gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Opioid switching from transdermal fentanyl to orally administered opioids in patients with cancer pain

Meeting Abstract

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  • corresponding author presenting/speaker Katri Elina Clemens - Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Centre for Palliative Medicine, Malteser Hospital Bonn, University of Bonn, Deutschland
  • Eberhard Klaschik - Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Centre for Palliative Medicine, Malteser Hospital Bonn, University of Bonn

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocOP532

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Clemens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Aim of Investigation: Transdermal fentanyl (F) is a widely used opioid for the treatment of cancer pain. Simplicity of use and high patient compliance are the main advantages of this opioid. However, we repeatedly had the impression that especially in terminally ill palliative care patients F often seems not to be efficacious. In this retrospective analysis of our 2004 and 2005 data we investigated pain management and need for opioid switching in cancer patients admitted to our palliative care unit (PCU).

Methods: Of 354 patients admitted to our PCU 81 patients were pre-treated with F. Patients and cancer-related data (diagnosis, symptoms, pain score on NRS) were compared. Statistics: mean±SD, ANOVA, significance p<0.05.

Results: 81 patients (age 65.4±12.2 years; 49.4% men) were pre-treated with F at admission. Mean F dose at admission was 81.0±55.8 μg/h (193.7±134.0 mg morphine equivalent (EQD)). The average length of stay was 11.9±6.7 days. Main symptoms were insufficient analgesia (100%), sweating (63%), cachexia (35%), nausea (50%), vomiting (29%), constipation (69%) and dyspnoea (30%). In 79 patients F treatment was discontinued. In two patients, analgesic treatment according to WHO I provided sufficient pain relief. 77 patients were switched to other opioids: 33 patients to oral morphine (M) and 44 patients to oral hydromorphone (HM). In patients switched to M the dose at discharge (104.7±88.8 mg) was lower than at admission (165.5±135.0 mg EQD). In patients switched to HM the dose of 277.8±255.0 mg morphine equivalent was higher than at admission 218.2±131.4 mg (considering an equianalgesic conversion ratio M:HM = 7.5:1). Pain scores at admission decreased significantly after opioid switching (NRS at rest/on exertion: 5/7 vs. 0/1; p<0.001).

Conclusions: It was surprising that sufficient pain relief was achieved in the M group with similar equianalgesic morphine doses. The reasons why the opioid dose at discharge in the HM group was higher than in the M group need to be investigated, i.e. if the conversion ratio used in clinical practice should be reconsidered. Patients with far advanced cancer often suffer from sweating and cachexia, which may have a negative effect on the absorption of F. Opioid switching to oral Mor HM was well tolerated and proved to be an efficacious option for cancer pain treatment in patients with far advanced cancer.