40 percent of cancer patients receive opioids at end of life

Irene J. Higginson, B.M.B.S., Ph.D., and Wei Gao, Ph.D., from King's College London, used data from the United Kingdom General Practice Research Database to examine opioid prescribing rates in the last three months of life in a cohort of 29,825 patients diagnosed with lung, colorectal, female breast, prostate, and head and neck cancers. All patients died between 2000 and 2008.

The researchers found that 43.6 percent of patients received at least one prescription of opioids during the last three months of life, including the most prescribed opioids: 33.4 percent morphine, 11.6 percent diamorphine, and 10.2 percent fentanyl family. For opioids predominant during specific time periods, especially oxycodone, prescription rates increased over time. Compared with patients younger than 50 years, patients older than 60 years had significantly lower chances of receiving opioids, even after adjustment for comorbidity (prevalence ratio range, 0.14 to 0.78). Compared with men, women were slightly but significantly more likely to receive any opioid (prevalence ratio, 1.07). Compared with prostate cancers, morphine and diamorphine were more commonly prescribed for lung and colorectal cancers, while fentanyl family drugs were more commonly prescribed for head and neck cancers.

"We found an encouraging increasing trend of opioid prescribing by general practitioners in the United Kingdom for patients with cancer who are in the last three months of life," the authors write. "However, people older than age 60 years were significantly underprescribed opioids and should be targeted for improvement in their end-of-life cancer care."

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Journal reference: Journal of Clinical Oncology

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