title: Prescriptions of analgesics during complete disease trajectories in patients who are diagnosed with and die from cancer within the five-year period 2005-2009.
abstract: Even though validation studies of the WHO analgesic ladder have indicated that the simple approach of the analgesic ladder can provide adequate pain control in most patients, prevalence studies have documented a high prevalence of pain in cancer patients. Little is known about how analgesics are actually prescribed for cancer pain. The aim of the study was to study prescriptions of analgesics during the entire disease trajectory in patients dying from cancer within five years of diagnosis.
  
  
  
  Complete national data from the Norwegian Cancer Registry, the Norwegian Prescription Database, the Cause of Death Registry and Statistics Norway were used to study prescriptions of analgesics in a complete study population of all patients dying from cancer within five years of diagnosis in Norway from 2005 to 2009.
  
  
  
  Of a total of 10,977 subjects who received prescriptions for analgesics between diagnosis and death, 56% started analgesic treatment at step I of the analgesic ladder, 29% started at step II and 14% started at step III. Of the patients starting at step I, 28% continued to step II, 37% bypassed step II and moved directly to step III whereas the remaining 35% remained at step I. Approximately 60% received one or more dispensed prescription of a step III analgesic during the disease trajectory, whereas nearly 20% remained at step I and 20% at step II respectively.
  
  
  
  The study indicates that clinicians seem to individually tailor analgesic treatment instead of applying the stepwise approach in the WHO analgesic ladder.
  
  
  
  Complete national data covering the complete disease trajectory in cancer patients dying within five years of diagnosis. The majority of patients do not receive treatment in concordance with the stepwise approach suggested by the WHO analgesic ladder.
authors.affiliation: 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: O M S
authors.initials: OM
authors.lastname: Fredheim
authors.affiliation: Department of Oncology, Regional Center for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Norway.|Østfold Hospital Trust, Fredrikstad, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Brelin
authors.affiliation: Department of Oncology, Regional Center for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Norway.|Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Center, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: M J
authors.initials: MJ
authors.lastname: Hjermstad
authors.affiliation: Department of Oncology, Regional Center for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Norway.|Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Norway.
authors.forename: J H
authors.initials: JH
authors.lastname: Loge
authors.affiliation: Department of Oncology, Regional Center for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Norway.|Faculty of Medicine, University of Oslo, Norway.
authors.forename: N
authors.initials: N
authors.lastname: Aass
authors.affiliation: Cancer Registry of Norway, Oslo, Norway.
authors.forename: T B
authors.initials: TB
authors.lastname: Johannesen
authors.affiliation: Faculty of Medicine, University of Oslo, Norway.|Division of Epidemiology, Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Skurtveit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000072716:Cancer Pain / Q000188:drug therapy* / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D018450:Disease Progression; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D059408:Pain Management; D011446:Prospective Studies; D012042:Registries; D012959:Socioeconomic Factors; D014944:World Health Organization; D055815:Young Adult
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal