• Hao-Ying Lin, Jyh-Gang Hsieh, Chia-Jung Hsieh, and Ying-Wei Wang.
• Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan, Republic of China.
• J Pain Symptom Manage. 2020 Jun 1; 59 (6): 1232-1238.

ContextIt is uncertain whether terminally ill schizophrenic cancer patients are hypoalgesic or have disparities in pain management.ObjectivesThe objective of this study was to analyze the dosage of opioids used in terminally ill cancer patients with and without schizophrenia.MethodsThis is a population-based retrospective cohort study based on data derived from the Taiwan National Health Insurance Research Database. Patients aged >20 years and newly diagnosed between 2000 and 2012 with at least one of the six most common cancers were included. After 1:4 matching, 1001 schizophrenic cancer patients comprised the schizophrenia cohort, while 4004 cancer patients without schizophrenia comprised the nonschizophrenia cohort. The percentage of opioid use, accumulated dose, and average daily dose near the end of life were analyzed for each cohort using multiple logistic and linear regression models.ResultsThe percentage of opioid use was lower in the schizophrenic cohort than the nonschizophrenic cohort during the last month before death (69.6% vs. 84.8%, odds ratio = 0.40, 95% CI = 0.34-0.48). The accumulated dose of opioid consumption was also lower in the schizophrenic cohort (2407 mg vs. 3694 mg, P value < 0.05).ConclusionNear the end of life, cancer patients with schizophrenia use less opioid than their nonschizophrenic counterparts. Cognitive impairment may be a cause in the disparity in end-of-life care for terminally ill schizophrenic cancer patients. Thus, we should formulate a more accurate pain scale system and pay attention to their need for pain treatment.Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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