[Outpatient opiate therapy in cancer patients during their last days of life].
BACKGROUND
Pain is one of the symptoms that many tumor patients are especially afraid of in the final phase of their illness. Symptoms can change rapidly, making quick adaptation of the therapy necessary. This poses particular challenges to organizational structures in outpatient treatment if the patients' desire to spend their last days of life in their accustomed surroundings is to be realized.


METHODS
Pain intensity and the associated symptoms in a WHO step III opiate therapy during the last 3 days of life were investigated retrospectively among 601 tumor patients who had received medical care from Home Care Berlin. Differences in gender, age, living conditions/care situation and place of death were evaluated with due consideration for the different pain medications administered and for the different forms and routes of administration.


RESULTS
More than 80% of the patients reported freedom from pain or only moderate pain during the opiate therapy. Care provided by the hospice-at-home medical service Home Care Berlin allowed excellent control of tumor patients' symptoms with only moderate side-effects in their final days of life. Among patients receiving opioids by the transdermal route there were significantly more frequent complaints of pain (p=0.004) and nausea (p=0.001). During the last days of life continuous subcutaneous infusions containing opiates facilitated good analgesia within an acceptable spectrum of side-effects. Most problems with controlling symptoms in outpatients were encountered in younger patients.


CONCLUSIONS
Morphine emerged as the drug of first choice in this investigation, because it can be given parenterally and also because of its price. The use of subcutaneous and intravenous administration systems such as PCA pumps requires trained nursing services and regular house visits by physicians experienced in palliative medicine.
Maier
R
R
Praxis für Anästhesiologie, Schmerztherapie, Palliativmedizin, Dorotheenstr. 56, 10117, Berlin, Germany. renate.gatterfeld@berlin.de
Maier
A
A
Müller-Busch
C
C
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D005260:Female; D006699:Home Care Services; D006738:Hospices; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D009369:Neoplasms / Q000503:physiopathology*; D009735:Nursing Homes; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D013727:Terminal Care
D000701:Analgesics, Opioid; D009020:Morphine