Abstract
Introduction Opioids are the most important drugs in treating pain in palliative care patients. Transdermal formulations are especially useful due to their noninvasive nature and minimal interference in daily life. However, studies have shown a controversial relationship of opioids to survival and a rise in deaths associated with the use of transdermal opioids. Although applying precise doses is paramount, we have no clear recommendations for the exact equianalgesic ratio for buprenorphine patch and no recommendation for the type of transdermal opioid to use in hospice. Methods We analyzed the differences between the transdermal fentanyl and buprenorphine group by analyzing patient characteristics and evaluating the differences in survival in hospice patients over the age of 65, from 2013 to 2017. Results A total of 292 patients (75.8%) used fentanyl patch and 93 (24.1%) were on buprenorphine patch. Patients had virtually the same characteristics in both groups. However, when using a 1:100 buprenorphine equianalgesic ratio, there were significant differences in initial and final doses, and it seems that a 1:80 conversion rate is more accurate for elderly hospice patients. Finally, there was no difference in survival between the two groups using transdermal opioids, with or without adjuvant analgesics. Discussion There were no differences in survival between the group using transdermal fentanyl and the group using buprenorphine in the elderly hospice population. Although adjuvant NSAIDs could be useful in the treatment of pain in terminal cancer, they do not affect survival or reduce the opioid doses, while a 1:80 equianalgesic ratio of buprenorphine might be the most appropriate in this population.
Highlights
Opioids are the most important drugs in treating pain in palliative care patients
Quality of life and the level of pain should be the primary concerns when choosing the opioid, but it is important to assess that these drugs do not have a negative effect on the survival in the frail hospice population, especially knowing there is a rise in deaths associated with the use of TD opioids [9]
The ratio of 1:100 we initially used for buprenorphine produced statistically significant changes in opioid doses between the fentanyl and buprenorphine group of patients
Summary
Opioids are the most important drugs in treating pain in palliative care patients. Transdermal formulations are especially useful due to their noninvasive nature and minimal interference in daily life. There were no differences in survival between the group using transdermal fentanyl and the group using buprenorphine in the elderly hospice population. Adjuvant NSAIDs could be useful in the treatment of pain in terminal cancer, they do not affect survival or reduce the opioid doses, while a 1:80 equianalgesic ratio of buprenorphine might be the most appropriate in this population. Quality of life and the level of pain should be the primary concerns when choosing the opioid, but it is important to assess that these drugs do not have a negative effect on the survival in the frail hospice population, especially knowing there is a rise in deaths associated with the use of TD opioids [9]. At-risk populations include cachectic cancer patients, who have impaired absorption of the TD opioids [10], the elderly due to multiple comorbidities and medicines used [11], as well as patients with hepatic impairment [12], all of which are common traits in hospice patients
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