Opioid Use in Older Adults with Cancer Pain Admitted to an Acute Palliative Care Unit: Does Age Matter? A Secondary Analysis.

BACKGROUND

Cancer pain in older adults presents unique management challenges because of age-related pharmacokinetic and pharmacodynamic changes. Data on age-stratified opioid prescribing within acute palliative care units remain scarce.

OBJECTIVE

We aimed to evaluate the influence of age on opioid dosing, drug selection, and breakthrough pain management in patients with advanced cancer admitted to an acute palliative care unit.

METHODS

We conducted a secondary analysis of a prospective observational study conducted over 5 months. Patients were stratified into three cohorts: adults (A, aged <65 years), young-old (O, aged 65-75 years), and old-old (OO, aged >75 years). Opioid doses, expressed as oral morphine equivalents (mg/24 h), drug choice, and route of administration were recorded at admission, at each opioid prescription change, and at discharge. Kruskal-Wallis tests with pairwise post hoc comparisons using Holm correction and Friedman tests were used for between- and within-group analyses, respectively.

RESULTS

One-hundred and thirteen patients were analyzed (A: n = 46, O: n = 43, OO: n = 24). No significant differences in oral morphine equivalents were observed at admission (p = 0.177). Significant between-group differences emerged from the first opioid prescription (p = 0.007), persisted at the second prescription (p = 0.026), and were most pronounced at discharge (p < 0.001). Pairwise post hoc comparisons consistently showed higher oral morphine equivalent doses in adults than in both geriatric age groups, whereas no significant differences were observed between the young-old and oldest-old groups. Methadone was used predominantly in adults. At the first breakthrough pain prescription, adults also received significantly higher rescue oral morphine equivalent doses than the two older groups (p < 0.05). Pain intensity significantly improved from admission to discharge in all three age groups, with no significant between-group differences observed either at admission or at discharge.

CONCLUSIONS

Age was associated with clinically significant differences in opioid prescribing within the acute palliative care unit. Compared with patients aged ≥65 years, adults aged <65 years received higher opioid doses and more complex opioid regimens, whereas prescribing patterns were similar in the two geriatric age groups. Despite age-related differences in opioid prescribing, comparable pain control was achieved across all age groups (see Table 1 and Results), supporting individualized age-tailored opioid titration in specialist palliative care.