December 2013
J Pain Symptom Manage. 2013. [Epub ahead of print]
Reddy A, Yennurajalingam S, Cruz MD, Palla SL, Wang X, Kwon JH, Frisbee-Hume S, Bruera E
This preliminary ad hoc analysis of a previously published study used medical charts to assess factors influencing follow-up after opioid rotation in 190 consecutive outpatients with cancer and the effect of follow-up on symptoms and survival. Of these 190 patients, 120 (63%) had a follow-up visit, which was more likely to happen if the patient had localised disease, good performance status, substance abuse history and uncontrolled pain. Patients with higher symptom distress (especially fatigue and anorexia), delirium or opioid-induced neurotoxicity (sedation, confusion, hallucinations and myoclonus) were less likely to attend follow-up. Follow-up improved survival estimates by 4.3 months and if the opioid rotation was successful median survival improved by 3 months. Although further larger studies are needed to confirm these findings, it is important to try and ensure follow-up of patients having a change in opioids who are less likely to return to clinic.