Highlights
- •Men without close relatives were found to receive less opioids.
- •Older men were found to receive less ADT, opioids and anxiolytics.
- •Opioids were prescribed to 72% of the men in the cohort at death.
- •use of medications for mood disorders was found to increase in terminal disease.
- •Low education was found to increase the probability to receive opioids.
Abstract
Background
Symptoms of terminal cancer have previously been reported as undertreated. The aim
of this study was to assess the use of palliative medications before death from prostate
cancer.
Methods
This Swedish register study included men who died from 2009 to 2012 with prostate
cancer as the underlying cause of death. We assessed the proportion who collected
a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs,
paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics
and the differences in treatment related to age, time since diagnosis, educational
level, close relatives and comorbidities. Data were collected from 3 years before
death from prostate cancer.
Results
We included 8326 men. The proportion who received opioids increased from 30% to 72%
during the last year of life, and 67% received a strong opioid at the time of death.
Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics
from 21% to 33%. Men without close relatives and older men had lower probability to
receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47–0.66 for
>85 years versus <70 years) and (OR 0.78, 95% CI: 0.66–0.92 for unmarried without
children versus married with children).
Conclusion
Our results represent robust epidemiological data from Sweden for comparison of palliative
care quality between countries. The findings indicate that men without close relatives
and older men are disadvantaged with respect to the treatment of cancer pain and need
closer attention from health care providers and highlight the importance to identify
psychological distress in terminal prostate cancer.
Keywords
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Article info
Publication history
Published online: December 05, 2017
Accepted:
October 22,
2017
Received in revised form:
October 17,
2017
Received:
June 29,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
