title: Use of opioid analgesics among older persons with colorectal cancer in two health districts with palliative care programs.
abstract: BACKGROUND
  Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life.
  
  
  OBJECTIVE
  To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics.
  
  
  METHODS
  Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n=657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression.
  
  
  RESULTS
  In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR]=3.18, 95% CI=2.05-4.94), residence in a long-term care facility (OR=2.19, 95% CI=1.23-3.89), and a CRC cause of death (OR=1.75, 95% CI=1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR=0.97, 95% CI=0.95-0.99), male (OR=0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR=0.62, 95% CI=0.41-0.93).
  
  
  CONCLUSIONS
  PCPs may play an important role in enabling access to end-of-life care within the community.
authors.affiliation: Pharmaceutical Services, Department of Health and Wellness, Halifax, Nova Scotia, Canada. judith.fisher@gov.ns.ca
authors.forename: Judith
authors.initials: J
authors.lastname: Fisher
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.forename: Grace
authors.initials: G
authors.lastname: Johnston
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002170:Canada; D015179:Colorectal Neoplasms / Q000150:complications / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care; D012189:Retrospective Studies; D013727:Terminal Care; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid