Bruno Gagnon1, Susan Scott2, Lyne Nadeau2, Peter G Lawlor3. 1. Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Québec City, Québec, Canada; Centre de recherche sur le cancer de l'Université Laval, Québec City, Québec, Canada. Electronic address: gagnon.bruno@crchuq.ulaval.ca. 2. Division of Clinical Epidemiology, McGill University Health Center, Montreal, Québec, Canada. 3. Division of Palliative Care, Departments of Medicine, Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Abstract
CONTEXT: Studies of opioid use in cancer patients have been cross-sectional or have focused on mean consumption over a specific time interval. OBJECTIVES: This study aimed to determine the temporal pattern of prescribed opioids at a population level. METHODS: Using Quebec administrative databases, we ascertained details of cancer-related deaths and filled community-based opioid prescriptions (COPs) in 48,420 decedents from 2003 to 2006. RESULTS: Using group-based trajectory modeling, based on when people started to fill COPs, our population-based study demonstrated patterns of filled COPs with six distinct trajectories. An earlier start in opioid consumption resulted in a higher group average morphine daily dose; those who were already filling COPs at study entry (5.2%) had a final dose of more than 300mg by the time of death. Remarkably, 58.8% of people had not filled COPs with a biweekly average greater than 1mg earlier than two weeks before death, marking the end of follow-up. Breast cancer in women, prostate or colorectal cancer in men, and younger age and multiple myeloma in both sexes were positively associated with earlier filling of COPs. CONCLUSION: Patients dying of cancer require increasing doses of opioids over time; although we cannot distinguish the relative contributions of disease progression and opioid tolerance, age and certain cancers seem related to this phenomenon. Given the potentially prohibitive cost of prospective epidemiological studies, more elaborate clinical administrative databases that include regular pain assessment are necessary to determine optimal opioid use and factors associated with dose increases over time at a population level.
CONTEXT: Studies of opioid use in cancerpatients have been cross-sectional or have focused on mean consumption over a specific time interval. OBJECTIVES: This study aimed to determine the temporal pattern of prescribed opioids at a population level. METHODS: Using Quebec administrative databases, we ascertained details of cancer-related deaths and filled community-based opioid prescriptions (COPs) in 48,420 decedents from 2003 to 2006. RESULTS: Using group-based trajectory modeling, based on when people started to fill COPs, our population-based study demonstrated patterns of filled COPs with six distinct trajectories. An earlier start in opioid consumption resulted in a higher group average morphine daily dose; those who were already filling COPs at study entry (5.2%) had a final dose of more than 300mg by the time of death. Remarkably, 58.8% of people had not filled COPs with a biweekly average greater than 1mg earlier than two weeks before death, marking the end of follow-up. Breast cancer in women, prostate or colorectal cancer in men, and younger age and multiple myeloma in both sexes were positively associated with earlier filling of COPs. CONCLUSION:Patients dying of cancer require increasing doses of opioids over time; although we cannot distinguish the relative contributions of disease progression and opioid tolerance, age and certain cancers seem related to this phenomenon. Given the potentially prohibitive cost of prospective epidemiological studies, more elaborate clinical administrative databases that include regular pain assessment are necessary to determine optimal opioid use and factors associated with dose increases over time at a population level.
Authors: Amy J Davidoff; Maureen E Canavan; Shelli Feder; Shiyi Wang; Ella Sheinfeld; Erin E Kent; Jennifer Kapo; Carolyn J Presley Journal: Support Care Cancer Date: 2019-10-21 Impact factor: 3.603
Authors: Jason W Boland; Victoria Allgar; Elaine G Boland; Mike I Bennett; Stein Kaasa; Marianne Jensen Hjermstad; Miriam Johnson Journal: Eur J Clin Pharmacol Date: 2019-12-21 Impact factor: 2.953
Authors: Christoph Busemann; Andreas Jülich; Britta Buchhold; Vanessa Schmidt; Laila Schneidewind; Daniel Pink; Christian Andreas Schmidt; Thomas Neumann; William H Krüger Journal: J Cancer Res Clin Oncol Date: 2017-05-27 Impact factor: 4.553
Authors: Lucy E Ziegler; Cheryl L Craigs; Robert M West; Paul Carder; Adam Hurlow; Pablo Millares-Martin; Geoff Hall; Michael I Bennett Journal: BMJ Open Date: 2018-01-31 Impact factor: 2.692
Authors: Michael I Bennett; Elon Eisenberg; Sam H Ahmedzai; Arun Bhaskar; Tony O'Brien; Sebastiano Mercadante; Nevenka Krčevski Škvarč; Kris Vissers; Stefan Wirz; Chris Wells; Bart Morlion Journal: Eur J Pain Date: 2019-01-06 Impact factor: 3.931