Background: In England more than 70% of people prefer to die at home. 29% of all deaths have an underlying cause of cancer during 2004-2013. Pelvic cancer (Gynaecological, urological and colorectal) accounts for 18.6% of all cancer deaths. This group of patients have overlapping speciality care needs and similar complications which could lead to multiple hospital admissions and hence many die in hospital. Many people do not receive care which meets their individual needs including where they prefer to die.
A65901/01/2009 and 31/01/2013 were identified in The Health Improvement Network (THIN) database. Patients were excluded if they had history of; chronic kidney disease stage 4/5, cancer, neuropathic pain, sciatica/radiculopathy, diabetes, back pain or a prior prescription for a study drug. Patients were classified as responders if they were either "cured" (discontinued treatment) or stable (remained on treatment), or a non-responder if they were referred to a pain clinic or switched to a CYP2D6independent analgesic. Multivariate logistic regression was used to identify the predictors of response and estimate the influence of CYP2D6-inhibitors. Results: The cohort consisted of 43,632 patients: 90.8% were responders, and CYP2D6-inhibiting drugs were prescribed to 33.8% of the cohort. Almost three times as many patients failed to respond in those prescribed a CYP2D6-inhibitor (16% vs. 6%). Controlling for medication, demographics and co-morbidities the logistic regression indicated the odds of responding for those with a CYP2D6-inhibiting co-prescription were 39% lower than those without a co-prescription for a CYP2D6 inhibiting drug (OR= 0.61, 95% CI 0.57 to 0.66). ConClusions: Chronic non-malignant pain patients with a co-prescription for a CYP2D6-inhibiting medication were significantly less likely to respond to analgesia treatment and therefore received suboptimal pain management.
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