Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline

Mellar P. Davis; Andrew Davies; Mary Lynn McPherson; Akhila S. Reddy; Judith A. Paice; Eric J. Roeland; Declan Walsh; Sebastiano Mercadante; Amy A. Case; Robert M. Arnold; Eriko Satomi; Gregory Crawford; Eduardo Bruera; Kari Bohlke; Carla Ripamonti

doi:10.1007/s00520-025-09286-z

Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline

Mellar P. Davis^*, Andrew Davies, Mary Lynn McPherson, Akhila S. Reddy, Judith A. Paice, Eric J. Roeland, Declan Walsh, Sebastiano Mercadante, Amy A. Case, Robert M. Arnold, Eriko Satomi, Gregory Crawford, Eduardo Bruera, Kari Bohlke, Carla Ripamonti

^*Corresponding author for this work

Medicine, Hematology Oncology Division

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Purpose: To standardize and improve the safety and efficacy of opioid conversion in people with cancer. Methods: The Multinational Association of Supportive Care in Cancer (MASCC), American Society of Clinical Oncology (ASCO), American Academy of Hospice and Palliative Medicine (AAHPM), Hospice and Palliative Nurses Association (HPNA), and Network Italiano Cure di Supporto in Oncologia (NICSO) convened an Expert Panel to develop recommendations based on a systematic review of the literature and a formal consensus process. The systematic review focused on randomized and non-randomized studies published from database inception to June 2022. A modified Delphi approach was used to develop and finalize recommendations. Recommendations developed by the Expert Panel underwent two rounds of consensus voting before being finalized. Results: The systematic review, published separately, identified 208 eligible studies. These studies provided mixed and inclusive findings regarding optimal approaches to opioid conversion. In consensus voting, 58 of 84 statements met or exceeded the required 75% level of agreement and were accepted. This process demonstrated some consistencies in conversion ratios between particular opioids internationally, but also uncovered variability in opioid conversion ratios among experts, particularly for methadone. Recommendations: The recommendations address three main topics: pre-conversion assessments, strategies for conversion, and post-conversion assessments. The goal is to reduce the relative risk of overdosing or under-dosing opioids when converting from one opioid to another or converting administration routes. The strength of the evidence from the trials is modest, and there are large clinical practice and research gaps. The panel hopes this guideline will establish an international best practice baseline that can be built upon by new research and better-designed trials. Additional information is available at www.asco.org/supportive-care-guidelines.

Original language	English (US)
Article number	243
Journal	Supportive Care in Cancer
Volume	33
Issue number	3
DOIs	https://doi.org/10.1007/s00520-025-09286-z
State	Published - Mar 2025

Funding

The Expert Panel wishes to thank Drs. Tanyanika Phillips, Scott Baker, Cristiane Decat Bergerot, Vinnidhy Dave, the Consensus Panel, and the approval bodies for MASCC, ASCO, AAPHM, HPNA, and NICSO for their thoughtful reviews and insightful comments on this guideline.

Keywords

Conversion
Delphi consensus
Guideline
Opioid

ASJC Scopus subject areas

Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00520-025-09286-z

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Davis, M. P., Davies, A., McPherson, M. L., Reddy, A. S., Paice, J. A., Roeland, E. J., Walsh, D., Mercadante, S., Case, A. A., Arnold, R. M., Satomi, E., Crawford, G., Bruera, E., Bohlke, K., & Ripamonti, C. (2025). Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline. Supportive Care in Cancer, 33(3), Article 243. https://doi.org/10.1007/s00520-025-09286-z

