Article Per Year (5 Year)
p-Index From 2020 - 2025
0.778
P-Index
This Author published in this journals
All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Widya Deli Satuti
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

Published : 4 Documents Claim Missing Document
Claim Missing Document
Check
Articles

Found 4 Documents
Search

 1 
Opioid Rotation vs. Dose Titration in Refractory Cancer Pain: A Meta-Analysis of Efficacy and Adverse Events Arina Widya Murni; Dian Arfan As Bahri; Widya Deli Satuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1375

Abstract

Background: The management of refractory cancer pain represents a formidable clinical challenge at the intersection of oncology and palliative medicine. When patients with advanced malignancy fail to achieve adequate analgesia or develop intolerable adverse effects from their opioid regimen, clinicians are faced with a crucial decision: to escalate the dose of the current opioid (dose titration) or to switch to a different opioid agent (opioid rotation). The optimal strategy remains a subject of intense debate and variable practice. This meta-analysis was conducted to rigorously compare the efficacy and safety of these two common interventions. Methods: A systematic and comprehensive search was performed in the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) published between January 2015 and December 2024. We included studies that directly compared opioid rotation with dose titration in adult palliative care patients diagnosed with refractory cancer pain. The primary efficacy outcome was the change in pain intensity, analyzed using the Standardized Mean Difference (SMD) to accommodate pain scales such as the Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Primary safety outcomes were the incidence of severe neurotoxicity and severe constipation. Data were pooled using a random-effects model, and results were expressed as SMD for the continuous pain outcome and Risk Ratio (RR) for dichotomous adverse events, with corresponding 95% confidence intervals (CI). Results: Seven RCTs, encompassing a total of 962 patients, met the stringent inclusion criteria. The pooled analysis revealed that the strategy of opioid rotation resulted in a statistically significant and clinically substantial greater reduction in pain intensity compared to continued dose titration (SMD -0.65, 95% CI [-0.88, -0.42], p<0.00001; I²=81%). Furthermore, the risk of developing severe neurotoxicity, including delirium and myoclonus, was significantly lower in the rotation group (RR 0.62, 95% CI [0.45, 0.85], p=0.003; I²=18%). There was no statistically significant difference in the incidence of severe constipation between the two intervention groups (RR 0.90, 95% CI [0.71, 1.14], p=0.38; I²=24%). Conclusion: In patients with refractory cancer pain, the strategy of opioid rotation provided superior analgesia and was associated with a markedly lower risk of severe neurotoxicity when compared to the continued dose titration of the same opioid. These findings provide strong, high-level evidence to support the use of opioid rotation as a primary and proactive strategy for managing uncontrolled pain or dose-limiting side effects in the palliative care population.
Opioid Rotation vs. Dose Titration in Refractory Cancer Pain: A Meta-Analysis of Efficacy and Adverse Events Arina Widya Murni; Dian Arfan As Bahri; Widya Deli Satuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1375

