Factors Associated With Survival After Opioid Rotation in Cancer Patients Presenting to an Outpatient Supportive Care Center

 Journal of Pain and Symptom Management
Volume 48, Issue 1 , Pages 92-98, July 2014

• Akhila Reddy, MD
,
• Sriram Yennurajalingam, MD
,
• Maxine de la Cruz, MD
,
• Shana L. Palla, MS
,
• Xuan Wang, PhD
,
• Jung Hye Kwon, MD, PhD
,
• Susan Frisbee-Hume, RN, BSN, MS
,
• Eduardo Bruera, MD

Abstract 

Context

Data on cancer outpatients undergoing opioid rotation (OR) are limited. Understanding the characteristics of patients who do not follow up after OR could facilitate optimization of OR.

Objectives

To compare the characteristics and overall survival of patients with and without follow-up after OR.

Methods

In this preliminary ad hoc analysis, we reviewed consecutive patients who presented to our supportive care center in 2008 for OR. Data about demographics, scores on the Edmonton Symptom Assessment System and Memorial Delirium Assessment Scale (MDAS), opioid use, and indications for OR were collected. Univariate logistic regression models were used to determine the factors associated with follow-up. Kaplan-Meier curves were used to evaluate survival.

Results

Of the 190 patients who underwent OR, 120 (63%) had a follow-up visit. Follow-up visits occurred more frequently in patients with localized disease (89%; 24/27; P = 0.0023), history of substance abuse (100%; 12/12; P = 0.0085), performance status ≤ 2 (66%; 97/146; P = 0.0002), no delirium (67%; 118/177; P = 0.002), and uncontrolled pain as reason for OR (66%; 97/146; P = 0.036). Patients who underwent OR for opioid-induced neurotoxicity (44%; 15/34; P = 0.01) and had higher MDAS scores (P = 0.0009) were less likely to follow up. Both follow-up after OR (P < 0.001) and successful OR (P = 0.012) were associated with longer overall survival, with a difference in median survival of 4.3 and 3 months, respectively.

Conclusion

Our preliminary study suggests that patients with advanced cancer, poorer performance status, opioid-induced neurotoxicity, and higher MDAS scores are less likely to follow up after OR and may have shorter overall survival and, therefore, require closer follow-up. Patients with unsuccessful OR also may have a shorter overall survival. Further studies are warranted.

Key Words: Opioid rotation, outpatient, follow-up visit, survival, palliative care, cancer