Differences in the Opioid Consumption of Terminally Ill Schizophrenic and Nonschizophrenic Cancer Patients: Analysis of Secondary National Population Data |
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| Affiliation: | 1. Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan, Republic of China;2. Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China;3. School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China;4. Department of Public Health, Tzu Chi University, Hualien, Taiwan, Republic of China;1. Advance Care Planning Australia, Austin Health, Melbourne, Australia;2. Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia;3. Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia;4. Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, Australia;5. Neuroscience Research Australia, Sydney, Australia;6. Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia;7. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;8. HammondCare Centre for Learning & Research in Palliative Care, Greenwich Hospital and University of Sydney, Sydney, Australia;1. Department of Surgery, Massachusetts General Hospital, Boston, USA;2. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, USA;3. Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA;4. San Francisco Veterans Affairs Health Care System, San Francisco, California, USA;5. Department of Health Care Policy, Harvard Medical School, Boston, USA;6. Division of General Internal Medicine, Brigham and Women''s Hospital, Boston, USA;7. Division of Palliative Medicine, Department of Medicine, Brigham and Women''s Hospital, Boston, USA;1. Medical Oncology, University Hospital Basel, Basel, Switzerland;2. Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland;3. School of Nursing, Indiana University, Indianapolis, Indiana, USA;4. College of Nursing, Chungnam National University, Daejeon, South Korea;5. School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;6. School of Nursing, University of California San Francisco, San Francisco, California, USA;7. School of Medicine, University of California San Francisco, San Francisco, California, USA;8. School of Nursing, University of Michigan, Ann Arbor, Michigan, USA;1. Department of Behavioral Science, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA;2. Department of Neuro-Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA;3. Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA;4. Department of Symptom Research, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA;5. Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA;6. Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA;7. Department of Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA;8. Department of Oncology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA;9. Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA;1. School of Nursing, University of California, San Francisco, San Francisco, California, USA;2. School of Medicine, University of California, San Francisco, San Francisco, California, USA;3. The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts, USA;4. Rory Meyers College of Nursing, New York University, New York, New York, USA;5. Department of Nursing, Mount Sinai Medical Center, New York, New York, USA;6. School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA |
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| Abstract: | ContextIt is uncertain whether terminally ill schizophrenic cancer patients are hypoalgesic or have disparities in pain management.ObjectivesThe objective of this study was to analyze the dosage of opioids used in terminally ill cancer patients with and without schizophrenia.MethodsThis is a population-based retrospective cohort study based on data derived from the Taiwan National Health Insurance Research Database. Patients aged >20 years and newly diagnosed between 2000 and 2012 with at least one of the six most common cancers were included. After 1:4 matching, 1001 schizophrenic cancer patients comprised the schizophrenia cohort, while 4004 cancer patients without schizophrenia comprised the nonschizophrenia cohort. The percentage of opioid use, accumulated dose, and average daily dose near the end of life were analyzed for each cohort using multiple logistic and linear regression models.ResultsThe percentage of opioid use was lower in the schizophrenic cohort than the nonschizophrenic cohort during the last month before death (69.6% vs. 84.8%, odds ratio = 0.40, 95% CI = 0.34–0.48). The accumulated dose of opioid consumption was also lower in the schizophrenic cohort (2407 mg vs. 3694 mg, P value < 0.05).ConclusionNear the end of life, cancer patients with schizophrenia use less opioid than their nonschizophrenic counterparts. Cognitive impairment may be a cause in the disparity in end-of-life care for terminally ill schizophrenic cancer patients. Thus, we should formulate a more accurate pain scale system and pay attention to their need for pain treatment. |
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| Keywords: | Schizophrenia cancer opioid end-of-life care |
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