[Analgesics and supportive care in the last month of life : Retrospective analysis of outpatient prescriptions using BARMER data from patients with oncological diseases (2016-2021)].

Background

In Germany, various forms of outpatient palliative care (PC) for oncological patients have been established for years. However, no data is available on how prescription rates of analgesics and supportive care vary depending on the specific form of outpatient PC.

Methods

This retrospective cohort study analyzed data from 158,035 deceased statutory health insurance patients with advanced cancer between 2016 and 2021. Three groups were analyzed: patients without outpatient PC, with general outpatient PC or particularly qualified and coordinated PC (AAPV/BQKPmV), and with specialized outpatient PC (SAPV). The study focused on the prescription rates of various medication groups according to ATC codes (nonopioid and opioid analgesics, antineuropathic medication, antiemetics, systemic steroids, stool-regulating measures) and their combinations in the last month of life.

Results

SAPV patients showed the highest prescription rates, e.g., strong opioids (71.8%), followed by AAPV/BQKPmV (47.2%) and patients without PC (22.5%). The prescription rates for all supportive medications showed similar patterns. An inverse pattern was observed for weak opioids: SAPV (5.8%), AAPV/BQKPmV (8.9%), and no PC (9.1%). The guideline-adherent combination of strong opioid analgesics and laxatives was implemented in less than half of the cases in SAPV (44.2%) and even less frequently in AAPV/BQKPmV (32.4%).

Conclusion

This study provides comprehensive insights into medication prescription practices in outpatient PC in the last month of life, for the first time. The high prescription rates in SAPV reflects more intensive medication treatment of patients with possibly more complex symptoms in this specialized form of PC.