A comparison of subcutaneous morphine and fentanyl in hospice cancer patients

This study compares subcutaneous (sc) morphine and fentanyl with respect to pain control and side effects using a 6-day randomized, double-blind cross -over design. Results were obtained from 23 patients (12 males and 11 femal es: mean age of 70.5 years) who could tolerate morphine. Thirteen patients were randomized to receive morphine for the first 3 days followed by fentan yl; 10 received fentanyl first followed by morphine. There were no signific ant differences in the scores for pain between the two drugs, suggesting th at fentanyl is equally efficacious and the conversion ratio of morphine 10 mg: fentanyl 150 mu g is appropriate. Patients had more frequent bowel move ments during days 4-6 while on the fentanyl arm [t-test, df (22), P = 0.015 ]. Other measures for nausea, delirium, and cognitive function showed no di fferences between the two drugs. This study highlights the need to further assess the role of various opioids in hospice patients, and emphasizes the requirement for sensitive and simple cognitive tests in this population. (C ) U.S. Cancer Pain Relief Committee, 1999.