Bridging the Gap: Transforming Knowledge into Action
July 8-12, 2006, Washington, DC, USA
Tuesday, 11 July 2006 - 12:00 PM 169-26
Women Who Died of Ovarian Cancer: Documentation of Pain and Its Management at End of Life
Sharon J. Rolnick, PhD, MPH1, Jody M. Jackson, RN, BSN1, Winnie W. Nelson, PharmD, MS2, Amy Butani, BA1, Lisa J. Herrinton, PhD3, Mark C. Hornbrook, PhD4, Christine Neslund-Dudas, PhD5, Donald J. Bachman, MS4, and Steven S. Coughlin, PhD6. (1) HealthPartners Research Foundation, PO Box 1309, 8100 34th Avenue South, Minneapolis, MN 55440, (2) Applied Health Outcomes, Woodlands Parkway, Suite 500, Palm Harbor, FL 34685, (3) Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, (4) Center for Health Research, Northwest/Hawaii, Kaiser Permanente, 3800 North Interstate Avenue, Portland, OR 97227, (5) Henry Ford Health Systems, 1 Ford Place, 3A, Detroit, MI 48202, (6) Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, 4770 Buford Highway, NE (K-55), Atlanta, GA 30309
Objective: Studies indicate many dying cancer patients are under-treated and may suffer significant and unnecessary pain. We examined pharmaceutical pain management for patients in the last six months of life who died of ovarian cancer (n=421). Methods: Data were obtained retrospectively from three HMOs (1995-2000). Subjects were identified through cancer registries and administrative data. Pain documentation was obtained through record review. Out-patient pharmacy dispensings during the final six months of life were categorized according to the WHO pain management ladder. Results: Pain medication use shifted over the last 6 months of life, with medication intensity increasing as death approached. However, only about half the women received the highest intensity medications at any point in time. While 55% of women with pain were either on no or mild pain medication at five to six months before death, only 9% were using the highest intensity regimen. At three to four months, the percentage on mild drugs dropped to 15% and strong regimens accounted for 22%. At one to two months before death, the percentage on highest intensity medications rose to 54%. Younger women (<50) were more likely to be prescribed high strength analgesia compared to older women (70+) (70% vs. 44%, p=0.001). No differences were found by race, marital status, year of diagnosis, stage of disease, or comorbidity. Conclusions: Our findings, that only about half the women were on high intensity medications, suggest there is room for improvement in care of ovarian cancer patients at end of life.