Frequency of Opioid Use in a Population of Cancer Patients During the Trajectory of the Disease

Aims: Bearing in mind that Denmark has one of the world's highest legal uses of strong opioids per capita, the aim of the present study was to describe the frequency of opioid use in a complete, population-based cohort of cancer patients at different time points during the trajectory of the disease, and to analyse the influence of different factors on opioid use close to death. Materials and methods: All incident cancer patients registered in 1997-1998 (n=4006) from a population of 470 000 were followed individually from diagnosis to death (non-survivors) or for 5 years (survivors). The use of opioids was obtained from a prescription database covering the whole population. Results: Among the 43% cancer patients who survived for 5 years, 12% used opioids at diagnosis, 38% during follow-up and 10% after 5 years. For the non-survivors, 80% used opioids sometime during follow-up. At diagnosis, use related inversely to the cancer type's 5-year survival, and ranged from 20 to 46%; before death 64-76% used opioids. The odds ratios for opioid use at death were smaller for breast cancer (0.53; confidence interval 0.33-0.85), haemopoietic cancer (0.28; confidence interval 0.17-0.44) and the group of miscellaneous cancers (0.54; confidence interval 0.36-0.83) compared with colorectal cancer. Older age, longer disease duration and male gender (0.76; confidence interval 0.59-0.99) reduced the odds of opioid use at death. Conclusions: Judged by the use of opioids, moderate to severe pain is frequent throughout the trajectory of the cancer disease. The frequency of opioid use was in accordance with the frequency of moderate to severe cancer-related pain described in published studies. This completely population-based data set enables analyses of the actual practice regarding cancer patients' use of opioids, and it can serve as a more effective template for the management of cancer pain than the traditional measures, such as opioid consumption per capita, for international comparisons.