Relating Prescribing to Use of Unscheduled Care for Pain-Related Presentations in Patients with Cancer in their Last 12 Months of Life.

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The problem

: Incidence and prevalence of cancer are increasing in the UK, and unscheduled care provision over-stretched. This research aims to examine painkiller use in people with cancer in the last 12 months of life, and associations between patterns of painkiller use and an individual’s use of unscheduled care (GP out-of-hours [OOH] and Accident and Emergency).


Results anticipated in the latter half of 2015. The study objectives are, for patients with cancer in Tayside, in their last year of life :RO1: To establish what proportion attend GP OOH and A&E and what proportion of attendances are due to uncontrolled pain.RO2: To examine what proportion are prescribed analgesics, adjuvant pain modifying drugs, and drugs for predictable complications of analgesics, evaluated against the WHO pain ladder.RO3: To explore whether any of the prescribing practices listed above are associated with patients’ use of unscheduled care.

The approach

: Retrospective cohort study of NHS Tayside residents who died from cancer in 2012. Data for 2012 will obtained from the Health Informatics Centre (HIC), Dundee for NHS Tayside and from GP Out-Of-Hours. Data linkage will be conducted through a unique person identifier (Community Health Index (CHI) number) to other datasets including basic demographic information, prescribing data, A&E attendance and GRO deaths.· RO1–Descriptive analysis of use of GP OOH and A&E attendance in the last 12 months of life for people who have died of cancer, including the recorded reason for attendance.· RO2–Descriptive analysis of prescribed analgesics in the last 12 months of life for patients with cancer for the following drugs:o Paracetamol including combination products.o Non-Steroidal Anti-Inflammatory Drugso Weak opiateso Strong opiateso Adjuvant medications (gabapentin etc.).o Breakthrough analgesiao Medication to manage known side-effects of long-term opiate use (e.g. laxatives and anti-emetics).Analysis will explore whether patterns of treatment are consistent with the escalation recommended in the WHO analgesic ladder, co-prescriptions to manage side effects and whether those prescribed strong opioids are also prescribed breakthrough medication.· RO3-Patients will be characterized in terms of their prescribed analgesia and associations with unscheduled care use explored using cross-tabulation and regression where appropriate, including whether regular analgesic prescribing changes after unscheduled care consultation with uncontrolled pain.


This will improve understanding of why patients with cancer use unscheduled care services. It will allow us to examine what forms of analgesia they have been prescribed, and examine prescribing practices to see if there is an association between prescribing practices and presentation to unscheduled care services. This research will provide an observational analysis of the use of unscheduled care in patients with an established cancer diagnosis who are in their last year of life.


  • Sarah Mills, NHS Tayside Department of Palliative Care, Dundee, UK
  • Blair Smith, NHS Tayside Department of Palliative Care, Dundee, UK
  • Bruce Guthrie, NHS Tayside Department of Palliative Care, Dundee, UK
  • Nicola Torrence, NHS Tayside Department of Palliative Care, Dundee, UK
  • Deans Buchanan