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The use of palliative medications before death from prostate cancer: Swedish population-based study with a comparative overview of European data.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Urology.
Reg Canc Ctr Uppsala Orebro Reg, Uppsala, Sweden.
Reg Canc Ctr Uppsala Orebro Reg, Uppsala, Sweden.; Kings Coll London, Sch Med, Div Canc Studies, London, England..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Urology. Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden.ORCID iD: 0000-0002-8306-0687
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2017 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 88, p. 101-108Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Symptoms of terminal cancer have previously been reported as undertreated. The aim of this study was to assess the use of palliative medications before death from prostate cancer.

METHODS: This Swedish register study included men who died from 2009 to 2012 with prostate cancer as the underlying cause of death. We assessed the proportion who collected a prescription of androgen deprivation therapy, non-steroidal anti-inflammatory drugs, paracetamol, opioids, glucocorticoids, antidepressants, anxiolytics and sedative-hypnotics and the differences in treatment related to age, time since diagnosis, educational level, close relatives and comorbidities. Data were collected from 3 years before death from prostate cancer.

RESULTS: We included 8326 men. The proportion who received opioids increased from 30% to 72% during the last year of life, and 67% received a strong opioid at the time of death. Antidepressants increased from 13% to 22%, anxiolytics from 9% to 27% and sedative-hypnotics from 21% to 33%. Men without close relatives and older men had lower probability to receive opioids (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.47-0.66 for >85 years versus <70 years) and (OR 0.78, 95% CI: 0.66-0.92 for unmarried without children versus married with children).

CONCLUSION: Our results represent robust epidemiological data from Sweden for comparison of palliative care quality between countries. The findings indicate that men without close relatives and older men are disadvantaged with respect to the treatment of cancer pain and need closer attention from health care providers and highlight the importance to identify psychological distress in terminal prostate cancer.

Place, publisher, year, edition, pages
2017. Vol. 88, p. 101-108
Keywords [en]
Anxiety, Cancer pain, Castration, Depression, Fatigue, Observational study, Opioids, Palliative medicine, Prostate cancer, Sleep disorders
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-336227DOI: 10.1016/j.ejca.2017.10.023ISI: 000418290800012PubMedID: 29216521OAI: oai:DiVA.org:uu-336227DiVA, id: diva2:1165416
Funder
Swedish Cancer Society, CAN 2008/598:1Swedish Research Council, 2012-5047Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-06-26Bibliographically approved
In thesis
1. Living and dying with prostate cancer: Population-based register studies
Open this publication in new window or tab >>Living and dying with prostate cancer: Population-based register studies
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tailored treatment with adequate timing is essential for the quality of prostate cancer care at all stages. Overtreatment should be avoided due to the side effects, but undertreatment may on the other hand lead to progression and death. This thesis aims to describe the patterns of use for non-curative treatments of prostate cancer, alongside the time trends of disease characteristics of men who die from prostate cancer. The work was based on the National Prostate Cancer Register of Sweden (NPCR).

The first study included 45 147 men. The cumulative incidence of castration was 11.6% at ten years after diagnosis, while it was 10.8% for antiandrogen monotherapy. Estimated median durations of castration ranged from four years in the deferred treatment high-risk group to seventeen years in the prostatectomy low-risk group. The second study included 114 cases and 1140 controls. Four men out of ten received androgen deprivation therapy although they had prostate-specific antigen doubling time ≥12 months and biopsy Gleason score ≤7, which was defined as non-adherence to the guidelines of the European Association of Urology. Most of these men had low-risk features at diagnosis. The third study included 8326 men. During the last year before death from prostate cancer, use of opioids increased from 30% to 72%. Men without close relatives and older men had lower probability to receive opioids. The fourth study included 45 850 men. During the study period of 1992 to 2012, the time trend showed a stage shift towards lower risk group at diagnosis, longer disease duration, and higher age at death among men who died from prostate cancer.

The first two studies indicate that overtreatment with androgen deprivation therapy is common after curative treatment, why interventions to improve adherence to guidelines are needed.  The third study indicates that men without close relatives and older men are disadvantaged with respect to treatment of cancer pain, why they need closer attention from health care providers. The findings in the fourth study may reflect the synergetic effects of prolonged lead time, increased life expectancy, and improvements in the management of prostate cancer during the last two decades.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 65
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1474
Keywords
Androgen deprivation therapy; Palliative medicine; Population-based study; Prostate cancer.
National Category
Medical and Health Sciences
Research subject
Urology
Identifiers
urn:nbn:se:uu:diva-354470 (URN)978-91-513-0369-7 (ISBN)
Public defence
2018-09-07, Humanistiska teatern, Engelska parken, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-08-17 Created: 2018-06-20 Last updated: 2018-08-27

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Lycken, MagdalenaStattin, PärHolmberg, LarsBill-Axelson, Anna

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