Available Evidence on Hydromorphone for Oncological Pain Management in Older Adults: A Systematic Review

The management of cancer pain in older adults with hydromorphone requires careful consideration. This systematic review evaluates the current evidence regarding the efficacy and safety of hydromorphone in this population. The review protocol follows the PRISMA 2020 guidelines and the PICO framework. The search strategy used terms including "hydromorphone," "cancer pain," and "older adults" across four databases. Primary studies published between 2014 and 2024 in English, Spanish, French, Italian, and Portuguese were included. Data extraction was limited to studies involving patients older than 60 years. Qualitative studies and those lacking methodological rigor were excluded. Standardized instruments were used to assess the risk of bias. Of the 332 records initially identified, seven observational studies (retrospective cohorts and cross-sectional analyses) met the inclusion criteria, for a total of 41,608 patients. According to the GRADE methodology, the certainty of evidence regarding efficacy and safety was rated as low to very low due to high risk of bias and methodological heterogeneity. Evidence regarding the efficacy and safety of hydromorphone for cancer pain in older adults shows very low certainty. Routine clinical use requires caution. High-quality, randomized controlled trials are needed to guide clinical decision-making.