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High-Dose Morphine Safe for Hospice Patients

Posted on: 09/20/2004

High-Dose Morphine Safe for Hospice Patients

Mon 20 September, 2004 20:07
By Megan Rauscher

NEW YORK (Reuters Health) - The use of high or very high doses of morphine is safe for hospice patients being cared for at home, and does not reduce life expectancy, according to a report in the journal Cancer.

The findings show that "doctors should not be afraid to use large doses of morphine when needed, even when in the home," Dr. Michaela Bercovitch from Tel Aviv University commented to Reuters Health.

Bercovitch and a colleague, Dr. Abraham Adunsky, reviewed the records of 661 consecutive patients treated by a home-care hospice team. Roughly two thirds were treated with morphine for pain relief.

The great majority of these patients (91 percent) received low to moderate doses of morphine, while 7.4 percent received high doses of morphine and 1.6 percent received very high doses of morphine.

These figures, coupled with prior studies, "raise concern" over the relatively low number of inpatients and outpatients who receive high doses of this pain-relieving drug and "may reflect the reluctance of physicians, patients, and families to use high doses of morphine," the authors write.

The morphine dosage was higher among younger men with cancer and among those with gastrointestinal and lung cancers, as well as patients with advanced bone, ovarian, and brain cancer.

Of note, the average survival was longer in patients treated with high-dose and very high-dose morphine (27 days and 37 days, respectively) than in those treated with low-dose morphine or no morphine (18 days and 22 days, respectively).

"These high doses most likely did not change their life span," the authors point out, and "they may have provided for the patients the opportunity for better pain control and most likely a fairly good quality of life in their own environment."

Bercovitch said she hopes the findings stimulate "professional interest in this specific field, which is frequently considered to be too complex and too tedious by many medical and paramedical professionals."

SOURCE: Cancer, September 15, 2004.

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