Evidence map›Paper›PMID 25342316›Full record

Trial reportThe oncologist2014

The opioid rotation ratio of hydrocodone to strong opioids in cancer patients.

Akhila Reddy, Sriram Yennurajalingam, Hem Desai, Suresh Reddy, Maxine de la Cruz, Jimin Wu, Diane Liu, Eden Mae Rodriguez, Jessica Waletich, Seong Hoon Shin and 10 more

Open access · bronzeAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The oncologist, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
3.2field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.

  1. Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
    Guideline
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors at 2 institutions in 2 countries.

Akhila ReddyDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea asreddy@mdanderson.org.
Sriram YennurajalingamDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Hem DesaiDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Suresh ReddyDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Maxine de la CruzDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Jimin WuDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Diane LiuDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Eden Mae RodriguezDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Jessica WaletichDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Seong Hoon ShinDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Vicki GayleDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Pritul PatelDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Shalini DalalDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Marieberta VidalDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Kimberson TancoDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Joseph ArthurDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Kimmie TallieDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Janet WilliamsDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Julio SilvestreDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
Eduardo BrueraDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea.
The University of Texas MD Anderson Cancer Center · USKosin University · KR

Funding

Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Scott Kopetz · 1985 to 2026
$290.8M
NCI NIH HHS CA016672NCI NIH HHS P30 CA016672
6 · The paper itself

Abstract

purposeCancer pain management guidelines recommend initial treatment with intermediate-strength analgesics such as hydrocodone and subsequent escalation to stronger opioids such as morphine. There are no published studies on the process of opioid rotation (OR) from hydrocodone to strong opioids in cancer patients. Our aim was to determine the opioid rotation ratio (ORR) of hydrocodone to morphine equivalent daily dose (MEDD) in cancer outpatients. PATIENTS AND

methodsWe reviewed the records of consecutive patient visits at our supportive care center in 2011-2012 for OR from hydrocodone to stronger opioids. Data regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected from patients who returned for follow-up within 6 weeks. Linear regression analysis was used to estimate the ORR between hydrocodone and MEDD. Successful OR was defined as 2-point or 30% reduction in the pain score and continuation of the new opioid at follow-up.

resultsOverall, 170 patients underwent OR from hydrocodone to stronger opioid. The median age was 59 years, and 81% had advanced cancer. The median time between OR and follow-up was 21 days. We found 53% had a successful OR with significant improvement in the ESAS pain and symptom distress scores. In 100 patients with complete OR and no worsening of pain at follow-up, the median ORR from hydrocodone to MEDD was 1.5 (quintiles 1-3: 0.9-2). The ORR was associated with hydrocodone dose (r = -.52; p < .0001) and was lower in patients receiving ≥40 mg of hydrocodone per day (p < .0001). The median ORR of hydrocodone to morphine was 1.5 (n = 44) and hydrocodone to oxycodone was 0.9 (n = 24).

conclusionThe median ORR from hydrocodone to MEDD was 1.5 and varied according to hydrocodone dose.

Indexed as

AgedAnalgesics, OpioidFemaleHumansHydrocodoneIbuprofenLinear ModelsMaleMiddle AgedMorphineNeoplasmsOutpatientsPain ManagementRetrospective StudiesTreatment OutcomeAnalgesics, OpioidHydrocodoneIbuprofenMorphineCancerHydrocodoneOpioid analgesicsOpioid-related disordersPain managementPalliative care

Identifiers

PMID25342316
PMCPMC4221365
OpenAlexW2110525437

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.