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The epidemiology of opioid treatment in a population-based cohort of cancer patients.

8221 Background: Denmark has the highest use of strong opioids per capita in the world. Our aim was to analyze cancer patients' use of opioids in this population. Both tramadol and transdermal fentanyl were marketed during the observation period.


METHODS
By linkage between the Danish Cancer Register and a population-based prescription database we retrieved individual information on all cancer patients (n=24,190) living in a Danish county (n ∼ 470,000; 9% of the Danish population) from 1994 to 1998, and all the opioid prescriptions they redeemed.


RESULTS
The cancer patients' total consumption increased from 20 kg to 37 kg oral morphine equivalents (omeq) per year. The proportion of cancer patients, who used opioids, increased from 17% to 20% on a yearly basis. The rate of new opioid users per year remained stable (around 14 per 100 cancer-years). The average opioid consumption per user increased from 7.6 to 10.7 g omeq per year. The proportion of patients, who were alive 2 years after their first opioid prescription, increased from 38% to 55%. Tramadol became the most frequently used opioid, and the consumption of transdermal fentanyl reached the same level as morphine in 1998.


CONCLUSIONS
The large increase in the consumption of opioids among the cancer patients was caused by an increase both in the number of opioid users and in the average opioid consumption per patient. The substantial increase in 2-year survival after the first opioid prescription is most likely explained by an increasing tendency to initiate opioid treatment at earlier stages in the patients' symptomatic disease courses, which also could contribute to the other findings. No significant financial relationships to disclose.