title: Opioid use at the end of life and survival in a Hospital at Home unit.
abstract: BACKGROUND
  Although opioids are commonly used to treat pain, dyspnea, and other symptoms at the end of life, little information is available on the safety and efficacy of the use of these medications in terminally ill patients in the home care setting.
  
  
  OBJECTIVE
  To explore whether high doses of opioids, or increasing doses, influence survival in patients with terminal cancer in a Hospital at Home unit.
  
  
  METHODS
  A retrospective cohort study. Clinical records of 223 oncologic patients admitted to the Hospital at Home unit of Hospital Galdakao-Usansolo from 2003 to 2007 and who died at home were reviewed. Demographic variables (age and gender) as well as clinical variables at the time of admission (Eastern Cooperative Oncology Group Performance Status scale, previous intake of opioids, type of cancer, use of coadjuvant drugs) and daily doses of morphine during the admission were recorded. Main outcomes were the number of days from the maximum dose of opioids administered to death and total length of survival during the admission.
  
  
  RESULTS
  Median survival from day of maximum dose to death was longer for patients who received higher doses of opioids (6 days) than those who received lower doses (2 days; p = 0.010). These differences disappeared after adjusting by demographic and clinical variables (HR, 0.86; 95% CI, 0.62-1.18 [p = 0.338]). Patients who received more than twofold increases in their initial doses had longer median survival (22 days) than those who did not (9 days; hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.34-0.60 [p < 0.0001]); these differences persisted after adjustment.
  
  
  CONCLUSIONS
  Our results suggest that the use of opioids is safe in for use in Hospital at Home patients with cancer and is not associated with reduced survival.
authors.affiliation: Hospital at Home Unit, Galdakao-Usánsolo Hospital, Galdakao Usánsolo, Bizkaia, Spain. ekaitsi@hotmail.com
authors.forename: Itxaso
authors.initials: I
authors.lastname: Bengoechea
authors.forename: Susana Garcia
authors.initials: SG
authors.lastname: Gutiérrez
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Vrotsou
authors.forename: Miren Josune
authors.initials: MJ
authors.lastname: Onaindia
authors.forename: Jose Maria Quintana
authors.initials: JM
authors.lastname: Lopez
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013030:Spain; D016019:Survival Analysis; D019452:Terminally Ill
chemical_list: D000701:Analgesics, Opioid