Prediction of Patient Survival by Change in Daily Opioid Dosage in Advanced Cancer Patients: A Prospective Hospital-based Epidemiologic Study. (30th September 2014) - Chiang, Jui-Kun
Abstract : Objective: Pain control helps improve quality of life for advanced cancer patients, yet it is unknown whether opioid use increases risk of death. Analyzing the association between time-varying pain medication and the risk of death presents a challenge. This prospective observational study examined the predictability of the patients' survival by variations of daily opioid dosage during the last few days of life. Methods: Of the 231 cancer patients admitted to a hospice ward between July 2007 and June 2008 was conducted using Cox's model and adjusting for the effects of demography, clinical symptoms/signs, intravenous fluid supplements, antibiotics use and laboratory tests. Results: We found a 3-day negative slope in daily oral morphine equivalent 1 day before each death event to be an independently significant predictor of short time to death (hazard ratio = 1.55; 95% confidence interval: 1.06–2.27). The other significant predictors including faster heart-rate (hazard ratio = 1.01, 95% confidence interval: 1.00–1.02), comorbidity with diabetes (hazard ratio = 1.57, 95% confidence interval: 1.00–2.47), Eastern Cooperative Oncology Group with performance status of 3 or 4 (hazard ratio = 1.78, 95% confidence interval: 1.23–2.58), jaundice (hazard ratio = 2.01, 95% confidence interval: 1.29–3.15), hypercalcemia (hazard ratio = 2.05, 95% confidence interval: 1.40–3.00) and higher serum creatinine level (hazard ratio = 1.36, 95% confidence interval: 1.18–1.57), but use first generation of cephalosporin was a negative predictor of short time to death (hazard ratio = 0.44, 95% confidence interval: 0.28–0.68). Conclusion: A reduction of daily oral morphine equivalent over three consecutive days suggests worsening physical condition significantly and independently predicting imminent death ∼1 day later.