Five palliative home care teams participated in a prospective Swedish study that included 221 palliative cancer patients. All patients with incurable malignant disease that were admitted and died during 1999 were included. On admission, demographic data were recorded. When patients, despite ongoing home care, were referred to institutional care, doctors and nurses involved were interviewed about the reasons for this. After the patients' death next of kin involved in the care were interviewed according to a questionnaire. Approximately half of the patients died at home. The reasons for referral showed a wide diversity and included both social and psychosocial factors, medical emergencies and problems related to symptom control. A preference for dying at home and not living alone were shown to be the strongest predictors of home death (p = 0.001). However, 35% of patients living alone died at home. Interestingly enough, Karnofsky performance index (KPI) at admission was significantly lower for those dying at home, despite similar mean time of care. The understanding of impending death was significantly more common among the families of those patients dying at home.

despite converting to low-dose methadone, initial frequency of dosing was not excessive.Other studies have supported the finding that the morphine to methadone ratio is significantly positively correlated to the previous MEDD and have reported median ratios for specific morphine dosage bands. 2,5 However, when comparing the results of these studies, there are marked differences in these median ratios and in the quoted ranges. The very wide range of ratios in our study highlights the difficulty in predicting methadone conversion ratios and suggests that, until more consistent data are available, the ad libitum approach is the most appropriate conversion method for our patient population. It is important to be aware of the correlation with previous MEDD and using a maximum single methadone dose of 30 mg allows for the fact that those switching from higher dose opioids require relatively lower doses of methadone.There are no trials comparing different methods of switching from other opioids to methadone and comparison of data is difficult due to differing populations. It is clear that further research is needed to establish the safety and efficacy of the various conversion methods in current use. References1 Tse DMW, Sham MMK, Ng DKH, Ma HM. An ad libitum schedule for conversion of morphine to methadone in advanced cancer patients: an open uncontrolled prospective study in a Chinese population. Palliat Med 2003; 17: 206 ¡/11. 2 Morley JS, Makin MK. The use of methadone in cancer pain poorly responsive to other opioids. Pain Rev 1998; 5: 51 ¡/58. 3 Lawlor PG, Turner KS, Hanson J, Bruera ED. Dose ratio between morphine and methadone in patients with cancer pain: a retrospective study.