Sebastiano Mercadante


Affiliation: La Maddalena Cancer Center
Country: Italy


  1. Mercadante S, Bruera E. The effect of age on opioid switching to methadone: a systematic review. J Palliat Med. 2012;15:347-51 pubmed publisher
    ..Further prospective studies in a large sample of patients, subgrouped for classes of age, opioid doses, and reasons to switch, should be designed to provide more information. ..
  2. Mercadante S, Valle A, Agnelotti C, Caruselli A. The poor use of methadone in Italian hospices. Support Care Cancer. 2013;21:2225-8 pubmed publisher
    ..Physicians working in hospices should improve the knowledge regarding the use of opioids, including methadone, as well as complex treatments which can be the principal reason for hospice admission. ..
  3. Mercadante S, Porzio G, Aielli F, Averna L, Ficorella C, Casuccio A. The use of fentanyl buccal tablets for breakthrough pain by using doses proportional to opioid basal regimen in a home care setting. Support Care Cancer. 2013;21:2335-9 pubmed publisher
    ..This study suggests that FBT given in doses proportional to the basal opioid regimen for the management of BTcP is very effective and safe in clinical practice in the home care setting. ..
  4. Mercadante S, Masedu F, Maltoni M, de Giovanni D, Montanari L, Pittureri C, et al. Symptom expression in advanced cancer patients admitted to hospice or home care with and without delirium. Intern Emerg Med. 2018;: pubmed publisher
    ..Symptom expression is amplified in patients with delirium admitted to home care or hospices, while patients without delirium can be more responsive to palliative treatments with a significant decrease in intensity of ESAS items. ..
  5. Mercadante S, Adile C, Ferrera P, Cortegiani A, Casuccio A. Symptom Expression in Patients with Advanced Cancer Admitted to an Acute Supportive/Palliative Care Unit With and Without Delirium. Oncologist. 2018;: pubmed publisher
    ..Symptom expression is amplified in patients with cancer who have delirium, whereas patients without delirium may be more responsive to palliative treatments with a significant decrease in symptom intensity. ..
  6. Mercadante S, Adile C, Aielli F, Lanzetta G, Mistakidou K, Maltoni M, et al. Personalized Goal for Dyspnea and Clinical Response in Advanced Cancer Patients. J Pain Symptom Manage. 2019;57:79-85 pubmed publisher
    ..High values of dyspnea intensity, a lower Karnofsky level, as well as high level of Dyspnea Intensity Goal (that is less patients' expectations) favor the achievement of the target. ..
  7. Mercadante S, Vellucci R, Cuomo A, Adile C, Cortegiani A, Valle A, et al. Long-term efficacy and tolerability of intranasal fentanyl in the treatment of breakthrough cancer pain. Support Care Cancer. 2015;23:1349-54 pubmed publisher
    ..No serious adverse effects were found up to six months of assessment. The level of quality of sleep and patients' satisfaction was relatively good, considering the advanced stage of disease. ..
  8. Smith H. Painful boney metastases. Ann Palliat Med. 2012;1:14-31 pubmed publisher
    ..Additionally, potential future therapeutic approaches to painful osseous metastases may revolutionize approaches to analgesia for this condition, leading to optimal outcomes with maximal pain relief and minimal adverse effects. ..
  9. Mercadante S, Aielli F, Masedu F, Valenti M, Ficorella C, Porzio G. Pain characteristics and analgesic treatment in an aged adult population: a 4-week retrospective analysis of advanced cancer patients followed at home. Drugs Aging. 2015;32:315-20 pubmed publisher
    ..005). Careful opioid titration may achieve adequate analgesia in older patients by using lower doses of opioids, with a lower rate of opioid switching. The prevalence of BTP was only shown to be lower in the oldest group (O3). ..

More Information


  1. Mercadante S. The use of opioids for treatment of cancer pain. Expert Opin Pharmacother. 2015;16:389-94 pubmed publisher
    ..New opioids with specific receptor activities are under investigation. ..
  2. Mercadante S, Ferrera P, Arcuri E, Casuccio A. Opioid-induced hyperalgesia after rapid titration with intravenous morphine: Switching and re-titration to intravenous methadone. Ann Palliat Med. 2012;1:10-3 pubmed publisher
    ..Switching to IV-ME and titrating the doses could be taken into consideration to break this vicious circle before pain conditions worsen irreversibly. ..
  3. Mercadante S. Intravenous morphine for management of cancer pain. Lancet Oncol. 2010;11:484-9 pubmed publisher
    ..I.v. morphine is advantageous in specific clinical situations and should be part of armamentarium of all physicians treating pain in patients with cancer. ..
