Opioids for outpatients with cancer in their last year of life: A nationwide pharmacoepidemiological study

2016 ◽  
Vol 12 (1) ◽  
pp. 25 ◽  
Author(s):  
Siri Brelin, MD ◽  
Olav M. Fredheim, MD, PhD ◽  
Jon H. Loge, MD, PhD ◽  
Svetlana Skurtveit, PhD ◽  
Tom B. Johannesen, MD, PhD ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Prescription Database ◽  
Prescription Data ◽  
Pharmacoepidemiological Study ◽  
Patients With Cancer ◽  
Sociodemographic Data ◽  
Norwegian Prescription Database ◽  
Study Population ◽  
To Receive ◽  
Cancer Diseases

Objective: Opioids are the main pharmacological treatment for moderate-to-severe cancer pain. Few longitudinal studies have examined the prescription prevalence (PP) of opioids to patients with cancer. The aims of the study were to examine 1) changes in the PP of opioids from 2005 to 2009 among outpatients with cancer who were in their last year of life and 2) associations between the PP of opioids and medical and sociodemographic factors.Design: Retrospective, registry-based, national study.Patients: This study used data on all patients with cancer who died 2005-2009, combining the following three complete nationwide registries; prescription data from the Norwegian Prescription Database, data on cancer diseases from the Cancer Registry of Norway, and sociodemographic data from Statistics Norway.Results: The study population consisted of 44,579 adults (mean age 72 years at death, 54 percent males). The opioid PP increased from 74 to 82 percent during the study period. Oxycodone had the highest PP, and increased from 39.8 to 48.5 percent during the period, whereas the PP of morphine declined from 29.0 to 27.3 percent. The PP for fentanyl remained stable at 17 percent. The PP of opioids increased toward death with higher PP during the last 3 months of life compared to previous 3-month periods. Older patients (>60) were less likely to receive opioids, while prostate or pancreatic cancer increased the odds for opioid prescriptions (p < 0.001, Odds ratio [OR] 2.60 and OR 1.98, respectively).Conclusion: The PP increased yearly during the study period. Use of oxycodone increased while that of morphine decreased.

Use of a natural multicomponent mouthwash plus oral hygiene vs oral hygiene alone to prevent everolimus-induced stomatitis: the STOP multicenter, randomized trial

2020 ◽  
Vol 106 (3) ◽  
pp. 257-266
Author(s):  
Camillo Porta ◽  
Elena Verzoni ◽  
Silvia Zai ◽  
Caterina Messina ◽  
Vittorio Ferrari ◽  
...  
Keyword(s):  
Oral Hygiene ◽  
Mammalian Target Of Rapamycin ◽  
Dose Intensity ◽  
Treated Group ◽  
Patients With Cancer ◽  
Treatment Dose ◽  
Registration Number ◽  
Study Population ◽  
To Receive

Background: Stomatitis is highly prevalent in patients with cancer treated with the mammalian target of rapamycin inhibitor everolimus; it usually has an early onset and may compromise treatment dose intensity and patients’ quality of life. Within the randomized controlled Stomatitis Prevention trial (STOP, ISRCTN14568888), we investigated the possibility of using a commercial natural multicomponent mouthwash (Orasol Plus®) to prevent the development of stomatitis of any grade in patients with advanced renal cell carcinoma (RCC) treated with everolimus. Methods: Overall, 62 patients were randomized to receive either Orasol Plus in addition to oral hygiene or oral hygiene alone (31 patients per treatment arm). Results: In the whole study population, 28 episodes of stomatitis were observed (41.9%); in only 2 patients, stomatitis occurred more than once (2 episodes). As expected, the episodes of stomatitis occurred early in the course of treatment with everolimus. Treatment with Orasol Plus prevented the onset of everolimus-induced stomatitis: only 8 episodes of stomatitis were observed in the treated group with Orasol Plus in addition to oral hygiene vs 20 episodes in the group treated with oral hygiene only ( p = 0021). Also, a reduction in the average duration of mucositis in patients treated with Orasol Plus compared to patients treated with oral hygiene only was observed (8 days vs 11.2 days, p = 0.0416). Conclusion: This study showed that the use of a natural multicomponent mouthwash coupled with regular oral hygiene was able to reduce the severity and duration of everolimus-induced stomatitis in patients with RCC. Trial registration number: ISRCTN14568888

scholarly journals Antibiotic prescriptions and cycles of Mycoplasma pneumoniae infections in Norway: can a nationwide prescription register be used for surveillance?

