{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T05:26:11Z","timestamp":1793683571632,"version":"4.5.1"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2016,6,15]],"date-time":"2016-06-15T00:00:00Z","timestamp":1465948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Spanish Ministry of Health","award":["FIS: EC08\/00234"],"award-info":[{"award-number":["FIS: EC08\/00234"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction.<\/jats:title>\n                  <jats:p>Most clinical reports on methadone rotation describe outcomes in hospitalized patients. The few studies that have included outpatients are retrospective. The aim of this study was to assess the efficacy and safety of methadone as a second-line opioid in adult patients with advanced cancer after rotation in routine clinical practice at a palliative care outpatient clinic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients and Methods.<\/jats:title>\n                  <jats:p>This was a prospective, open-label study of 145 patients whose treatment was rotated from other opioids to methadone. Informed consent was obtained in all cases. The main outcome measure was change in the variable \u201cworst pain\u201d at day 28. Pain and pain interference were assessed with the Brief Pain Inventory, with side effects evaluated according to the Common Terminology Criteria for Adverse Events version 3.0. Pain levels were evaluated at study entry and at days 3, 7, 9, 14, 21, and 28.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results.<\/jats:title>\n                  <jats:p>Rotation to methadone was performed for the following reasons: poor pain control (77.9%), opioid side effects (2.1%), or both (20%). The mean daily oral morphine equivalent dose before rotation was 193.7 mg. The median worst and average pain scores decreased significantly (p &amp;lt; .0001) from baseline to day 28: The median worst pain score decreased from 9 (interquartile range [IQR]: 8\u201310) to 6 (IQR: 3\u20138), and the median average pain score decreased from 6 (IQR: 5\u20137) to 4 (IQR: 2\u20135). The proportions of patients with moderate to severe worst and average pain decreased by 30.3% and 47.5%, respectively, by day 28. No increase in opioid toxicity was observed during the study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion.<\/jats:title>\n                  <jats:p>In outpatients with advanced cancer, rotation to methadone as a second-line opioid was efficacious and safe when using a tiered scheme with close follow-up by experienced health professionals.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2015-0503","type":"journal-article","created":{"date-parts":[[2016,6,16]],"date-time":"2016-06-16T05:49:20Z","timestamp":1466056160000},"page":"981-987","source":"Crossref","is-referenced-by-count":29,"title":["Efficacy and Safety of Methadone as a Second-Line Opioid for Cancer Pain in an Outpatient Clinic: A Prospective Open-Label Study"],"prefix":"10.1093","volume":"21","author":[{"given":"Josep","family":"Porta-Sales","sequence":"first","affiliation":[{"name":"Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain"},{"name":"Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Garz\u00f3n-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Villavicencio-Ch\u00e1vez","sequence":"additional","affiliation":[{"name":"Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Llorens-Torrom\u00e9","sequence":"additional","affiliation":[{"name":"Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Gonz\u00e1lez-Barboteo","sequence":"additional","affiliation":[{"name":"Palliative Care Service, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, Barcelona, Spain"},{"name":"Center for Health and Social Studies, University of Vic, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,6,15]]},"reference":[{"key":"2021122309524428900_B1","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/0885-3924(95)90924-C","article-title":"Opioid rotation for toxicity reduction in terminal cancer patients","volume":"10","author":"De Stoutz","year":"1995","journal-title":"J Pain Symptom Manage"},{"key":"2021122309524428900_B2","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5694\/j.1326-5377.1999.tb126885.x","article-title":"Opioid substitution to reduce adverse effects in cancer pain management","volume":"170","author":"Ashby","year":"1999","journal-title":"Med J Aust"},{"key":"2021122309524428900_B3","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s005200000153","article-title":"Toxicity and\/or insufficient analgesia by opioid therapy: Risk factors and the impact of changing the opioid. 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