title: Prediction of patient survival by change in daily opioid dosage in advanced cancer patients: a prospective hospital-based epidemiologic study.
abstract: OBJECTIVE
  Pain control helps improve quality of life for advanced cancer patients, yet it is unknown whether opioid use increases risk of death. Analyzing the association between time-varying pain medication and the risk of death presents a challenge. This prospective observational study examined the predictability of the patients' survival by variations of daily opioid dosage during the last few days of life.
  
  
  METHODS
  Of the 231 cancer patients admitted to a hospice ward between July 2007 and June 2008 was conducted using Cox's model and adjusting for the effects of demography, clinical symptoms/signs, intravenous fluid supplements, antibiotics use and laboratory tests.
  
  
  RESULTS
  We found a 3-day negative slope in daily oral morphine equivalent 1 day before each death event to be an independently significant predictor of short time to death (hazard ratio = 1.55; 95% confidence interval: 1.06-2.27). The other significant predictors including faster heart-rate (hazard ratio = 1.01, 95% confidence interval: 1.00-1.02), comorbidity with diabetes (hazard ratio = 1.57, 95% confidence interval: 1.00-2.47), Eastern Cooperative Oncology Group with performance status of 3 or 4 (hazard ratio = 1.78, 95% confidence interval: 1.23-2.58), jaundice (hazard ratio = 2.01, 95% confidence interval: 1.29-3.15), hypercalcemia (hazard ratio = 2.05, 95% confidence interval: 1.40-3.00) and higher serum creatinine level (hazard ratio = 1.36, 95% confidence interval: 1.18-1.57), but use first generation of cephalosporin was a negative predictor of short time to death (hazard ratio = 0.44, 95% confidence interval: 0.28-0.68).
  
  
  CONCLUSIONS
  A reduction of daily oral morphine equivalent over three consecutive days suggests worsening physical condition significantly and independently predicting imminent death ∼1 day later.
authors.affiliation: Department of Family Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi.
authors.forename: Jui-Kun
authors.initials: JK
authors.lastname: Chiang
authors.affiliation: Department of Family Medicine, Tainan Municipal Hospital, Tainan, Taiwan m2200767@gmail.com.
authors.forename: Yee-Hsin
authors.initials: YH
authors.lastname: Kao
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000453:epidemiology* / Q000209:etiology; D059408:Pain Management; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: cancer; opioid; prediction; survival