2014 ◽  
Vol 143 (9) ◽  
pp. 1884-1892
Author(s):  
H. S. BLIX ◽  
D. F. VESTRHEIM ◽  
V. HJELLVIK ◽  
D. SKAARE ◽  
A. CHRISTENSEN ◽  
...  
Keyword(s):  
Drug Use ◽  
Mycoplasma Pneumoniae ◽  
Laboratory Data ◽  
Monitoring Systems ◽  
Antibiotic Prescribing ◽  
Prescription Database ◽  
Prescription Data ◽  
Age Group ◽  
Epidemic Season ◽  
Norwegian Prescription Database

SUMMARYMycoplasma pneumoniae outbreaks cause increased use of macrolides and tetracyclines. We aimed to investigate whether drug use data, in addition to laboratory data, could improve understanding of the spread of M. pneumoniae epidemics. Number of users of Mycoplasma antibiotics (erythromycin, doxycycline, clarithromycin) per week and county of residence in an indicator age group (6–12 years) was retrieved from the Norwegian prescription database for the epidemic season 2011–2012 and compared to non-epidemic seasons. In 2011, increased use of Mycoplasma antibiotics was first observed in September on the west coast of Norway. The Norwegian laboratory-based surveillance system showed the first increase in positive tests in August 2011 and an epidemic was announced on 25 October 2011. At that time the use of Mycoplasma antibiotics had already exceeded three times the use in non-epidemic periods. Data for three counties from the regional microbiological laboratories showed that the increase in number of positive samples coincided in time with the increase in prescription data. Laboratory data cannot accurately determine the extent of an epidemic, and drug use data cannot identify the cause. Establishing a systematic interaction between the two monitoring systems will enhance surveillance and probably contribute to improved infection control and prudent antibiotic prescribing.

Dispensing of prescribed analgesics in Norway among young people with foreign-or Norwegian-born parents

2011 ◽  
Vol 2 (1) ◽  
pp. 36-44 ◽  
Author(s):  
Tomas Log ◽  
Svetlana Skurtveit ◽  
Aage Tverdal ◽  
Kari Furu ◽  
Ingeborg Hartz
Keyword(s):  
Young People ◽  
Health Surveys ◽  
Prescription Database ◽  
Youth Health ◽  
Birth Country ◽  
Norwegian Prescription Database ◽  
Study Population ◽  
Muslim Majority ◽  
Males And Females

AbstractPurposeTo examine and compare dispensing of prescribed analgesics between young people with parents from countries with a Muslim majority and those with parents born in Norway.MethodsOur study-population constituted 11,542 adolescents from the Norwegian Youth Health Surveys conducted in 2000–2003. Users and non-users of prescribed analgesics at baseline were analysed separately. Self-reported information on their parents’ birth country was used to classify them into one of the three predefined groups: Norway, countries with a Muslim majority or others. To study and compare dispensing of prescribed analgesics, data from the youth surveys were linked to the Norwegian Prescription Database (NorPD) 2004–2007. Dispensed analgesics studied were antiinflammatory and antirheumatic products (non-steroid), opioids and other analgesics and antipyretics.ResultsAmong non-users of prescribed analgesics at baseline, 34% of all males with parents born in Norway received prescribed analgesics at least once during 2004–2007, compared to 36% in the group with parents from countries with a Muslim majority. The proportions of females receiving prescribed analgesics were about 44% in both of the two previously mentioned groups. Among users of prescribed analgesics at baseline, the proportion of individuals who were dispensed prescribed analgesics in 2004–2007 was generally higher than for those that were non-users at baseline. Both males and females with parents from countries with a Muslim majority reported more pain compared to those with parents born in Norway. No statistical differences were detected between participants with parents from countries with a Muslim majority compared to those with parents born in Norway in terms of prescribed analgesics dispensed or total amount of analgesics dispensed in 2004–2007. For the dispensing of all analgesics in 2004–2007 the adjusted OR for having parents from countries with a Muslim majority compared to parents born in Norway was 1.02 (0.87–1.21) among non-users of prescribed analgesics at baseline and 0.82 (0.57–1.16) among users.ConclusionsThere were no differences in the dispensing of prescribed analgesics between young people with parents born in countries with a Muslim majority and those with parents born in Norway. Nor did the amount of prescribed analgesics differ between these groups.

