{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:15:42Z","timestamp":1789038942003,"version":"build-2803163510"},"reference-count":80,"publisher":"Harborside Press, LLC","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Effective management of severe cancer pain remains challenging. Our phase II study suggested that intravenous patient-controlled analgesia with hydromorphone (IPCA-HM), delivered either as bolus-only or continuous infusion, is superior to oral morphine for patients with severe cancer pain, with bolus-only potentially providing comparable efficacy to infusion while resulting in a lower rate of morphine equivalent dose (MED) escalation. This phase III study aimed to validate these findings.\n                    <jats:bold>Patients and Methods:<\/jats:bold>\n                    Patients with solid tumors and severe cancer pain (\u22657 at rest on an 11-point Numeric Rating Scale [NRS]) who achieved successful 24-hour IPCA-HM dose-finding were randomized (2:2:1) to bolus-only IPCA-HM (bolus), continuous infusion IPCA-HM (infusion), or oral morphine (oral) for 6 days. The primary outcome was average NRS score over days 1\u20133 (3DNRS).\n                    <jats:bold>Results:<\/jats:bold>\n                    Of 1,349 patients from 48 oncology centers, 542 received bolus, 540 infusion, and 267 oral. Mean [SD] 3DNRS scores were 2.36 [0.89], 2.26 [0.87], and 2.94 [1.16], respectively. Both IPCA-HM arms were statistically significantly better than the oral arm in 3DNRS scores (bolus vs oral: mean difference, 0.58 [95% CI, 0.42 to 0.74]; infusion vs oral: 0.68 [95% CI, 0.52 to 0.84]; both\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.001). Bolus was noninferior to infusion (mean difference, 0.10 [95% CI, \u22120.01 to 0.20]; predefined noninferiority margin, 0.3;\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.001), achieving noninferiority in opioid-na\u00efve, but not opioid-tolerant, patients. Median (IQR) total MEDs over days 1\u20136 were 400 (260\u2013692) mg, 643 (380\u20131,117) mg, and 867 (540\u20131,313) mg for the bolus, infusion, and oral arms, respectively. Opioid-related adverse events (all grade 1 or 2) were comparable between the bolus (20.1%) and infusion (23.0%) arms, and both were lower than in the oral arm (33.7%).\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    For severe cancer pain, both IPCA-HM regimens provided statistically significantly better pain relief compared with oral morphine. The bolus regimen achieved noninferior efficacy compared with infusion while requiring lower opioid doses, providing a safe and effective analgesic option.\n                  <\/jats:p>","DOI":"10.6004\/jnccn.2025.7476","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:20:16Z","timestamp":1778599216000},"page":"257-264","source":"Crossref","is-referenced-by-count":1,"title":["Intravenous Patient-Controlled Analgesia Versus Oral Opioids to Maintain Analgesia for Severe Cancer Pain: A Randomized Phase III Trial"],"prefix":"10.6004","volume":"24","author":[{"given":"Rongbo","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China"},{"name":"Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lang","family":"He","sequence":"additional","affiliation":[{"name":"Department of Oncology, The Fifth People\u2019s Hospital of Chengdu, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingqian","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Yichang Central People\u2019s Hospital, Yichang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Palliative Care, Yunnan Cancer Hospital, Kunming, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Cancer Hospital Affiliated with Guizhou Medical University, Guiyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunfang","family":"Chen","sequence":"additional","affiliation":[{"name":"The Second Department of Oncology, Zhumadian Central Hospital, Zhumadian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junli","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Xingtai People\u2019s Hospital, Xingtai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaowei","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Public Health, Fujian Medical University, Fuzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shen","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China"},{"name":"Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyu","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China"},{"name":"Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Oncology, Fujian Medical University Xiamen Humanity Hospital, Xiamen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jincai","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhichun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Hainan Cancer Hospital, Haikou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyan","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Rare Diseases and Head and Neck Internal Medicine, Zhejiang Cancer Hospital, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yushuang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Qinghai University Affiliated Hospital, Xining, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Oncology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Interventional Oncology, Chengdu Qingbaijiang District People\u2019s Hospital, Chengdu, 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