Cancer patients often consider opioid treatment a sign of imminent death

Last Updated: 2008-01-02 16:00:06 -0400 (Reuters Health)

NEW YORK (Reuters Health) – Cancer patients often refuse opioid medications out of the belief that the drugs are offered as a "last resort" rather than as legitimate pain killers that can improve their quality of life, British investigators report.

"As a palliative care physician, I encounter patients almost daily who refuse morphine for their pain in spite of being compromised in terms of function and mood," Dr. Colette M. Reid told Reuters Health. "We conducted a qualitative study rather than using standard quantitative questionnaires to ask patients about their views on opioids, because we wanted to know what they actually thought."

Dr. Reid, at Gloucester Royal Hospital, and her associates interviewed 18 patients (ages 55 to 82 years) with uncontrolled pain caused by cancer, who were being offered morphine for the first time.

"’Morphine as a last resort’ is the central theme emerging from the data," the researchers report in the Annals of Oncology, published online on December 11. "When morphine was offered as an option, participants’ anticipation of dying was heightened, which frightened them." Many feared that morphine would hasten their death.

"The interviews showed us that from the moment an opioid was commenced, any deterioration in condition was blamed on the opioid rather than the cancer," Dr. Reid said. "I have been astounded by seeing this even in hospices, where communication about dying is excellent."

Why do these fears persist despite research documenting the safety of opiates and expert guidelines advocating their use based on pain intensity rather than stage of disease?

"Patients don’t have access to medical literature, so they haven’t read the research," Dr. Reid said. "They rely on personal stories and what health professionals tell them, and, unfortunately, I have as many encounters with health professionals who believe that opioids shorten life as I do with patients refusing them."

"I think education for the health professional offering the opioid is actually the best intervention possible" to improve the management of pain caused by cancer, Dr. Reid concluded.

Dr. Marco Maltoni echoes these sentiments in a related editorial, commenting that "a vision of pain management and palliative care that is not solely linked to the end-of-life but rather seen as a positive option, in the less advanced stage of disease as well, needs to be promoted."

Ann Oncol 2007.