[Opioid prescriptions in bone metastatic cancer patients: A cross sectional nationwide pharmacoepidemiological study]

Oncological situations represent the majority of palliative situations. Labeling the palliative stage often comes too late in oncology. Pain comes first among discomfort symptoms with the greatest impact on quality of life. We wondered whether the evolutionary stage of the cancer was linked with the prescriptions of opioid analgesics. We observed the prescriptions of strong opioids in patients suffering from metastatic bone cancer 3 months before and after identifying the situation as palliative. This is a cross-sectional observational study performed between January 1, 2012 and December 31, 2016 using data from the French (nationwide claims database). We included 38,399 patients with cancer with at least one metastatic bone location in a palliative situation. Seventeen percent (n=6544) of patients had a prescription of opioid analgesics after palliative care labeling, 19.8 % (n=7606) had a prescription before, 31.1 % (n=11 949) had a prescription before and after and 32.0 % had no prescription of opioid analgesics. An increase in the dosage of opioid analgesics is observed between before and after labeling the stage of the disease as palliative with an average dosage ranging from 99.6 to 142.3mg per day. This study shows that labeling a situation as palliative affects prescriptions of strong opioid analgesics. An early identification of the situation as palliative is essential to provide appropriate care.