{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T22:30:49Z","timestamp":1782858649187,"version":"3.54.5"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,10,9]],"date-time":"2015-10-09T00:00:00Z","timestamp":1444348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Transdermal fentanyl (TDF) is 1 of the most common opioids prescribed to patients with cancer. However, the accurate opioid rotation ratio (ORR) from other opioids to TDF is unknown, and various currently used methods result in wide variation of the ORR. The objective of this study was to determine the ORR of the oral morphine equivalent daily dose (MEDD) to the TDF dose when correcting for the MEDD of breakthrough opioids (the net MEDD) in cancer outpatients.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The records of 6790 consecutive patients were reviewed at the authors' supportive care center from 2010 to 2013 to identify those who underwent rotation from other opioids to TDF. Data regarding Edmonton Symptom Assessment Scale scores and MEDDs were collected for patients who returned for a follow\u2010up visit within 5 weeks. Linear regression analysis was used to estimate the ORR between the TDF dose and the net MEDD (the MEDD before opioid rotation [OR] minus the MEDD of the breakthrough opioid used along with TDF after OR).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In total, 129 patients underwent OR from other opioids to TDF. The mean patient age was 56 years, 59% were men, and 88% had advanced cancer. Uncontrolled pain (80%) was the most frequent reason for OR. In 101 patients who underwent OR and had no worsening of pain at follow\u2010up, the median ORR from net MEDD to TDF (in mg per day) was 0.01 (range, \u22120.02 to 0.04), and the correlation coefficient of the TDF dose to the net MEDD was 0.77 (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001). The ORR was not significantly impacted by body mass index or serum albumin. The ORR of 0.01 suggests that an MEDD of 100\u2009mg is equivalent to 1\u2009mg TDF daily or approximately 40 micrograms per hour of TDF (1000\u2009micrograms\/24 hours).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The median ORR from MEDD to TDF in mg per day was 0.01. These results warrant further studies <jats:bold><jats:italic>Cancer<\/jats:italic> 2016;122:149\u2013156.<\/jats:bold> \u00a9 <jats:italic>2015 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.29688","type":"journal-article","created":{"date-parts":[[2015,10,9]],"date-time":"2015-10-09T09:02:43Z","timestamp":1444381363000},"page":"149-156","source":"Crossref","is-referenced-by-count":24,"title":["The opioid rotation ratio of strong opioids to transdermal fentanyl in cancer patients"],"prefix":"10.1002","volume":"122","author":[{"given":"Akhila","family":"Reddy","sequence":"first","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supakarn","family":"Tayjasanant","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Siriraj Hospital Mahidol University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Haider","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Heung","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriram","family":"Yennurajalingam","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxine","family":"de la Cruz","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eden Mae","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Waletich","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieberta","family":"Vidal","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Arthur","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimmie","family":"Tallie","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelique","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rony","family":"Dev","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Bruera","sequence":"additional","affiliation":[{"name":"Department of Palliative Care and Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,10,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)01310-0"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70040-2"},{"key":"e_1_2_8_4_1","first-page":"1","article-title":"Report of a WHO Expert Committee","volume":"804","author":"Cancer pain relief and palliative care","year":"1990","journal-title":"World Health Organ Tech Rep Ser"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.01.004"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(95)00084-6"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(93)90232-E"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(94)90084-1"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(95)90924-C"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(96)00050-4"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1999.tb126885.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s005200000153"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2006.03.001"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2012.01357.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2012.01356.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(01)00294-9"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0269"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2007.12.024"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200464230-00002"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311406577"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2419-5"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2014.08.010"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2004.12.010"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(97)00082-1"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(95)00180-8"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1185\/030079903125003026"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(99)00051-2"},{"key":"e_1_2_8_28_1","first-page":"599","article-title":"A pilot study of the reduced effects of adverse events caused by oral morphine and oxycodone after rotating to fentanyl patch in patients with metastatic breast cancer [article in Japanese]","volume":"39","author":"Ikeda M","year":"2012","journal-title":"Gan To Kagaku Ryoho"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1998.16.4.1588"},{"key":"e_1_2_8_30_1","first-page":"695","article-title":"An alternative algorithm for dosing transdermal fentanyl for cancer\u2010related pain","volume":"14","author":"Breitbart W","year":"2000","journal-title":"Oncology (Williston Park)"},{"key":"e_1_2_8_31_1","unstructured":"Janssen Pharmaceuticals Inc. Duragesic (Fentanyl transdermal system).Full US Prescribing Information. Available at:http:\/\/www.duragesic.com\/sites\/default\/files\/pdf\/duragesic_0.pdf. Accessed July 9 2014."},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(94)90149-X"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(94)00060-X"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2012.0424"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/082585979100700202"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(96)00316-8"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(87)90061-1"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2011.03.027"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26082"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2013-0001"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2008.0037"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.03.017"},{"key":"e_1_2_8_43_1","volume-title":"The MD Anderson Symptom Control and Palliative Care Handbook","author":"Elsayem A","year":"2008"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24754"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2014-0130"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(03)00162-3"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2007.0285"},{"key":"e_1_2_8_48_1","first-page":"CD010270","article-title":"Transdermal fentanyl for cancer pain [serial online]","volume":"10","author":"Hadley G","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_49_1","first-page":"1401","article-title":"Efficacy and safety of transdermal fentanyl patches for opioid initiation in patients with gastrointestinal obstruction [article in Japanese]","volume":"41","author":"Miyoshi T","year":"2014","journal-title":"Gan To Kagaku Ryoho"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-008-0570-y"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1248\/bpb.b14-00119"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e318266f6a5"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2009.04.012"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.29688","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.29688","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T14:12:57Z","timestamp":1760278377000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.29688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,9]]},"references-count":52,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2016,1]]}},"alternative-id":["10.1002\/cncr.29688"],"URL":"https:\/\/doi.org\/10.1002\/cncr.29688","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"value":"0008-543X","type":"print"},{"value":"1097-0142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10,9]]}}}