  4. Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, Fusco F, et al. Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients. Support Care Cancer. 2015;23:3249-55 pubmed publisher
  5. Mercadante S, Porzio G, Valle A, Fusco F, Aielli F, Costanzo V. Palliative sedation in patients with advanced cancer followed at home: a systematic review. J Pain Symptom Manage. 2011;41:754-60 pubmed publisher
    ..Although the existing studies provide only low-quality evidence, the decision to use PS does not seem to anticipate patients' death. More homogeneous prospective studies on a large number of patients should confirm this observation. ..
  6. Mercadante S, Adile C, Lanzetta G, Mystakidou K, Maltoni M, Guilherme Soares L, et al. Personalized Symptom Goals and Patient Global Impression on Clinical Changes in Advanced Cancer Patients. Oncologist. 2019;24:239-246 pubmed publisher
    ..Some factors may be implicated in determining the individual target and clinical response. ..
  7. Mercadante S, Ferrera P, Arcuri E. The use of fentanyl buccal tablets as breakthrough medication in patients receiving chronic methadone therapy: an open label preliminary study. Support Care Cancer. 2011;19:435-8 pubmed publisher
    ..FBT was effective as breakthrough pain medication in patients receiving methadone for their background analgesia, confirming that this group of patients are not inevitably resistant to other opioids. ..
  8. Mercadante S, Vitrano V. Pain in patients with lung cancer: pathophysiology and treatment. Lung Cancer. 2010;68:10-5 pubmed publisher
    ..More complex strategies, such as interventional procedures, are seldom necessary and require an appropriate selection of patients. ..
  9. Mercadante S, Gatti A, Porzio G, Lo Presti C, Aielli F, Adile C, et al. Dosing fentanyl buccal tablet for breakthrough cancer pain: dose titration versus proportional doses. Curr Med Res Opin. 2012;28:963-8 pubmed publisher
    ..Further studies should confirm this data in patients receiving higher doses of opioids, with other rapid-onset opioids, and in other settings. ..
  10. Mercadante S, Adile C, Cuomo A, Aielli F, Cortegiani A, Casuccio A, et al. Fentanyl Buccal Tablet vs. Oral Morphine in Doses Proportional to the Basal Opioid Regimen for the Management of Breakthrough Cancer Pain: A Randomized, Crossover, Comparison Study. J Pain Symptom Manage. 2015;50:579-86 pubmed publisher
  11. Mercadante S, Porzio G, Aielli F, Adile C, Verna L, Ficorella C, et al. Opioid switching from and to tapentadol extended release in cancer patients: conversion ratio with other opioids. Curr Med Res Opin. 2013;29:661-6 pubmed publisher
  12. Mercadante S, Aielli F, Masedu F, Valenti M, Verna L, Porzio G. Age differences in the last week of life in advanced cancer patients followed at home. Support Care Cancer. 2016;24:1889-95 pubmed publisher
    ..Older patients had also a lower opioid consumption, a more frequent use of the subcutaneous route, and a lower need for palliative sedation. ..
  13. Mercadante S, Caruselli A, Casuccio A. The use of ketamine in a palliative-supportive care unit: a retrospective analysis. Ann Palliat Med. 2018;7:205-210 pubmed publisher
    ..Although the role of ketamine remains controversial, it should not deter physicians to do not use that in specific conditions. ..
  14. Mercadante S, Porzio G, Ferrera P, Aielli F, Adile C, Ficorella C, et al. Tapentadol in cancer pain management: a prospective open-label study. Curr Med Res Opin. 2012;28:1775-9 pubmed publisher
    ..It can be considered as a flexible drug to be used in patients with moderate-severe pain. This was an open-label study for exploratory purposes. Data should be confirmed in controlled studies with a larger number of patients. ..
  15. Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, Cartoni C, et al. Sleep Disturbances in Patients With Advanced Cancer in Different Palliative Care Settings. J Pain Symptom Manage. 2015;50:786-92 pubmed publisher
    ..Several factors associated with sleep disorders have been identified and should prompt physicians to make a careful examination and subsequent treatment of these disturbances. ..
  16. Mercadante S, Aielli F, Adile C, Valle A, Fusco F, Ferrera P, et al. Epidemiology and Characteristics of Episodic Breathlessness in Advanced Cancer Patients: An Observational Study. J Pain Symptom Manage. 2016;51:17-24 pubmed publisher
  17. Mercadante S, Casuccio A, Tirelli W, Giarratano A. Equipotent doses to switch from high doses of opioids to transdermal buprenorphine. Support Care Cancer. 2009;17:715-8 pubmed publisher
    ..6:0.8, respectively, maintaining the same level of analgesia. ..
