Clinical Experience With Strong Opioids in Pain Control of Terminally ill Cancer Patients in Palliative Care Settings in Taiwan

Background: Strong opioids have been recommended as the mainstay of therapy for moderate-to-severe pain, which is highly prevalent in terminally ill cancer patients. Purposes: The aims of this study were to collect valuable data on the clinical use of strong opioid analgesics in the management of pain in terminally ill cancer patients receiving palliative care in Taiwan and disseminate the knowledge gleaned from these data to guide practical opioid treatment and improve pain control in end-of-life care. Methods: This study retrospectively reviewed 150 cancer patients who received palliative care in a Taiwanese medical center between July 2005 and August 2008. Information regarding medications for pain control (opioid type, daily dosage, frequency, and route), adverse events, and pain assessments in the last 2 weeks before death was analyzed. Results: In the second-last week of life, 97 (64.6%) patients were prescribed morphine only and 43 (28.7%) of them received two or more different opioids. In the last week, patients tended to prefer morphine to other opioids. The mean (standard deviation) daily morphine dosage was significantly higher in the last week [96.79 mg (110.55 mg)] than in the second-last week [88.08 mg (100.87 mg)]. The mean daily dose differed significantly between the gender and the three age groups (≤50, 51-70, and ≥71 years) in the last week of life but did not show difference in the second-last week of life. Subcutaneous injection (114 of 150, 76%) was the most frequent route of opioid administration. In the second-last week before death, patients with an improvement in their usual breakthrough pain level had taken a significantly higher dose of opioids than those who showed no improvement. Conclusion: Overall, through appropriate dose adjustments, strong opioid regimens, and appropriate routes, strong opioids can be administered as extremely effective analgesics in the palliative care of patients with intractable cancer pain.