scholarly journals Effect of the market withdrawal of dextropropoxyphene on use of other prescribed analgesics

2018 ◽  
Vol 18 (4) ◽  
pp. 667-674 ◽  
Author(s):  
Askild Reset ◽  
Svetlana Skurtveit ◽  
Kari Furu ◽  
Eva Skovlund
Keyword(s):  
Prescription Database ◽  
User Group ◽  
High User ◽  
Individual Level ◽  
Market Withdrawal ◽  
Defined Daily Doses ◽  
Norwegian Prescription Database ◽  
Study Population ◽  
Single User ◽  
Strong Opioids

Abstract Background and aims Dextropropoxyphene (DXP) is a synthetic opioid that was prescribed worldwide for mild to moderate pain. It was withdrawn from the European market in 2009. In this study we aim to investigate the effect of the market withdrawal of dextropropoxyphene in Norway on overall use of opioids and other analgesics at an individual level. Methods Data were collected from the nationwide Norwegian Prescription Database (NorPD). It covers all prescription of drugs from 01 January 2004 from Norwegian pharmacies dispensed to individuals outside institutions. The study period was divided in two 2-year periods from 01 September 2008 to 31 August 2010, and from the market withdrawal of DXP on 01 September 2010 to 31 August 2012. We included every individual that filled at least one prescription of dextropropoxyphene in the first 2-year period in our study population. In this study dextropropoxyphene, codeine and tramadol are defined as “weak opioids”, and all other opioids are termed “strong opioids”. Results Nine thousand one hundred and seventy-one individuals were included in our study population. Four thousand two hundred and ninety filled a prescription of DXP only once and were classified as “single users”, 2,990 were users with prescriptions of up to 200 defined daily doses (DDD) over the first 2-year period, or “sporadic users”, and 1,886 were classified high users with over 200 DDDs over a 2-year period. After the market withdrawal 8,392 continued to be prescribed analgesics or benzodiazepines. In the single user group, the proportion of users of weak opioids decreased from 69.5% to 57.6%, whereas the proportion of users of strong opioids was unchanged. Among the sporadic user group, the proportion of users of weak opioids went from 69.7% to 71.0%, the proportion using tramadol from 39.1% to 43.9%, and the users of strong opioids from 25.8% to 31.3%. In the high user group, there was an increase in the number of users of strong opioids from 37.8% to 51.4%. The amount of strong opioids prescribed in the high user group increased from a mean of 262.5 DDD to a mean of 398.3 DDD in the following 2 years. The amount of tramadol increased in all groups and was 3 times as high in the high user group after market withdrawal of DXP. Conclusions Our study showed that the withdrawal of DXP lead to an increase in prescription of other analgesics. The proportion of users increased in all three groups and so did the prescribed amount of other analgesics. Both the proportion of users of other opioids and the amount prescribed increased considerably. However, 1 in 10 earlier users of DXP stopped using prescribed analgesics altogether in the following 2 years. The increase in use among earlier high users of DXP was most striking. Implications This study documents markedly increased prescriptions of other opioids after withdrawal of dextropropoxyphene due to its high risk of serious complications. However, consequences of the increased use of opioids among earlier high users of DXP such as changes in risk of poisonings, accidental deaths and suicides remain to be investigated.

