Inadequate Pain Relief at End of Life in Elderly Patients

HealthDay News

November 13, 2008

Elderly cancer patients often do not receive appropriate pain relief at the end of life, and about one-quarter are admitted to a hospice within days of death, according to a report published online Nov. 10 in the Journal of Clinical Oncology.

Soko Setoguchi, M.D., from Brigham and Women's Hospital in Boston, and colleagues analyzed data from Medicare and pharmaceutical claims as well as cancer registry data to identify factors associated with quality end-of-life care in elderly patients (65 years and older) with breast, colorectal, lung or prostate cancer. The study examined a prospective group of 33,675 patients and a retrospective group of 32,810 patients (who had died).

The researchers found that opiate use was low in both groups (9.1 in the prospective group and 10.1 percent in the retrospective group). About one-quarter of patients in both groups were admitted to a hospice within three days of death (28.8 and 26.4 percent, respectively). Rates of death in an acute care hospital were also similar in both groups (31.3 and 30.1 percent, respectively). Patients who saw an oncologist were more likely to receive chemotherapy, opiates and hospice care. Among the retrospective group, patients seeing an oncologist in a small group practice were more likely to receive chemotherapy, while those cared for outside of teaching hospitals were less likely to receive hospice care. Among the prospective group, patients seen outside teaching hospitals were more likely to experience toxicity. Among all patients, patients seen in small practices were less likely to receive hospice care, while those seen outside teaching hospitals were more likely to receive chemotherapy but less likely to receive opiates.

"This analysis suggests that benchmarks for the underuse of palliative services, which includes opiates, may be more similar between prospective and retrospective approaches to assess the quality of end-of-life care than measures of overuse of aggressive disease-modifying therapy," Setoguchi and colleagues conclude.

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