The use of opioids in the last month of life in a tertiary cancer center in Jordan.

Abstract

54 Background: The low rates of utilization of opioids is a major barrier to optimal pain control in cancer patients in developing countries. The presence of a palliative care service may improve opioid utilization. In our study we assessed opioid utilization in the last month of life for patients admitted to our tertiary care cancer center in Jordan, and compared the use of opioids with and without palliative care involvement. Methods: We conducted a retrospective chart review to examine opioid use for all adult patients who died at King Hussein Cancer Center between January 1st, 2012 until December 31st, 2012. Patient demographics, cancer diagnosis, type of opioid and total daily dose of opioids in morphine oral equivalent (OME) were collected in the last 30 days of life while admitted to the hospital. Results: Among the 297 patients included, the median age was 58 years (range, 19- 95), 134 (45%) were males, and 186 (62.6%) died under the palliative care service. The median admission length was 7 days. The average daily doses of opioids were 187mg, 214mg, 222mg (OME) in the last 24 hours, 48 hours, and 30 days of life, respectively, In the last 24 and 48 hours before death, 140 (47%) and 228 (77%) patients were on opioids, respectively. Younger age was associated with higher doses of opioids (P= 0.0001). We found no significant differences in patient characteristics between palliative and non-palliative care patients; however, patients under palliative care received significantly higher doses of opioids compared to non-palliative care patients in the last 30 days of life, the average daily dose of opioids (OME) was 249.4mg vs. 11.2mg (P< 0.001). There was no survival difference between palliative and non-palliative patients (P= 0.2244), or between patients who were on opioids or patients who were not (p= 0.57). Conclusions: A large minority of patients did not receive opioids at the end-of-life. Palliative care service was associated with higher utilization of opioids. Palliative care service may assist in pain management at the end-of-life.