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Concern that opioids hasten death may be among the reasons that pain is treated
inadequately in populations with advanced illness. To determine whether survival
after last opioid dose change is associated with opioid dosing characteristics
and other factors, data from the National Hospice Outcomes Project, a large
prospective cohort study involving 13 U.S. hospice programs, were analyzed.
Of 1,306 patients, 725 received opioids and underwent at least one dose change
before death. Subsamples based on maximum opioid dose compared patients receiving
usual doses with those receiving high-dose therapy. Spearman rank correlations
examined bivariate associations between survival after final dose change and
other variables, including dose in morphine equivalent mg and percentage dose
increase. Multivariate least squares regression analyses determined associations
between survival and other variables, including those significant in bivariate
analyses. The mean+/-SD number of days between final dose change and death was
12.46+/-23.11. Multivariate models demonstrated a significant association between
shorter survival and higher opioid dose, a cancer diagnosis, unresponsiveness,
and pain of <5 on a 0-10 scale, but none of these models explained >10% of the
variance in time till death. Analyses of subsamples did not reveal additional
effects of dose.
This analysis revealed that opioid dosing was associated with time till death,
but this factor would explain very little of the variation in survival. In a
hospice population, survival is influenced by complex factors, many of which
may not be measurable. Based on these findings, concern about hastening death
does not justify withholding opioid therapy. Portenoy RK, Sibirceva U, Smout
R, Horn S, Connor S, Blum RH, Spence C, Fine P. From J
Pain Symptom Manage. J Pain Symptom Manage. 2006 Dec;32(6):532-540.
PMID 17157755
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
Credit: PubMed, developed by the National Center for Biotechnology Information
(NCBI) at the
National Library of Medicine (NLM).
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