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Eur J Cancer. 2018 Jan;88:101-108. doi: 10.1016/j.ejca.2017.10.023. Epub 2017 Dec 6.

The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data.

Author information

1
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: magdalena.lycken@surgsci.uu.se.
2
Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden.
3
Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden; King's College London, School of Medicine, Division of Cancer Studies, London, UK.
4
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
5
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
6
Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
7
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Regional Cancer Centre Uppsala Örebro Region, Uppsala, Sweden; King's College London, School of Medicine, Division of Cancer Studies, London, UK.
8
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

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:

Anxiety; Cancer pain; Castration; Depression; Fatigue; Observational study; Opioids; Palliative medicine; Prostate cancer; Sleep disorders

PMID:
29216521
DOI:
10.1016/j.ejca.2017.10.023
[Indexed for MEDLINE]

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