Opioids use in Palliative Cancer Patients at the Time of his Death: “The Myth of Morphine”
Originally published in the journal El Dolor 65 12-15; 2016
DOI:
https://doi.org/10.47924/neurotarget2017154Keywords:
Opioids, Morphine, Palliative care, Terminal illnessAbstract
Objectives: To determine which were the opioids used at the time of death, time usage and increasing doses.
Materials and Methods: Palliative patients admitted to the National Cancer Institute in 2008. Data were obtained from the book income and prescription computer records.
Results: 456 patients were treated, 170 died (37%), with median age of 66 (16-97) and 53% women. At death time, 14% was not receiving opioids. Used opioids were 11.7% codeine; 32.4% tramadol; 0.7% oxycodone; 37.2% morphine; 4.8% methadone; 10.3% TTS buprenorphine and 2.8% TTS fentanyl. All average doses were low (morphine 26,9 mg/day, methadone 17,9 mg/ day, tramadol, 142,8 mg/ day, buprenorphina 19 µg/h and fentanyl 19,5 µg/h). A significant increase in dose was not observed. Average time since the last change of opiod was 41.3 DE+63.5 days with a median of 26 days (1-366), no difference was found between different opioids.
Discussion: Half of the patients who died were in OMSIII. Only 37% of strong opioids users was using morphine. The average doses of all were low. Time between start opioid use and death was no different for different opioids. So not all palliative patients died using morphine, and no differences were observed in opioids time of use, or increasing doses which demystifies two beliefs: “If I use morphine I will die sooner” and “If I use morphine, I will increase the dose and I will be dependent”.
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References
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Cleveland CS,Gonin R, Hatfield AK,et al. Pain and its treatment in outpatiens with metastatic cancer. N Engl J Med 1994; 330:592-506.
Coyle N, Adelhardt J, Foley KM, Portenoy RK. Character of terminal illness in the advanced cancer patient: pain andother symptoms during the last four weeks of life. J pain Symptom Manage 1990; 5:83-89.
Miaskowski C, Dodd MJ, West C, et al. Lack of adherence with the analgesic regimen: A significant barrier to effective cancer pain management. J Clin Oncol 2001;19: 4275-4279.
De Lima L, Krakauer EL, Lorenz K, et al.Ensuring palliative medicine availability: The development of the IAHPC list of essential medicines for palliative care. J Pain Symptom Manage 2007;33:521-526.
Zens M, Willweber-Strumpf A. Opiophobia and cancer pain in Europe. Lancet 1993; 341:1075-1076.
Gomes-Sancho M, Modulo VI Historia del opio. Mitos y realidades de la morfina. En: Gomes-Sancho M, Pascual A, López E editores. Avances en Cuidados Paliativos. Vol II. España: GAFOS editores, Gabinete de Asesoramiento y Formación Sociosanitaria S.L. 2003: p355-369.
C. M. Reid, R. Gooberman-Hill, G. W. Hanks. Opioid analgesics for cancer pain: symptom control for the living or comfort for the dying? A qualitative study to investigate the factors influencing the decision to accept morphine for pain caused by cancer. Annals of Oncology. 2008; 19: 44-48.
Marit a, Harris J, Rosland JH. Living with advanced cancer and Short life expectancy: patients`experiences with managing medication. Journal of Palliative Care 2009; 25;85-91.
Bailey FA, Ferguson L, Williams BR, Woodby LL, Redden DT, Durham RM, Goode PS, Burgio KL. Palliative care intervention for choice and use of opioids in the last hours of life. J Gerontol A Biol Sci Med Sci. 2008 Sep;63(9):974-8.
Vitetta L, Kenner D, Sali, A. Sedation and analgesia-prescribing patterns in terminally ill patients at the end of life. Amer J of Hospice & Pall Med, 2005; 22:465-473.
Bugueño JL, Kramer MV y Ahumada M. Uso de Analgésicos Opiodes y Escala de la OMS en un Centro de Atención Terciario de Cuidados Paliativos. Presentación Poster. XXVIII Congreso Chileno de Medicina Interna. Viña del Mar, Octubre, 2006.
Twycross RG.Strongnarcotic analgesic.Clin Oncol 1984;3:109-133.
Melzack R, MountBM, Gordon JM. The brompton mixture versus morphine solution given orally:effects on pain. Can Med assoc J 1979;120:435-438.
Boisvert M, Cohen R. Opiod use in Advanced malignant disease:Why Do different Centers Use vastly Different Doses? A Plea for Standarized reporting. J Pain Symptom Manage 1995;8:632-63.
Bruera E, Brnneis C, Michaud M et al. Use of the subcutaneous route for the administration of narcotics in patients with cancer pain. Cancer 1988;62:407-511.
Bruera E, Navigante A, Barugel M, Macmillan K, MacDonal RN, Chacon R. Treatment of pain and other symptoms in cancer patients: patterns in a North American and South American hospital. J Pain Symptom Manage 1990;5:78-92.
Drexel H, Dzien A, Spiegel RW et al. Treatment of severe cancer pain by low-dose continuos subcutaneous morphine. Pain 1989;36:169-176.
Klepstad P, Kaasa S, Cherny N, et al: Pain and pain treatments in European palliative care units. A cross sectional survey from the European Association for Palliative Care Research Network. Palliat Med. 2005; 19:477-484.
Bercovitch M, Waller A, Adunsky A. High dose morphine use in the hospice setting: a database survey of patient characteristics and effect on life expectancy. Cancer, 1999; 86:871-877.
Brown W. Opioid use in dying patients in hospice and hospital, with and without specialist palliative care team involvement. Eur J Cancer Care (Engl). 2008 Jan;1 7(1):65-71.
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Copyright (c) 2017 Verónica Kramer, Barbarita Peralta, Tomás Stamm, Carla Lemp, Natalia Aravena, Marcela Cárcamo
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