The Use of Opioids in the Last Week of Life in an Acute Palliative Care Unit

Mercadante, Sebastiano; Ferrera, Patrizia; Casuccio, Alessandra

doi:10.1177/1049909110366010

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…About 60 % of patients were receiving opioid drugs, principally parenteral morphine and transdermal fentanyl. As expected, opioid doses were significantly less than those observed in acute palliative care units [14]. The day before dying, on average of 18 days, more patients (70 %) were receiving opioid drugs, prevalently parenteral morphine.…”

Section: Discussionmentioning

confidence: 76%

Pattern and characteristics of advanced cancer patients admitted to hospices in Italy

Mercadante

Valle

Sabba³

et al. 2012

Support Care Cancer

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The aim of this multicenter study was to assess the pattern and the characteristics of advanced cancer patients admitted to hospices. A consecutive sample of patients admitted in a period of 6 months was taken into consideration. Two hundred thirty-six patients admitted to hospices were consecutively assessed. Ninety-six percent of patients were admitted in acute hospital in the previous 3 months, with a mean time spent in hospital of 34.5 days, and 47 % of patients had received chemotherapy the month before hospice admission. Thirty-four percent of patients for whom data were available had significant persistent pain, and 44 % of them presented episodes of breakthrough pain. Sixty-one percent of patients were receiving opioid drugs at admission, and 70 % the day before death, with parenteral morphine and transdermal fentanyl being the opioids most frequently administered. The mean admission time in hospice was 18.4 days. Eighty-six percent died in hospice. Palliative sedation was performed in 25 % of patients who died in hospice. The short survival and the number of patients dying in hospice were the principal finding, as it appears that hospice admission is only one way for end of life treatments. Patients receive specialized palliative care only for 2-3 weeks before death, implying an inacceptable timing for patients with several problems presumed to be present early during the course of disease. Data from hospice activities in Italy strongly suggest to spread palliative care in other settings, other than home care and hospice, to intercept oncologic patients in their disease trajectory early.

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Section: Discussionmentioning

confidence: 76%

Pattern and characteristics of advanced cancer patients admitted to hospices in Italy

Mercadante

Valle

Sabba³

et al. 2012

Support Care Cancer

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“…Among the available opioids, morphine stands out as the gold standard for treating moderate and severe pain, according to literature 25 . In a palliative care unit, patients received intravenous morphine more frequently 27 .…”

Section: Opioids and Tramadolmentioning

confidence: 99%

Sedação paliativa do paciente terminal

Nogueira¹,

Sakata²

2012

Rev. Bras. Anestesiol.

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“…Prior studies describe medication use either in small clinical cohorts or in selected settings such as nursing homes, [18][19][20] hospitals, 21,22 hospice, 23 or palliative care centers common in Western Europe, the U.K., and Canada. [24][25][26] Population-based studies on specific palliative care services for home-based older adults are limited and have focused primarily on medication management for pain. 20,27,28 In this study, we begin to fill this gap, reporting on receipt of pharmacologic symptom management interventions in the outpatient setting outside hospice, to manage symptoms during the six-month EOL period for Medicare beneficiaries who die of lung cancer.…”

Section: Introductionmentioning

confidence: 99%

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Saphire¹,

Prsic²,

Canavan³

et al. 2020

Journal of Pain and Symptom Management

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Context.-Older adults with advanced lung cancer experience high symptom burden at end of life (EOL), yet hospice enrollment often happens late or not at all. Receipt of medications to manage symptoms in the outpatient setting, outside the Medicare hospice benefit, has not been described. Objectives.-We examined patterns of symptom management medication receipt at EOL for older adults who died of lung cancer. Methods.-This retrospective cohort used the Surveillance, Epidemiology, and End Results-Medicare database to identify decedents diagnosed with lung cancer at age 67 years and older between January 2008 and December 2013 who survived six months and greater after diagnosis. Using Medicare Part B and D claims, we identified monthly receipt of outpatient medications for symptomatic management of pain, emotional distress, fatigue, dyspnea, anorexia, and nausea/ vomiting. Multivariable logistic regression estimated associations between medication receipt and patient demographic characteristics, comorbidity, and concurrent therapy. Results.-Of the 16,246 included patients, large proportions received medications for dyspnea (70.7%), pain (62.5%), and emotional distress (49.4%), with lower prevalence for other symptoms. Medication receipt increased from six months to one month before death. Women and dual Medicaid enrolled were more likely to receive medications for pain, emotional distress, dyspnea, and nausea/vomiting. Receipt of symptom management medications decreased with increasing age and racial/ethnical minorities. Conclusion.-Symptom management medication receipt was common and increasing toward EOL. Lower use by males, older adults, and nonwhites may reflect poor access or poor patientprovider communication. Further research is needed to understand these patterns and assess adequacy of symptom management in the outpatient setting.

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The Use of Opioids in the Last Week of Life in an Acute Palliative Care Unit

Cited by 8 publications

References 22 publications

Pattern and characteristics of advanced cancer patients admitted to hospices in Italy

Pattern and characteristics of advanced cancer patients admitted to hospices in Italy

Sedação paliativa do paciente terminal

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

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