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Palliative cancer care (Indicator 20)

Published Updated

The indicator describes the following: Access to palliative care assessed by morphine-equivalent consumption of strong opioid analgesics (in grams of morphine) per death from cancer.

The indicator describes the following: Access to palliative care assessed by morphine-equivalent consumption of strong opioid analgesics (in grams of morphine) per death from cancer.


Results

Average morphine consumption per death from cancer increased from 62 to 86 grams of morphine during the period from 2011 to 2018. The figure is based on total annual sales of strong opioid analgesics and on the number of deaths from cancer per year.

Figure 1
Figure 1: Average consumption of morphine in Norway per death from cancer. Based on total sales of opioids divided by total number of cancer deaths. Source: Wholesaler-based pharmaceutical statistics and Cause of Death Registry, Norwegian Institute of Public Health.  See table below.
Table 1
Table 1: Average consumption of morphine in Norway per death from cancer. Based on total sales of opioids divided by the total number of cancer deaths. Sources: Wholesaler-based pharmaceutical statistics, Norwegian Institute of Public Health, ATC/DDD version: 2019 * data for 2013 to 2016 is updated due to incomplete reporting from one of the wholesalers from 2013 to 2016. The sales numbers are slightly higher than previously reported in this indicator set. Source: Cause of Death Registry, Norwegian Institute of Public Health. Click on table to enlarge.

Data sources

The data source for this indicator is the Norwegian Prescription Database

A description and definitions follow below.

Data source: Norwegian Prescription Database

Description 

Wholesaler-based medicines data at the Norwegian Institute of Public Health have provided statistics on sales of opioids from the ATC groups N02AA, N02AB and N02AG, stated in grams of opioid, during the period 2011-2018. The data include sales of medicines with marketing licences and unregistered medications. ATC/DDD version 2019 was used.

Effect measure

  • Average consumption of morphine in Norway per cancer death per year. Calculated according to total sales of opioids in grams of morphine in Norway, divided by total number of cancer deaths. 

Conversion formula for morphine equivalents (1 gram morphine):

 (1*morphine)+(83.3*fentanyl)+(5*hydromorphone)+(1.33*oxycodone)+(0.25*pethidine)

Data source: Cause of Death Registry

Description 

The cause of death statistics are compiled on the basis of notices of death completed by public sector doctors. In addition, information is obtained from the Norwegian Cancer Registry, the Medical Birth Registry of Norway, hospital autopsy results and forensic examinations.

The following ICD10 diagnosis codes are included: 

  • Cancer C00-C97

The number of cancer deaths per year are included in the calculation of the effect measure for the indicator.

Interpretation and sources of error

The data only provide a rough estimate since strong opioid analgesics are also used for other types of disease.

Global indicator definition

Indicator 20. Access to palliative care assessed by morphine-equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer. 

History

Authors and contacts

Text compiled by the Department of Nutrition, Prevention and Public Health, Public Health Division, the Norwegian Directorate of Health in collaboration with the Department of Chronic Diseases and Ageing at the Norwegian Institute of Public Health.