scholarly journals GPs’ drug treatment for depression by patients’ educational level: registry-based study

BJGP Open ◽  
2021 ◽  
pp. BJGPO-2020-0122
Author(s):  
Anneli Borge Hansen ◽  
Valborg Baste ◽  
Oystein Hetlevik ◽  
Inger Haukenes ◽  
Tone Smith-Sivertsen ◽  
...  
Keyword(s):  
General Practice ◽  
Drug Treatment ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Prescription Database ◽  
Highly Educated ◽  
Cox Proportional Hazard ◽  
Norwegian Prescription Database ◽  
To Receive

BackgroundAntidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment.AimTo investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and to what extent sex and age influence the association.Design & settingA nationwide registry-based cohort study was undertaken in Norway from 2014–2016.MethodThe study comprised all residents of Norway born before 1996 and alive in 2015. Information was obtained on all new depression diagnoses in general practice in 2015 (primary care database) and data on all dispensed depression medication (Norwegian Prescription Database [NorPD]) 12 months after the date of diagnosis. Independent variables were education, sex, and age. Associations with drug treatment were estimated using a Cox proportional hazard model and performed separately for sex.ResultsOut of 49 967 patients with new depression (61.6% women), 15 678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (hazard ratio [HR] = 0.93; 95% confidence interval [CI] = 0.88 to 0.98) than women with low education. No such differences appeared among men. Women aged 20–29 years were more likely to be treated with drugs than those aged 30–59 years, and women aged ≥70 years were more likely to receive drugs (HR = 1.65; 95% CI = 1.54 to 1.77) than those aged 20–29 years. The pattern was similar but less pronounced for men.ConclusionEducational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be explored.

scholarly journals End-of-Life Discussions, Goal Attainment, and Distress at the End of Life: Predictors and Outcomes of Receipt of Care Consistent With Preferences

2010 ◽  
Vol 28 (7) ◽  
pp. 1203-1208 ◽  
Author(s):  
Jennifer W. Mack ◽  
Jane C. Weeks ◽  
Alexi A. Wright ◽  
Susan D. Block ◽  
Holly G. Prigerson
Keyword(s):  
End Of Life ◽  
Odds Ratio ◽  
Terminal Illness ◽  
Goal Attainment ◽  
Terminally Ill ◽  
Full Sample ◽  
Patients With Cancer ◽  
Physical Distress ◽  
Eol Care ◽  
To Receive

Purpose Physicians have an ethical obligation to honor patients' values for care, including at the end of life (EOL). We sought to evaluate factors that help patients to receive care consistent with their preferences. Methods This was a longitudinal multi-institutional cohort study. We measured baseline preferences for life-extending versus symptom-directed care and actual EOL care received in 325 patients with advanced cancer. We also measured associated sociodemographic, health, and communication characteristics, including EOL discussions between patients and physicians. Results Preferences were assessed a median of 125 days before death. Overall, 68% of patients (220 of 325 patients) received EOL care consistent with baseline preferences. The proportion was slightly higher among patients who recognized they were terminally ill (74%, 90 of 121 patients; P = .05). Patients who recognized their terminal illness were more likely to prefer symptom-directed care (83%, 100 of 121 patients; v 66%, 127 of 191 patients; P = .003). However, some patients who were aware they were terminally ill wished to receive life-extending care (17%, 21 of 121 patients). Patients who reported having discussed their wishes for EOL care with a physician (39%, 125 of 322 patients) were more likely to receive care that was consistent with their preferences, both in the full sample (odds ratio [OR] = 2.26; P < .0001) and among patients who were aware they were terminally ill (OR = 3.94; P = .0005). Among patients who received no life-extending measures, physical distress was lower (mean score, 3.1 v 4.1; P = .03) among patients for whom such care was consistent with preferences. Conclusion Patients with cancer are more likely to receive EOL care that is consistent with their preferences when they have had the opportunity to discuss their wishes for EOL care with a physician.

