Abstract
BACKGROUND: Pain is one of the most distressing symptoms for cancer patients. It remains a public health problem, and there is a need for better pain management at the societal level. OBJECTIVES: The purpose of this study is to characterize the opioid dosages and its type administered to adult cancer patients during their last week of life and to investigate the factors that may have contributed to it by the palliative care team at King Abdulaziz Medical City in Riyadh, Saudi Arabia. METHODS: A retrospective cross-sectional study was performed at the King Abdulaziz Medical City (KAMC), utilizing charts of adult cancer patients admitted to palliative care. We studied the use of opioids in the last week of the patient's life (day 7 before patient's death and day 1 before patient's death). We studied all cancer patients who were admitted to the palliative care department at KAMC and died in the hospital from 1/1/2022 to 1/1/2023 (one year). RESULTS: The study included 178 patients who met the inclusion and exclusion criteria. Of our sample, 47.2% were male and 52.8% were female. The average age at death was 67.82(± 14.03) years. The average length of last admission to palliative care department was 22.25(± 14.25) days. The most frequent tumor types were gastrointestinal cancers (30.9%), then pancreatic cancers (12.9%), breast cancers and hepatocellular cancers (10.1% for each one of them). Morphine was the most common opioid prescribed at 32.0% 7-days prior to death and increasing to 37.6% 1-day prior to death. Hydromorphone was second most common opioid prescribed, at 17.4% 7-days prior to death and increasing to 24.2% 1-day prior to death. Using a morphine to hydromorphone conversion ratio of 5:1, the mean opioid equivalent to oral morphine 7 days prior to death was 32.01 mg, and on the day prior to death it was 27.78 mg. CONCLUSION: Our study showed that the use of opioids in palliative inpatient care is common in Saudi Arabia, with morphine and hydromorphone being the most commonly used opioids. Our study results emphasize the need for an individualized approach to palliative care, considering patient-specific factors such as comorbidities and pain management.