Use national health insurance database to explored factors influencing patterns of strong opioid use in advanced cancer patients in their final 12 months of life.
Cancer patients who died from cancer during 2008-2011 were included in this analysis. Data in prescription of strong opioids in outpatient clinics during their last 12 months of life were collected and analyzed using National Health Insurance Research Database (NHIRD). Patient's characteristics, such as cancer types, as well as information on the provider's characteristics, such as specialty, gender and age of the physician, the ownership and level of accreditation of the hospital, and the level of urbanization of the hospital where it is located, were also retrieved and included as the controlled variables in the analysis.
Of the 162,679 cancer deaths, the ratio of male-to-female cancer patients was 1.75: 1. Most patients were inflicted by gastrointestinal cancers (44.9%). 7,578 patients were prescribed strong opioids in clinics in their last year of life (35.4 percent). More than half of the opiod users (53.2%) received opiods in last 3-months. The overall median strong opioid use was 81 days before death. Patients with head/neck cancer (52.8%) or who were treated in the hematology & oncology departments (45.8%) tend to be most likely to receive strong opioid. Patients with gastroenterology cancers (HR: 0.65; 95% CI: 0.64–0.67) or treated in gastroenterology departments (HR: 0.88; 95% CI: 0.84–0.93) were least likely to have strong opioid.
aHR: adjusted Hazard Ratio
There are significant difference in strong opioids prescription among different cancer types and care providers for advanced cancer patients. Information from this study can guide further efforts in improving educations to the care providerss and patients with advanced cancer.
Clinical trial identification
All authors have declared no conflicts of interest.