  18. Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati R, Vellucci R, et al. Factors Influencing the Clinical Presentation of Breakthrough Pain in Cancer Patients. Cancers (Basel). 2018;10: pubmed publisher
    ..i>Conclusions: BTP has a variable presentation depending on interdependent relationships among its different characteristics. ..
  19. Mercadante S. Efficacy and safety of dual opioid therapy. Expert Opin Drug Saf. 2014;13:1433-6 pubmed publisher
    ..More research is needed to better elucidate these issues in the near future. ..
  20. Mercadante S. Opioid metabolism and clinical aspects. Eur J Pharmacol. 2015;769:71-8 pubmed publisher
    ..The recognition of possible metabolic problems and the consideration of adverse drug-drug interactions are fundamental to optimize the use of opioids in clinical practice. ..
  21. Mercadante S. Episodic Breathlessness in Patients with Advanced Cancer: Characteristics and Management. Drugs. 2018;78:543-547 pubmed publisher
    ..Strategies to prevent the occurrence of EB should be taken into consideration, including optimization of the condition of persistent dyspnea or treating psychologic or environmental causes. ..
  22. Mercadante S, Costanzi A, David F, Villari P, Musso M, Marchetti P, et al. Supportive care services in hemato-oncology centers: a national survey. Support Care Cancer. 2016;24:4407-11 pubmed publisher
    ..298). Integration between hemato-oncology and other professionals is unlikely to be optimal in Italy. Such integration is complex and needs great efforts to solve several organizational problems. ..
  23. Mercadante S, Cuomo A. Breakthrough Cancer Pain: Ten Commandments. Value Health. 2016;19:531-6 pubmed publisher
    ..These steps may help clinicians to recognize and treat BTcP adequately. ..
  24. Mercadante S, Adile C, Cuomo A, Aielli F, Marinangeli F, Casuccio A. The use of low doses of a sublingual fentanyl formulation for breakthrough pain in patients receiving low doses of opioids. Support Care Cancer. 2017;25:645-649 pubmed publisher
    ..No serious adverse effects were observed for the subsequent 2 h. This study suggests that SLF given in low doses in patients receiving lower doses of opioids for background analgesia is safe and effective in clinical practice. ..
  25. Mercadante S. Non pharmacological interventions and non-fentanyl pharmacological treatments for breakthrough cancer pain: A systematic and critical review. Crit Rev Oncol Hematol. 2018;122:60-63 pubmed publisher
    ..These treatments are worthwhile of further investigation, particularly in determined conditions that should fit the pharmacokinetics of oral opioids. ..
  26. Mercadante S, Masedu F, Mercadante A, Marinangeli F, Aielli F. Attitudes of palliative home care physicians towards palliative sedation at home in Italy. Support Care Cancer. 2017;25:1615-1620 pubmed publisher
    ..These data should prompt health care agencies to make a minimal set of drugs easily available for home care. Further research is necessary to compare attitudes in countries with different sociocultural profiles. ..
  27. Mercadante S, Marchetti P, Cuomo A, Mammucari M, Caraceni A. Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group. Support Care Cancer. 2016;24:961-968 pubmed publisher
    ..The doses of opioids used for background pain should guide the choice of the doses of fentanyl products. The choice of fentanyl products should be based on individual clinical conditions. ..
  28. Mercadante S, Adile C, Ferrera P, Casuccio A. Characteristics of advanced cancer patients who were readmitted to an acute palliative/supportive care unit. Support Care Cancer. 2017;25:1947-1952 pubmed publisher
    ..Re-exacerbation of pain seems to be the most frequent reason. A further clinical reassessment and treatment were equally effective in controlling the symptom burden of these patients at any readmission. ..
  29. Mercadante S, Adile C, Ferrera P, Casuccio A. The effects of alcoholism and smoking on advanced cancer patients admitted to an acute supportive/palliative care unit. Support Care Cancer. 2017;25:2147-2153 pubmed publisher
    ..Clinical response was not strongly influenced by these risk factors. ..
  30. Mercadante S, Marchetti P, Adile C, Caruselli A, Ferrera P, Costanzi A, et al. Characteristics and care pathways of advanced cancer patients in a palliative-supportive care unit and an oncological ward. Support Care Cancer. 2018;26:1961-1966 pubmed publisher
    ..001). SPCU allows a better planning admission to hospital and a better care trajectory in advanced cancer patients in comparison to a busy OW, where unselected emergencies more frequently occur. ..