Abstract

Background: The management of refractory cancer pain represents a formidable clinical challenge at the intersection of oncology and palliative medicine. When patients with advanced malignancy fail to achieve adequate analgesia or develop intolerable adverse effects from their opioid regimen, clinicians are faced with a crucial decision: to escalate the dose of the current opioid (dose titration) or to switch to a different opioid agent (opioid rotation). The optimal strategy remains a subject of intense debate and variable practice. This meta-analysis was conducted to rigorously compare the efficacy and safety of these two common interventions. Methods: A systematic and comprehensive search was performed in the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) published between January 2015 and December 2024. We included studies that directly compared opioid rotation with dose titration in adult palliative care patients diagnosed with refractory cancer pain. The primary efficacy outcome was the change in pain intensity, analyzed using the Standardized Mean Difference (SMD) to accommodate pain scales such as the Numerical Rating Scale (NRS) and Visual Analogue Scale (VAS). Primary safety outcomes were the incidence of severe neurotoxicity and severe constipation. Data were pooled using a random-effects model, and results were expressed as SMD for the continuous pain outcome and Risk Ratio (RR) for dichotomous adverse events, with corresponding 95% confidence intervals (CI). Results: Seven RCTs, encompassing a total of 962 patients, met the stringent inclusion criteria. The pooled analysis revealed that the strategy of opioid rotation resulted in a statistically significant and clinically substantial greater reduction in pain intensity compared to continued dose titration (SMD -0.65, 95% CI [-0.88, -0.42], p<0.00001; I²=81%). Furthermore, the risk of developing severe neurotoxicity, including delirium and myoclonus, was significantly lower in the rotation group (RR 0.62, 95% CI [0.45, 0.85], p=0.003; I²=18%). There was no statistically significant difference in the incidence of severe constipation between the two intervention groups (RR 0.90, 95% CI [0.71, 1.14], p=0.38; I²=24%). Conclusion: In patients with refractory cancer pain, the strategy of opioid rotation provided superior analgesia and was associated with a markedly lower risk of severe neurotoxicity when compared to the continued dose titration of the same opioid. These findings provide strong, high-level evidence to support the use of opioid rotation as a primary and proactive strategy for managing uncontrolled pain or dose-limiting side effects in the palliative care population.
The Role of Antidepressants in a Malignancy Patient with Palliative Care: A Systematic Literature Review Yovanda, Ryandri; Arina Widya Murni; Widya Deli Satuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i8.1051

Abstract

Background: Depression is a common complication in malignancy patients, and can worsen their quality of life and prognosis. Palliative care aims to improve the quality of life of patients with life-limiting illnesses, and antidepressants are often used in this context. Methods: This systematic review was conducted to evaluate the effectiveness of antidepressants in malignancy patients with palliative care. A literature search was conducted in three databases: PubMed, Cochrane, and ScienceDirect. Search terms included “Antidepressants,” “Malignancies,” and “Palliatives.” Results: Two studies met inclusion criteria: First study: Randomized controlled clinical trial evaluating the effectiveness of mirtazapine compared with escitalopram in malignant patients with depression. The results showed that mirtazapine was more effective in improving quality of life and reducing depressive symptoms compared with escitalopram. Second study: a study evaluating the effectiveness of antidepressants in elderly malignancy patients with depression. The results suggest that antidepressants may be effective in reducing depressive symptoms and improving quality of life, but further research is needed to confirm their effectiveness and safety. Conclusion: Available evidence suggests that antidepressants may be effective in treating depression in malignancy patients with palliative care. However, further research is needed to identify the most effective and safe antidepressants for this patient population.
The Role of Antidepressants in a Malignancy Patient with Palliative Care: A Systematic Literature Review Yovanda, Ryandri; Arina Widya Murni; Widya Deli Satuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i8.1051

Abstract

Background: Depression is a common complication in malignancy patients, and can worsen their quality of life and prognosis. Palliative care aims to improve the quality of life of patients with life-limiting illnesses, and antidepressants are often used in this context. Methods: This systematic review was conducted to evaluate the effectiveness of antidepressants in malignancy patients with palliative care. A literature search was conducted in three databases: PubMed, Cochrane, and ScienceDirect. Search terms included “Antidepressants,” “Malignancies,” and “Palliatives.” Results: Two studies met inclusion criteria: First study: Randomized controlled clinical trial evaluating the effectiveness of mirtazapine compared with escitalopram in malignant patients with depression. The results showed that mirtazapine was more effective in improving quality of life and reducing depressive symptoms compared with escitalopram. Second study: a study evaluating the effectiveness of antidepressants in elderly malignancy patients with depression. The results suggest that antidepressants may be effective in reducing depressive symptoms and improving quality of life, but further research is needed to confirm their effectiveness and safety. Conclusion: Available evidence suggests that antidepressants may be effective in treating depression in malignancy patients with palliative care. However, further research is needed to identify the most effective and safe antidepressants for this patient population.
Co-Authors Arina Widya Murni Dian Arfan As Bahri Yovanda, Ryandri