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Opioid prescribing for patients with cancer in the last year of life: a longitudinal population cohort study

Ziegler, Lucy; Mulvey, Matthew; Blenkinsopp, Alison; Petty, Duncan; Bennett, Michael I.

doi: 10.1097/j.pain.0000000000000656
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We linked UK cancer registry data with the corresponding electronic primary care medical records of 6080 patients who died of cancer over a 7-year period in a large United Kingdom city. We extracted all prescriptions for analgesics issued to each patient in the linked cohort during the 12 months before death and analysed the extent and duration of strong opioid treatment with clinical and patient characteristics. Strong opioids were prescribed for 48% of patients in the last year of life. Median interval between first prescription of a strong opioid and death was 9 weeks (interquartile range 3-23). Strong opioid prescribing was not influenced by cancer type, duration of illness, or gender but was adversely influenced by older age. Compared with patients who died in a hospice, those who died in a hospital were 60% less likely to receive a strong opioid in primary care before admission (relative risk ratio 0.4, CI 0.3-0.5, P < 0.01). The study provides the first detailed analysis of the relatively late onset and short duration of strong opioid treatment in patients with cancer before death in a representative UK cohort. This pattern of prescribing does not match epidemiological data which point to earlier onset of pain. Although persistent undertreatment of cancer pain is well documented, this study suggests that strategies for earlier pain assessment and initiation of strong opioid treatment in community-based patients with cancer could help to improve pain outcomes.

Supplemental Digital Content is Available in the Text.Fewer than half (48%) of patients that died from cancer received a strong opioid, and in those that did, median treatment duration was 9 weeks.

aAcademic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom

bBradford School of Pharmacy, University of Bradford, Bradford, United Kingdom

Corresponding author. Address: Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds LS2 9LJ, United Kingdom. Tel.: +44 0113 3437351. E-mail address: L.e.ziegler@leeds.ac.uk (L. Ziegler).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received February 22, 2016

Received in revised form April 12, 2016

Accepted June 09, 2016

© 2016 International Association for the Study of Pain
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