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Background: Management of cancer pain is one of the most important goals of palliative care. Relieving pain is often problematic. High doses of morphine at home may be required to relieve patients' pain, and is therefore feared. The goals of the current study were to assess the feasibility of high-dose morphine use at home, to characterize the patients, and to examine whether the use of high-dose morphine might affect their survival., Methods: The authors retrospectively studied the medical charts of 661 outpatients, which were completed by a home-care hospice team. The authors collected data regarding demographic parameters, medical diagnosis, pain type, morphine dosage, use of rescue doses in addition to regular doses, use of coanalgesics and adjuvant treatments, and survival time as associated with morphine dosage. The authors also compared the data of patients receiving high-dose morphine with those of a group of patients receiving regular doses., Results: The authors identified 435 patients (65.8%) who received morphine for pain relief. Of these, 396 patients (91%) received a dose of 5-299 mg of morphine per day), 32 patients (7.4%) received 300-599 mg of morphine per day), and 7 patients (1.6%) received very high doses (> or = 600 mg of morphine per day). Overall, 39 patients (9%) received > 299 mg per day. Morphine dosage was found to be inversely correlated (r) with age (r = -0.254; P < 0.001). Male patients required slightly higher dosages than female patients (62.5% of high-dose and 71% of very high-morphine groups, respectively). Primary gastrointestinal (P = 0.015) and lung (P = 0.027) carcinomas, as well as metastatic bone disease (P = 0.001), ovarian carcinoma (P = 0.037), and brain tumors (P = 0.0053) were associated with higher and very higher morphine dosages. Adverse effects were similar in the groups receiving regular, high, and very high doses of morphine. The median survival of patients treated with high doses of morphine was 27 days and was 37 days for those treated with very high doses. Patients treated with low doses of morphine survived for 18 days. Patients not treated with morphine survived for 22 days (P = 0.001 by Mantel-Cox analysis; P = 0.029 by Breslow analysis)., Conclusions: The use of high and very high morphine doses at home proved safe and did not appear to affect the patients' life expectancy adversely. The use of high or very high-dose morphine should not be a barrier to providing palliative terminal care for home-care hospice patients., (Copyright 2004 American Cancer Society.)

Background: Pain control is one of the most important goals of end-of-life care, and the use of opioids for this purpose is extremely common in hospice settings. However, it is unknown how many of the patients require high dose morphine (HDM, >299 mg/day of oral morphine equivalent), what the characteristics of these patients are, and whether the use of HDM might affect their survival., Methods: The authors retrospectively studied the medical records of all 651 inpatients hospitalized at their center between January 1996 and December 1997. Information was collected regarding demographic parameters, medical diagnosis, pain mechanism, morphine dosage, use of rescue doses in addition to regular doses, use of coanalgesics and adjuvant treatments, and survival time in the hospice setting as associated with morphine dosage., Results: The authors identified 453 patients (69.58%) who received morphine for pain relief, of whom 55 (12.14%) needed more than 299 mg/day. Morphine dosage was negatively associated with age (r = -0.35, P = 0.01). Male patients and nonwhite patients required slightly higher dosages than others. Primary breast and genitourinary cancers, as well as metastases to bone and spinal diseases, were associated with higher morphine dosages. Statistical analysis indicated a positive correlation between the log maximum of morphine dosage and the total number of rescue dosages (r = 0.307, P = 0.025). The median survival of patients on HDM was 15.6 days and did not differ from the survival of patients taking a lower dosage., Conclusions: A fairly strong correlation exists between morphine dosage and some clinicodemographic data. No significant dose-limiting adverse effects were observed, suggesting a high clinical safety profile. High morphine dosage does not affect patient survival. Awareness of the dosage factors will improve our ability to treat and predict probable HDM dosage, thus shortening the period until pain relief is reached., (Copyright 1999 American Cancer Society.)