Prevalence and factors associated with high-risk opioid prescribing among cancer patients receiving palliative care at a community hospital
Keywords:
opioid, pain management, cancer, hospice care, palliative, community hospitalAbstract
Introduction: As the demand for palliative and oncological care continues to increase, opioids remain a cornerstone of symptoms and pain management in patients with advanced cancer. However, evidence on opioid prescribing patterns in these care settings, particularly within community hospitals, remains limited, and systematic evaluation is needed to support safe and effective clinical practice.
Objective: This study aimed to evaluate opioid prescribing patterns and the prevalence of high-risk opioid prescribing among patients with cancer receiving palliative care at Sanpatong Hospital.
Methods: This retrospective study reviewed electronic medical records of palliative cancer patients aged ≥ 20 years who received opioids during the final six months of life without concurrent anticancer treatment between 2018 and 2023. Patients were identified using ICD-10 codes Z51.5 (palliative care) and Z71.4 (other specified counseling) at Sanpatong Hospital. High-risk opioid prescribing was defined by opioid prescribing patterns calculated as morphine milligram equivalents (MME) and concomitant medication use, including opioid–benzodiazepine co-prescription, high-dose opioid therapy (≥ 90 MME/day for ≥ 7 days), or specific initial prescribing characteristics.
Results: Among 44 patients, 36 patients (81.8%) met high-risk criteria, with prolonged initial opioid prescribing observed in 35 patients (97.2%) and initial prescribing of long-acting opioid formulations in 30 patients (83.3%). Median daily MME was significantly higher in the high-risk group than in the low-risk group (20 vs. 4 mg/day, p = 0.004). No significant associations were found between high-risk of opioid-related problems and palliative performance status, adjuvant analgesic use, or tetrahydrocannabinol co-prescription.
Conclusion: High-risk opioid prescribing was commonly observed among hospice palliative care patients in a community hospital. These findings demonstrate the need for balanced opioid prescribing practices and enhanced monitoring in community-based palliative care to mitigate potential opioid-related harm.
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