Drugs in palliative care: results from a representative survey in Germany

Abstract

The development of palliative medicine in inpatient units in Germany has been impressive in the last years. As a first step of quality assurance, a core documentation form was developed in 1996. In 2001, 55 of the 83 palliative inpatient units in Germany and one unit each in Switzerland and Austria participated in the third phase of the evaluation of the core documentation. A total of 1304 patients were documented consecutively in the 57 units for a period of up to three months. This study investigates the frequency of drugs used in palliative care units in Germany. During inpatient treatment, the most common drug classes were strong opioids (68% of the patients), nonopioids (59%), corticosteroids (32%), laxatives (31%), antiemetics (27%), gastric protection agents (24%), neuroleptics (19%), sedatives/anxiolytics (18%), antidepressants (16%) and diuretics (15%). These ten drug classes made up for 72% of all prescriptions in the palliative care units. The substances used most frequently were dipyrone (47% of the patients), morphine (42%), fentanyl (28%), dexamethasone (27%), metoclopramide (21%), sodium picosulfate (15%), haloperidol (13%), pantoprazole (11%), macrogol (11%), amtriptyline (11%), furosemide (10%), omeprazole (9%), lactulose (8%), rofecoxib (8%) and lorazepam (7%). The 15 most commonly used drugs accounted for 54% of the prescriptions in the palliative care units in Germany. Drug treatment was related to sex, age and functional status of the patients. Patients who died in a palliative care unit had received significantly more frequent doses of neuroleptics (P < 0.001), corticosteroids (P < 0.001), sedatives/anxiolytics (P < 0.001) and strong opioids (P < 0.001). This study is the first representative and systematic evaluation of drug treatment in palliative care units in a European country. Many of the 'top 15' drugs were drugs included in the list of essential drugs of the World Health Organisation though availability and cultural differences have an effect on the use of drugs, e.g., the high usage of dipyrone in Germany. Age and sex-related differences in drug therapy were seen, and more research is needed to recognize possible undertreatment of symptoms in subgroups of patients, e.g., treatment of depression in older or male patients.

Non-cancer patients in specialized palliative care in Germany: What are the problems?

“…10,11 HOPE was used in several epidemiological surveys in Germany. 10,[12][13][14][15] Further evaluation of the psychometric properties is currently being performed.…”

Palliative Care Consultation Service and Palliative Care Unit: Why Do We Need Both?

“…As in our institution, this is mainly achieved by mere symptomatic treatment [18]. In general, patients admitted to PCUs are in refractory stages of their disease; thus, antineoplastic agents are seldom administered and cardiopulmonary resuscitation is no longer indicated [7,12].…”

“…HOPE is a nationwide, multisectoral, and multiprofessional core documentation system that provides standardized online documentation of patient-related data as a tool for quality assurance, benchmarking, and scientific evaluation [14,15]. Therefore, it has been implemented in many PC studies in Germany concerning epidemiology [16], symptom control [17], drug use [18,19], PC interventions [20], and the comparison of different PC populations (e.g., cancer versus noncancer) [21,22].…”

The use of corticosteroids in Swedish palliative care

“…Only one study used a multicentre setup [12]. In summary, the studies show that between one third and a half of all palliative patients being enrolled in palliative care are treated with corticosteroids for symptom control.…”