UICC World Cancer Congress 2006

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.