Prescription patterns of analgesics in the last 3 months of life: a retrospective analysis of 10202 lung cancer patients

Abstract

Background: To describe the prescription patterns of analgesics during the last 3 months of life in lung cancer and to determine the associated factors.

Methods: Data on lung cancer patients (N=10,202) who died during 2000-2008 were extracted from the General Practice Research Database (GPRD). This database records prescriptions of patients received from UK general practices (GP), but not those from non-GP routes. Prescription prevalences were estimated. The associated factors were investigated using log-binomial regression.

Results: The overall prescription prevalences were 50.4% (95% confidence interval (CI): 49.4-51.4%) for level 1 (e.g., paracetamol), 34.1% (95% CI: 33.2-35.0%) for level 2 (weak opioids), and 55.5 % (95% CI: 54.5-56.4%) for level 3 analgesics (strong opioids). Prescription prevalence of analgesics of all levels showed an increasing trend over the period 2000-2008 (annual increases range: 1.1-1.5%) but a decreasing trend with age (average decrease per group range: -5.8 to -1.8%). Patients in the older age groups were less likely to be prescribed level 3 analgesics than those in the younger age groups (PR('90+' vs '<50')=0.55 (95% CI: 0.45-0.67); PR('80-89' vs '<50')=0.73 (95% CI: 0.66-0.79); PR('70-79' vs '<50')=0.84 (95% CI: 0.77-0.90)).

Conclusion: Analgesics have been increasingly prescribed in lung cancer. However, analgesics, especially at level 3, were relatively under-prescribed to people older than 70 years, warranting further investigation.

Figure 1

Time trend of prescription prevalence (95% CI) of level 1, level 2, and level 3 analgesics (according to the WHO analgesic ladder) in patients with lung cancer and proportion of patients without analgesic prescriptions during the last 3 months of life, 2000–2008 (n=10 202). Annual change: level 1: 1.2% (95% CI: 0.8–1.6%, P=0.001); level 2: 1.1% (95% CI: 0.8–1.5%, P<0.001); level 3: 1.5% (95% CI: 1.1–2.0%, P<0.0001); No prescription: −1.4% (95% CI: −1.8 to −1.0% P<0.001).

Figure 2

Prescription prevalence (95% CI) of level 1, level 2, and level 3 analgesics (according to the WHO analgesic ladder) in patients with lung cancer and proportion of patients without analgesic prescriptions by age groups (n=10 202). Average change per age group: level 1: −1.8% (95% CI: −2.5 to −1.2%, P=0.005); level 2: −2.6% (95% CI: −3.2 to −1.9%, P=0.002); level 3: −5.8% (95% CI: −7.6 to −4.1%, P=0.003); No prescription: 2.9% (95% CI: 2.2–3.6% P=0.001).