scholarly journals Self-reported data on medicine use in the Norwegian Mother and Child cohort study compared to data from the Norwegian Prescription Database

2014 ◽  
Vol 24 (1-2) ◽  
Author(s):  
Svetlana Skurtveit ◽  
Randi Selmer ◽  
Ingvild Odsbu ◽  
Marte Handal
Keyword(s):  
Cohort Study ◽  
Drug Use ◽  
Pregnant Women ◽  
Time Windows ◽  
Prescription Database ◽  
Prescription Data ◽  
Reference Standard ◽  
Mother And Child ◽  
Norwegian Prescription Database ◽  
Reported Data

<p><em>Aims:</em> To study information on prescribed drug use (opioids, antidepressants and benzodiazepines (BZD)) recorded in the Norwegian Prescription Database (NorPD) and to compare this information with selfreported drug use among pregnant women in the Norwegian Mother and Child Cohort Study (MoBa).</p><p><em>Materials and methods:</em> The study population consisted of 28 479 women who participated in MoBa and who answered all questionnaires in pregnancy and whose pregnancy started after 1 March 2004. Data on dispensed drugs in NorPD were extracted for three different time windows: a) the pregnancy period, b) 30 days prior to pregnancy in addition to pregnancy, c) 60 days prior to pregnancy in addition to pregnancy. Data on self- reported drug use in MoBa were used as the reference standard in the validity analysis. Sensitivity and specificity were calculated.</p><p><em>Results:</em> Sensitivity of drug use as recorded in NorPD for the pregnancy period was highest for antidepressants (66.9%) and BZD-antiepileptics (100%) and lowest for BZD-anxiolytics (44.8%) and BZDhypnotics (27.8%). Expansion of the time windows for dispensed drugs in the NorPD to include intervals 30 and 60 days before pregnancy led to higher sensitivity, but lower specificity of all classes of drugs. For opioids, sensitivity increased from 48.8% to 53.6%, while specificity decreased from 98.7 to 97.6%. For antidepressants and BZD-anxiolytics, specificity decreased for both from 99.7 to 99.4%.</p><p><em>Conclusion:</em> Using self-reported data as reference standard, the prescription data provides valid information on current exposures to BZD-antiepileptics and antidepressants in pregnant women if time windows are selected with adequate consideration depending on the investigated problem. However, validity is lower for other benzodiazepines and opioids.</p>

scholarly journals General practitioners’ drug treatment for depression by patients’ educational level: registry-based study

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.0122
Author(s):  
Anneli Borge Hansen ◽  
Valborg Baste ◽  
Oystein Hetlevik ◽  
Inger Haukenes ◽  
Tone Smith-Sivertsen ◽  
...  
Keyword(s):  
General Practice ◽  
Drug Treatment ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Prescription Database ◽  
Highly Educated ◽  
Cox Proportional Hazard ◽  
Gender And Age ◽  
Norwegian Prescription Database ◽  
To Receive

Background: Antidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment. Aim: To investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and how gender and age influence the association. Design and setting: Nationwide registry-based cohort study, Norway, 2014-2016. Method: The study comprised all residents of Norway born before 1996 and alive in 2015. We obtained information on all new depression diagnoses in general practice in 2015 (Primary Care Database) and data on all dispensed depression medication (Norwegian Prescription Database) 12-months after the date of diagnosis. Independent variables were education, gender, and age. Associations with drug treatment were estimated using a Cox proportional hazard model, for genders separately. Results: Out of 49,967 patients with new depression (61.6% women), 15,678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (Hazard Ratio (HR) =0.93, 95% CI (0.88 – 0.98)) than women with low education. No such differences appeared among men. Women aged 20-29 were more likely to be treated with drugs than those aged 30-59, and women aged 70+ were more likely to receive drugs (HR=1.65, (1.54 – 1.77)) than those aged 20-29. The pattern was similar but less pronounced for men. Conclusion: Educational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be

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