title: Opioids for outpatients with cancer in their last year of life: A nationwide pharmacoepidemiological study.
abstract: OBJECTIVE
  Opioids are the main pharmacological treatment for moderate-to-severe cancer pain. Few longitudinal studies have examined the prescription prevalence (PP) of opioids to patients with cancer. The aims of the study were to examine 1) changes in the PP of opioids from 2005 to 2009 among outpatients with cancer who were in their last year of life and 2) associations between the PP of opioids and medical and sociodemographic factors.
  
  
  METHODS
  Retrospective, registry-based, national study.
  
  
  METHODS
  This study used data on all patients with cancer who died 2005-2009, combining the following three complete nationwide registries; prescription data from the Norwegian Prescription Database, data on cancer diseases from the Cancer Registry of Norway, and sociodemographic data from Statistics Norway.
  
  
  RESULTS
  The study population consisted of 44,579 adults (mean age 72 years at death, 54 percent males). The opioid PP increased from 74 to 82 percent during the study period. Oxycodone had the highest PP, and increased from 39.8 to 48.5 percent during the period, whereas the PP of morphine declined from 29.0 to 27.3 percent. The PP for fentanyl remained stable at 17 percent. The PP of opioids increased toward death with higher PP during the last 3 months of life compared to previous 3-month periods. Older patients (>60) were less likely to receive opioids, while prostate or pancreatic cancer increased the odds for opioid prescriptions (p < 0.001, Odds ratio [OR] 2.60 and OR 1.98, respectively).
  
  
  CONCLUSIONS
  The PP increased yearly during the study period. Use of oxycodone increased while that of morphine decreased.
authors.affiliation: Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; Østfold Hospital Trust, Fredrikstad, Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Brelin
authors.affiliation: Professor, Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St Olav University Hospital, Trondheim, Norway; Centre of Palliative Medicine, Surgical Division, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Olav M
authors.initials: OM
authors.lastname: Fredheim
authors.affiliation: Professor, Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Jon H
authors.initials: JH
authors.lastname: Loge
authors.affiliation: Professor, Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Skurtveit
authors.affiliation: Cancer Registry of Norway, Oslo, Norway.
authors.forename: Tom B
authors.initials: TB
authors.lastname: Johannesen
authors.affiliation: Professor, Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Nina
authors.initials: N
authors.lastname: Aass
authors.affiliation: Professor, Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: Stig
authors.initials: S
authors.lastname: Ottesen
authors.affiliation: Professor, Regional Center for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ullevål, Oslo, Norway; European Palliative Care Research Center, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Hjermstad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010045:Outpatients; D017891:Pharmacoepidemiology / Q000379:methods; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid