Opioids, survival, and advanced cancer in the hospice setting.
OBJECTIVE
Although pain is common among advanced cancer patients, it can be controlled in a large proportion of patients. Several barriers hinder this, including the concern that opioids hasten death. We examined whether opioids influence survival among advanced cancer patients.


METHODS
Retrospective observational study from September 2006 to October 2007.


METHODS
In-patient hospice unit.


METHODS
Participants were 114 consecutive hospice patients (mean age 71.7 ± 13.9 years).


METHODS
Analysis of survival (days) following admission, according to opioid usage. Standardized Oral Morphine Equivalents (OME mg/d) were calculated.


RESULTS
On admission 74.6% received opioids, rising to 92.1% at death. Mean opioid dosage was OME of 146 ± 245 mg/d, and mean survival was 12.3 ± 12.15 days. Mean survival, according to opioid dosage of 0, 1 to 119, and greater than or equal to 120 OME mg/d respectively at admission, was 16.7 ± 13.4, 11.2 ± 12.1, 10.0 ± 10.2 (P = .009), and according to dose at death was 17.0 ± 15.1, 12.3 ± 12.1, 11.1 ± 11.3 (P = ns). Increasing overall opioid dosage was associated with improved survival compared with no change or decreasing overall dosage (mean survival 14.0 ± 12.7 days versus 9.3 ± 9.8 versus 9.1 ± 11.4, days respectively, P = .01). Adjusting for clinical variables in Cox proportional hazards models, no significant association was found between mortality and of the following aspects of opioid usage: (1) dose on admission (Hazard Ratio [HR] 1.009, 95% confidence interval [CI] 0.999-1.019); (2) dose at death (HR 1.004, 95% CI 0.996-1.013); (3) mean dose (HR 1.006, 95% CI 0.997-1.016); (4) overall dose increase (HR 0.733, 95% CI 0.417-1.288) and decrease (HR 0.967, 95% CI 0.472-1.984); (5) day-by-day dosage changes (HR 1.005, 95% CI 0.996-1.013).


CONCLUSIONS
Opioid usage, even at high dosages, had no effect on survival among advanced cancer patients in a hospice setting.
Department of Geriatrics and Rehabilitation, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
Daniel
D
Azoulay
Jeremy M
JM
Jacobs
Ron
R
Cialic
Eliana Ein
EE
Mor
Jochanan
J
Stessman
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000075202:Contraindications; D017051:Hospice Care; D006801:Humans; D009367:Neoplasm Staging; D009369:Neoplasms; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D019452:Terminally Ill
D000701:Analgesics, Opioid