Opioids Titration Study in Advanced Cancer Patients in Hong Kong
Status:
Completed
Trial end date:
2020-12-07
Target enrollment:
Participant gender:
Summary
Pain is a common symptom that is experienced by patients with advanced cancer. Whilst mild
pain can usually be controlled with simple analgesics, more severe pain may require
initiation of opioid analgesics. The World Health Organization (WHO) has developed a specific
guideline for titration of analgesics. Known as the WHO Pain Ladder, patients who have severe
pain despite non-opioid and weak opioid analgesics are advised to step up to level 3 -
"Strong Opioids". Morphine is the most common opioid strong analgesic prescribed in Hong
Kong. To the best of our knowledge, there is no formal opioid pain control guideline
developed for cancer patients in Hong Kong. The prescription practices of various physicians
who treat advance cancer patients, including oncologists and palliative care physicians have
never been audited or standardized.
Furthermore, there are inherent issues with the administration of oral morphine. Currently,
only one fixed concentration is available in a liquid formulation. Patients are known to have
difficulties in receiving the appropriate dose. Accurate measurement of the volume required
is extremely difficult, and many a times patients will report to have spilled the oral
morphine during decanting, or will report that they have not been taking adequate doses
because they are worried that they will decant too much into a spoon or syringe and overdose
themselves.
Oxycodone is a semisynthetic strong opioid analgesic, which has recently been introduced to
Hong Kong. It is formulated as a capsule, and again, 2 preparations (sustained-release
(Oxycontin) and immediate release (Oxycodone IR)) are available. Inherent advantages include
ease of administration; different groups have previously reported less adverse effects and
better treatment compliance. However, to date, there has been no prospective 'head-to-head'
comparison have ever been carried out comparing this with the traditional, well-accepted
methods.
The purpose of this study is to assess whether or not the use of Oxycontin and Oxycodone IR
may be superior to traditional medication choices and schedules in terms of time required for
onset of pain control, the side effect profile, patients' tolerability and compliance to
treatment. Interestingly, through this randomized open-label prospective study, we also aim
to capture information on current opioid prescription practices by clinicians who manage
patients with advanced cancers, which will be useful for us to consider the establishment of
territory-wide treatment guidelines at a later juncture.