POTENTIAL INAPPROPRIATE USE OF STRONG OPIOID ANALGESICS IN CANCER
OUTPATIENTS DURING THE LAST YEAR OF LIFE IN FRANCE AND ASSOCIATED
FACTORS
Abstract
Aim: A better knowledge of opioid prescribing patterns would help to
identify areas of potential improvement in cancer pain management. This
study aimed to identify potential inappropriate use (PIU) of strong
opioid analgesics in cancer outpatients in their last year of life.
Methods: A retrospective cohort of cancer patients dead between 2011 and
2014 and who were exposed as outpatient to a strong opioid analgesic in
the last year of life was identified in the “Echantillon Généraliste de
Bénéficiaires” (a 1/97th random sample of the French general
population). Prescribing patterns of strong opioids were analyzed and
PIU was defined by at least one of these criteria: overlapping
prescriptions; contraindicated prescriptions; lack of laxatives;
potential drug interactions; prescription in patients hospitalized for
opioid-related disorders. Factors associated with PIU were investigated
through a multiple logistic regression model. Results: One third of the
2,236 patients (median age 72 years (IQR: 61-82), 44.1% of women)
presented a PIU (insufficient laxative prescription (19.6% of
patients), insufficient background treatment with transmucosal fentanyl
(14.8%), overlapping prescriptions (2.6%)). The rate of PIU
significantly decreased from 37.6% (2011) to 29.8% (2014). For
patients with a duration of opioid use 3 months, factors associated
with PIU were fentanyl prescription (aOR=2.36; 95% CI [1.86-3.00])
and previous use of strong opioid (aOR=1.88; [1.50-2.36])
Conclusion: In France, one third of cancer patients exposed to strong
opioids experienced PIU and this proportion tended to decrease over
time. There is still room for progress in cancer pain management at the
end of life.