title: Dyspnea, relative youth and low daily doses of opioids predict increased opioid dosage in the last week of a terminal cancer patient's life.
abstract: OBJECTIVE
  Most cancer patients become increasingly anxious toward the end of their life. The objective of this study was to identify predictors of increased opioid dosage in the last week of a terminal cancer patient's life.
  
  
  METHODS
  We retrospectively reviewed charts of patients who died in our palliative care unit. We assigned the patients to increased group or decreased group according to changes in oral morphine equivalent dosage in their last 7 days. Logistic regression analysis was used to identify predictors of increased oral morphine equivalent dosage.
  
  
  RESULTS
  We analyzed data of 158 patients (female: 43.7%, median age: 64 years). The median oral morphine equivalent dosages on Days 7 and 1 before death were 50 mg (interquartile range: 24-122) and 61 mg (28-129), respectively. Independent predictors of increased oral morphine equivalent dosage included dyspnea (odds ratio: 11.5, 95% confidence interval: 4.98-28.83, P < 0.01), age <65 years (odds ratio: 2.3, 95% confidence interval: 1.04-5.26, P = 0.04) and oral morphine equivalent dosage <50 mg on Day 7 before death (odds ratio: 3.7, 95% confidence interval: 1.68-8.89, P < 0.01). The median oral morphine equivalent dosages on Days 7 and 1 before death were 48 mg (interquartile range: 20-126) and 75 mg (36-170) in patients with dyspnea, and 50 mg (25-120) and 57 mg (25-124) in patients with pain, respectively.
  
  
  CONCLUSIONS
  Dyspnea, relative youth and oral morphine equivalent dosage <50 mg on Day 7 before death were predictive of increased oral morphine equivalent dosage in the last 7 days. Our findings may help oncologists to more accurately inform patients about expected opioid requirements and thus relieve their end-of-life anxiety.
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa tomiura@east.ncc.go.jp.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Pharmacy, National Cancer Center Hospital East, Kashiwa.
authors.forename: Shinya
authors.initials: S
authors.lastname: Motonaga
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Hasuo
authors.affiliation: Palliative Care Center, Shimane University Hospital, Matsue, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001007:Anxiety / Q000150:complications / Q000517:prevention & control; D004334:Drug Administration Schedule; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods; D019452:Terminally Ill; D013810:Therapeutic Equivalency
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: dyspnea; opioid; pain; palliative care