The Norwegian Medical Association should continue to oppose assisted dying. / Legeforeningen bør fortsatt si nei til dødshjelp.

The Norwegian Medical Association has long taken a clear stance against the legalisation of assisted dying. Recently, the British Medical Association moved to a neutral stance. Is it now time for the Norwegian Medical Association to change its course?

Opioids for outpatients with cancer in their last year of life: A nationwide pharmacoepidemiological study.

OBJECTIVE: Opioids are the main pharmacological treatment for moderate-to-severe cancer pain. Few longitudinal studies have examined the prescription prevalence (PP) of opioids to patients with cancer. The aims of the study were to examine 1) changes in the PP of opioids from 2005 to 2009 among outpatients with cancer who were in their last year of life and 2) associations between the PP of opioids and medical and sociodemographic factors. DESIGN: Retrospective, registry-based, national study. PATIENTS: This study used data on all patients with cancer who died 2005-2009, combining the following three complete nationwide registries; prescription data from the Norwegian Prescription Database, data on cancer diseases from the Cancer Registry of Norway, and sociodemographic data from Statistics Norway. RESULTS: The study population consisted of 44,579 adults (mean age 72 years at death, 54 percent males). The opioid PP increased from 74 to 82 percent during the study period. Oxycodone had the highest PP, and increased from 39.8 to 48.5 percent during the period, whereas the PP of morphine declined from 29.0 to 27.3 percent. The PP for fentanyl remained stable at 17 percent. The PP of opioids increased toward death with higher PP during the last 3 months of life compared to previous 3-month periods. Older patients (>60) were less likely to receive opioids, while prostate or pancreatic cancer increased the odds for opioid prescriptions (p < 0.001, Odds ratio [OR] 2.60 and OR 1.98, respectively). CONCLUSION: The PP increased yearly during the study period. Use of oxycodone increased while that of morphine decreased.

Antidepressants to cancer patients during the last year of life--a population-based study.

OBJECTIVE: Although depression is common among incurable cancer patients, the prescription prevalence of antidepressants (ADs) to these patients is largely unknown. Aims were to examine the prescription prevalence of ADs in the last year of life in a 2-year national cancer death cohort and to examine its associations with sociodemographic and medical variables. METHODS: Nationwide, 20,627 cancer deaths in adults were identified by combining the Norwegian Central Population and Cancer Registries. Individual prescriptions of ADs in the 12 months prior to death were identified in the Norwegian Prescription Database. The study population consisted of 17,753 patients who died from cancer in 2005 and 2006, after excluding patients assumed to be hospitalized whose prescriptions were not registered in the Norwegian Prescription Database. RESULTS: Twenty-two percent (N = 3836) had at least one prescription of ADs in their last year of life (men 19%/women 25%), compared with 6% in the general population (men 4%/women 8%). Patients who died within 1 year from diagnosis had lower prescription prevalence (20%) than patients with longer disease duration (23%) (p < 0.001). Prescription prevalence increased toward death for both genders, but the prevalence of first-time prescriptions in the last 6 months of life was similar across genders. About 10% of ADs were prescribed for the first time 30 days or less before death. CONCLUSION: The prescription prevalence among cancer patients in the last year of life was almost four times higher than in the general population. One of 10 patients was prescribed with ADs so close to death that the clinical effects can be questioned.