Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

Abstract

Context-Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life.Objectives-To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics.Methods-Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n = 657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression.Results-In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR] = 3.18, 95% CI = 2.05-4.94), residence in a long-term care facility (OR = 2.19, 95% CI = 1.23-3.89), and a CRC cause of death (OR = 1.75, 95% CI = 1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR = 0.97, 95% CI = 0.95-0.99), male (OR = 0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR = 0.62, 95% CI = 0.41-0.93).Conclusion-PCPs may play an important role in enabling access to end-of-life care within the community.

Evidence-based clinical practice guidelines on the management of pain in older people – a summary report

“…Similarly, studies focused exclusively on people aged above 65 years related to palliative pain care management are scarce and the available evidence-base lacks high-quality RCT findings. [40][41][42][43][44]…”

Opioid use and associated factors among pancreatic cancer patients diagnosed between 2007 and 2015

“…Palliative care use was associated with more frequent prescription of opioids in our univariable analysis. Wang et al, 22 Tse et al, 23 and Fisher et al, 24 reported older pancreatic cancer patients using palliative care consumed opioids significantly more frequently than those receiving standard oncology care. We suggest that the higher likelihood of using opioids among those with palliative care use might be attributed to the practice of prescribing strong and high dose opioids to manage severe pain for cancer patients in the palliative care stage 17,18 …”

Accuracy of using Diagnosis Procedure Combination administrative claims data for estimating the amount of opioid consumption among cancer patients in Japan

“…In order to fill this knowledge gap, many developed countries calculate the total amount of opioids prescribed to cancer patients by analyzing administrative claims data or prescription database (3)(4)(5). Claims data are useful for monitoring medical utilization and prescription patterns, but it requires that its accuracy, validity and reliability are tested, so that characteristics and limitations of the dataset is well understood by those who use the data for future research (6)(7)(8)(9).…”