Abstract
Context: Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life. Objectives: To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics. Methods: Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n = 657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression. Results: In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR] = 3.18, 95% CI = 2.05-4.94), residence in a long-term care facility (OR = 2.19, 95% CI = 1.23-3.89), and a CRC cause of death (OR = 1.75, 95% CI = 1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR = 0.97, 95% CI = 0.95-0.99), male (OR = 0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR = 0.62, 95% CI = 0.41-0.93). Conclusion: PCPs may play an important role in enabling access to end-of-life care within the community.
| Original language | English |
|---|---|
| Pages (from-to) | 20-29 |
| Number of pages | 10 |
| Journal | Journal of Pain and Symptom Management |
| Volume | 46 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jul 2013 |
| Externally published | Yes |
Bibliographical note
Funding Information:Judith Fisher received postdoctoral funding through the Network for End of Life Studies Interdisciplinary Capacity Enhancement, funded by the Canadian Institutes for Health Research through a strategic initiative grant ( #HOA-80067 ), 2006–2011, the Canadian Health Services Research Foundation , and the Nova Scotia Health Research Foundation . This work was undertaken during her postdoctoral work at Dalhousie University. The study was supported by a Team Grant from the Canadian Institutes for Health Research (grant no. AQC-83513 ) and local funding partners ( Cancer Care Nova Scotia , Nova Scotia Department of Health , Capital District Health Authority , Dalhousie Medical Research Foundation , and Dalhousie University's Faculty of Medicine ). The funding sources had no role in study design or in the collection, analysis, interpretation, or presentation of data. The authors have no potential conflicts of interest to declare with regard to this study.
ASJC Scopus Subject Areas
- General Nursing
- Clinical Neurology
- Anesthesiology and Pain Medicine
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't
