Opioids for outpatients with cancer in their last year of life: A nationwide pharmacoepidemiological study

Siri Brelin, MD; Olav M. Fredheim, MD, PhD; Jon H. Loge, MD, PhD; Svetlana Skurtveit, PhD; Tom B. Johannesen, MD, PhD; Nina Aass, MD, PhD; Stig Ottesen, MD, PhD; Marianne J. Hjermstad, PhD

doi:10.5055/jom.2016.0309

Authors

Siri Brelin, MD
Olav M. Fredheim, MD, PhD
Jon H. Loge, MD, PhD
Svetlana Skurtveit, PhD
Tom B. Johannesen, MD, PhD
Nina Aass, MD, PhD
Stig Ottesen, MD, PhD
Marianne J. Hjermstad, PhD

DOI:

https://doi.org/10.5055/jom.2016.0309

Keywords:

opioids, cancer pain, end of life, pharmacoepidemiology

Abstract

Objective: Opioids are the main pharmacological treatment for moderate-to-severe cancer pain. Few longitudinal studies have examined the prescription prevalence (PP) of opioids to patients with cancer. The aims of the study were to examine 1) changes in the PP of opioids from 2005 to 2009 among outpatients with cancer who were in their last year of life and 2) associations between the PP of opioids and medical and sociodemographic factors.

Design: Retrospective, registry-based, national study.

Patients: This study used data on all patients with cancer who died 2005-2009, combining the following three complete nationwide registries; prescription data from the Norwegian Prescription Database, data on cancer diseases from the Cancer Registry of Norway, and sociodemographic data from Statistics Norway.

Results: The study population consisted of 44,579 adults (mean age 72 years at death, 54 percent males). The opioid PP increased from 74 to 82 percent during the study period. Oxycodone had the highest PP, and increased from 39.8 to 48.5 percent during the period, whereas the PP of morphine declined from 29.0 to 27.3 percent. The PP for fentanyl remained stable at 17 percent. The PP of opioids increased toward death with higher PP during the last 3 months of life compared to previous 3-month periods. Older patients (>60) were less likely to receive opioids, while prostate or pancreatic cancer increased the odds for opioid prescriptions (p < 0.001, Odds ratio [OR] 2.60 and OR 1.98, respectively).

Conclusion: The PP increased yearly during the study period. Use of oxycodone increased while that of morphine decreased.

Author Biographies

Siri Brelin, MD

Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; Østfold Hospital Trust, Fredrikstad, Norway

Olav M. Fredheim, MD, PhD

Professor, Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St Olav University Hospital, Trondheim, Norway; Centre of Palliative Medicine, Surgical Division, Akershus University Hospital, Lørenskog, Norway

Jon H. Loge, MD, PhD

Professor, Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

Svetlana Skurtveit, PhD

Professor, Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

Tom B. Johannesen, MD, PhD

Cancer Registry of Norway, Oslo, Norway

Nina Aass, MD, PhD

Professor, Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway

Stig Ottesen, MD, PhD

Professor, Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway

Marianne J. Hjermstad, PhD

Professor, Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; European Palliative Care Research Center, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

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