  31. Mercadante S, Adile C, Ferrera P, Masedu F, Valenti M, Aielli F. Sleep disturbances in advanced cancer patients admitted to a supportive/palliative care unit. Support Care Cancer. 2017;25:1301-1306 pubmed publisher
    ..Assessment of sleep disorders is mandatory in this population for the obvious interference with quality of life. ..
  32. Mercadante S, Marchetti P, Cuomo A, Caraceni A, Mediati R, Mammucari M, et al. Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS). Adv Ther. 2017;34:120-135 pubmed publisher
    ..The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients. Molteni Farmaceutici, Italy. ..
  33. Mercadante S, Masedu F, Valenti M, Mercadante A, Aielli F. The characteristics of advanced cancer patients followed at home, but admitted to the hospital for the last days of life. Intern Emerg Med. 2016;11:713-8 pubmed publisher
    ..2 days (SD 8.2, range 0-40). This study provides preliminary data on the risk factors of hospitalization at the end of life for advanced cancer patients followed at home. ..
  34. Mercadante S. Options for Treating Pain in Cancer Patients with Dysphagia. Drugs. 2017;77:629-635 pubmed publisher
    ..In addition, a new class of opioid formulations has been developed for use in dysphagic patients that are administered via nasogastric or enteral tubes while maintaining their sustained-release properties. ..
  35. Mercadante S, Adile C, Ferrera P, Casuccio A. Characteristics of patients with an unplanned admission to an acute palliative care unit. Intern Emerg Med. 2017;12:587-592 pubmed publisher
    ..Such units in a comprehensive cancer center might improve symptom control and pose as referral centers for non-cancer hospitals, emergency departments, or the territory. ..
  36. Mercadante S, Masedu F, Balzani I, de Giovanni D, Montanari L, Pittureri C, et al. Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care. Support Care Cancer. 2018;26:913-919 pubmed publisher
    ..Further studies should elucidate whether an earlier approach to palliative care would decrease the prevalence of delirium at a late stage of disease. ..
  37. Mercadante S, Bruera E. Methadone as a First-Line Opioid in Cancer Pain Management: A Systematic Review. J Pain Symptom Manage. 2018;55:998-1003 pubmed publisher
    ..Further studies should provide information regarding the long-term use of methadone or the need to switch from methadone to other opioids when a loss of analgesic response occurs. ..
  38. Mercadante S, Aielli F, Adile C, Costanzi A, Casuccio A. Fentanyl Pectin Nasal Spray Versus Oral Morphine in Doses Proportional to the Basal Opioid Regimen for the Management of Breakthrough Cancer Pain: A Comparative Study. J Pain Symptom Manage. 2016;52:27-34 pubmed publisher
    ..When used in doses proportional to the basal opioid regimen, FPNS showed a superior analgesic effect over OM for the management of BTcP. Only minor adverse effects were found with both medications. ..
  39. Mercadante S. Oral trasmucosal fentanyl citrate for breakthrough pain treatment in cancer patients. Expert Opin Pharmacother. 2012;13:873-8 pubmed publisher
    ..However, it is likely that patients receiving high doses of opioids for background analgesia will not be candidates for titration with minimal initial doses of OTFC, as they are opioid tolerant and the process would be time consuming. ..
  40. Mercadante S. Intravenous patient-controlled analgesia and management of pain in post-surgical elderly with cancer. Surg Oncol. 2010;19:173-7 pubmed publisher
    ..The success of such a technique depends on close evaluation of all preoperative and intraoperative factors that can cause or contribute to acute delirium. In the present paper we review the literature on this pivotal field. ..
  41. Mercadante S, Vitrano V, Catania V. Sexual issues in early and late stage cancer: a review. Support Care Cancer. 2010;18:659-65 pubmed publisher
    ..To provide this component of care, professionals need to have good communication skills, an open and non-judgmental approach, and knowledge of the potential ramifications of disease and treatment of sexuality problems. ..
  42. Mercadante S, Villari P, Ferrera P, Arcuri E, David F. Opioid switching and burst ketamine to improve the opioid response in patients with movement-related pain due to bone metastases. Clin J Pain. 2009;25:648-9 pubmed publisher
    ..Further studies in animals could confirm these preliminary data, with specific design to parallel this clinical context. ..
  43. Mercadante S, Porzio G, Ferrera P, Fulfaro F, Aielli F, Verna L, et al. Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management. Eur J Pain. 2008;12:1040-6 pubmed publisher