Supplemental online content for: Comparing Patient ...
JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK
Supplemental online content for:
Comparing Patient-Controlled Analgesia Versus Non-PCA Hydromorphone Titration for Severe Cancer Pain: A Randomized Phase III Trial
Rongbo Lin, MD; Sunzhi Lin, MD; Shuitu Feng, MD; Qingyi Wu, MD; Jianqian Fu, MD; Fang Wang, MD; Hui Li, MD; Xiaofeng Li, MD; Gaowang Zhang, MD; Yongzhi Yao, MD; Min Xin, MD; Tianyang Lai, MD; Xia Lv, MD; Yigui Chen, MD; Shangwang Yang, MD; Yubiao Lin, MD; Lixia Hong, MD; Zhenyu Cai, MD; Jianfeng Wang, MD; Gen Lin, MD; Shaowei Lin, MD; Shen Zhao, MD; Jinfeng Zhu, MD; and Cheng Huang, MD J Natl Compr Canc Netw 2021;19(10):1148?1155 eFigure 1: Median Accumulated Hydromorphone Consumption From the Start of Titration to TST eFigure 2: Median Accumulated Hydromorphone Consumption From the Start of Titration to Hour 24 eFigure 3: Median Number of Delivered Boluses eTable 1: Common Opioid Conversion Chart eTable 2: ESAS at Baseline and Hour 24 eTable 3: Frequency of Main Adverse Effects
? JNCCN--Journal of the National Comprehensive Cancer Network | Volume 19 Issue 10 | October 2021
Lin et al ? 1
A
25
20
P=.086
B
25
20
P=.009
C
25
20
P=.793
Dose of Successful Titration Dose of Successful Titration Dose of Successful Titration
15
15
15
10
10
10
5
5
5
0
PCA
Non-PCA
All Patients
0
PCA
Non-PCA
Opioid-Tolerant Patients
0 PCA
Non-PCA
Opioid-Na?ve Patients
eFigure 1. Median accumulated hydromorphone consumption from the start of titration to TST in the PCA versus non-PCA groups, respectively, for (A) all patients [1.0 mg (IQR, 0.5?2.0 mg) vs 1.5 mg (IQR, 1.0?2.5 mg); P5.086]; (B) opioid-tolerant patients [1.0 mg (IQR, 1.0?2.0 mg) vs 2.0 mg (IQR, 1.0?4.0 mg); P5.009]; and (C) opioid-na?ve patients [1.0 mg (IQR, 0.5?2.0 mg) vs 1.0 mg (IQR, 0.5?2.0 mg); P5.793]. Abbreviations: IQR, interquartile range; PCA, patient-controlled analgesia; TST, time to successful titration.
A
40
B
40
C
40
Dose Over 24 Hours Dose Over 24 Hours Dose Over 24 Hours
30
P=.600 20
30
P=.028 20
30
P=.048 20
10
10
10
0
PCA
Non-PCA
All Patients
0
PCA
Non-PCA
Opioid-Tolerant Patients
0
PCA
Non-PCA
Opioid-Na?ve Patients
eFigure 2. Median accumulated hydromorphone consumption from the start of titration to hour 24 in the PCA versus non-PCA groups, respectively, for (A) all patients [4.5 mg (IQR, 2.5?6.0 mg) vs 4.0 mg (IQR, 2.3?8.3 mg); P5.600]; (B) opioid-tolerant patients [5.5 mg (IQR, 2.5?8.3 mg) vs 6.3 mg (IQR, 4.0?12.0 mg); P5.028]; and (C) opioid-na?ve patients [4.0 mg (IQR, 2.5?5.5 mg) vs 2.5 mg (IQR, 2.0?4.3 mg); P5.048]. Abbreviations: IQR, interquartile range; PCA, patient-controlled analgesia.
| Volume 19 Issue 10 | October 2021
2 ? Lin et al
Injections/Presses (N) Injections/Presses (N) Injections/Presses (N)
A
16 12
8 4
P=.400
B
16 12
8 4
P=.687
C
16 12
8 4
P=.143
PCA
Non-PCA
All Patients
PCA
Non-PCA
Opioid-Tolerant Patients
PCA
Non-PCA
Opioid-Na?ve Patients
eFigure 3. Median number of delivered boluses in the PCA versus non-PCA groups, respectively, in (A) all patients [6 (IQR, 4?9) presses vs 6 (IQR, 4?9) boluses per patient; P5.400]; (B) opioid-tolerant patients [6 (IQR, 4?9) presses vs 7 (IQR, 4?9) boluses per patient; P5.687]; and (C) opioid-na?ve patients [7 (IQR, 4?9) presses vs 4 (IQR, 4?8) boluses per patient; P5.143]. Abbreviations: IQR, interquartile range; PCA, patient-controlled analgesia.
? JNCCN--Journal of the National Comprehensive Cancer Network | Volume 19 Issue 10 | October 2021
eTable 1. Common Opioid Conversion Chart
Opioid
Parenteral Dose
Oral Dose
Morphine Hydromorphone Oxycodone Fentanyla
10 mg 1.5 mg
-- 15 mcg/h
30 mg --
15?20 mg --
aFor transdermal patch conversions.
Lin et al ? 3
eTable 2. ESAS at Baseline and Hour 24
ESAS Item
PCA Median (IQR)
Baseline
Non-PCA Median (IQR)
P Value
PCA Median (IQR)
Hour 24
Non-PCA Median (IQR)
Total, n
106
108
105
107
Pain
8 (7?8)
8 (7?8)
.419
2 (2?2)
2 (2?5)
Tiredness
5 (4?6)
5 (4?6)
.718
2 (2?5)
3 (2?5)
Nausea
1 (1?1)
1 (0?2)
.158
2 (2?5)
3 (2?4)
Depression
3 (2?4)
3 (3?4)
.122
2 (2?3)
2 (2?4)
Anxiety
3 (3?4)
3 (3?4)
.570
2 (1?2)
2 (2?3)
Drowsiness
2 (2?3)
2 (1?3)
.182
2 (0?5)
2 (1?3)
Appetite
5 (4?6)
5 (4?6)
.555
5 (2?5)
5 (2?5)
Well-being
7 (6?7)
7 (6?7)
.759
5 (2?5)
5 (2?5)
Itching
1 (0?1)
1 (0?1)
.803
1 (0?2)
0 (0?2)
Dyspnea
2 (1?3)
2 (1?2)
.315
1 (1?2)
2 (1?2)
Overall score
36 (34?38)
37 (34?39)
.154
25 (16?29)
26 (19?35)
Abbreviations: ESAS, Edmonton Symptom Assessment System; IQR, interquartile range; PCA, patient-controlled analgesia.
P Value
.060 .129 .316 .107 .074 .827 .630 .458 .981 .173 .096
eTable 3. Frequency of Main Adverse Effects
Adverse Effect
PCA n (%)
Non-PCA n (%)
P Value
Total, n Constipation Nausea Vomiting Dizziness Pruritus Somnolence Dry mouth
106 5 (4.7) 7 (6.6) 2 (1.9) 2 (1.9) 4 (3.8) 3 (2.8) 5 (4.7)
108 4 (3.7) 10 (9.3) 3 (2.8) 4 (3.7) 3 (2.8) 5 (4.6) 3 (2.8)
.747 .615 1.000 .683 .720 .721 .699
Abbreviation: PCA, patient-controlled analgesia.
| Volume 19 Issue 10 | October 2021
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