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abstract = "Purpose: To standardize and improve the safety and efficacy of opioid conversion in people with cancer. Methods: The Multinational Association of Supportive Care in Cancer (MASCC), American Society of Clinical Oncology (ASCO), American Academy of Hospice and Palliative Medicine (AAHPM), Hospice and Palliative Nurses Association (HPNA), and Network Italiano Cure di Supporto in Oncologia (NICSO) convened an Expert Panel to develop recommendations based on a systematic review of the literature and a formal consensus process. The systematic review focused on randomized and non-randomized studies published from database inception to June 2022. A modified Delphi approach was used to develop and finalize recommendations. Recommendations developed by the Expert Panel underwent two rounds of consensus voting before being finalized. Results: The systematic review, published separately, identified 208 eligible studies. These studies provided mixed and inclusive findings regarding optimal approaches to opioid conversion. In consensus voting, 58 of 84 statements met or exceeded the required 75% level of agreement and were accepted. This process demonstrated some consistencies in conversion ratios between particular opioids internationally, but also uncovered variability in opioid conversion ratios among experts, particularly for methadone. Recommendations: The recommendations address three main topics: pre-conversion assessments, strategies for conversion, and post-conversion assessments. The goal is to reduce the relative risk of overdosing or under-dosing opioids when converting from one opioid to another or converting administration routes. The strength of the evidence from the trials is modest, and there are large clinical practice and research gaps. The panel hopes this guideline will establish an international best practice baseline that can be built upon by new research and better-designed trials. Additional information is available at www.asco.org/supportive-care-guidelines.",

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author = "Davis, {Mellar P.} and Andrew Davies and McPherson, {Mary Lynn} and Reddy, {Akhila S.} and Paice, {Judith A.} and Roeland, {Eric J.} and Declan Walsh and Sebastiano Mercadante and Case, {Amy A.} and Arnold, {Robert M.} and Eriko Satomi and Gregory Crawford and Eduardo Bruera and Kari Bohlke and Carla Ripamonti",

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AU - Davis, Mellar P.

AU - Davies, Andrew

AU - McPherson, Mary Lynn

AU - Reddy, Akhila S.

AU - Paice, Judith A.

AU - Roeland, Eric J.

AU - Walsh, Declan

AU - Mercadante, Sebastiano

AU - Case, Amy A.

AU - Arnold, Robert M.

AU - Satomi, Eriko

AU - Crawford, Gregory

AU - Bruera, Eduardo

AU - Bohlke, Kari

AU - Ripamonti, Carla

N1 - Publisher Copyright: © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.

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Y1 - 2025/3

N2 - Purpose: To standardize and improve the safety and efficacy of opioid conversion in people with cancer. Methods: The Multinational Association of Supportive Care in Cancer (MASCC), American Society of Clinical Oncology (ASCO), American Academy of Hospice and Palliative Medicine (AAHPM), Hospice and Palliative Nurses Association (HPNA), and Network Italiano Cure di Supporto in Oncologia (NICSO) convened an Expert Panel to develop recommendations based on a systematic review of the literature and a formal consensus process. The systematic review focused on randomized and non-randomized studies published from database inception to June 2022. A modified Delphi approach was used to develop and finalize recommendations. Recommendations developed by the Expert Panel underwent two rounds of consensus voting before being finalized. Results: The systematic review, published separately, identified 208 eligible studies. These studies provided mixed and inclusive findings regarding optimal approaches to opioid conversion. In consensus voting, 58 of 84 statements met or exceeded the required 75% level of agreement and were accepted. This process demonstrated some consistencies in conversion ratios between particular opioids internationally, but also uncovered variability in opioid conversion ratios among experts, particularly for methadone. Recommendations: The recommendations address three main topics: pre-conversion assessments, strategies for conversion, and post-conversion assessments. The goal is to reduce the relative risk of overdosing or under-dosing opioids when converting from one opioid to another or converting administration routes. The strength of the evidence from the trials is modest, and there are large clinical practice and research gaps. The panel hopes this guideline will establish an international best practice baseline that can be built upon by new research and better-designed trials. Additional information is available at www.asco.org/supportive-care-guidelines.

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Opioid conversion in adults with cancer: MASCC-ASCO-AAHPM-HPNA-NICSO guideline

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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