s colleagues in the study were Dr. Richard P. Mansour (lead investigator) and Dr. Howard G. Wold.