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Palliative cancer care (Indicator 20)

Published

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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.


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Results

Average morphine consumption per death from cancer increased from 62 to 73 grams of morphine during the period from 2011 to 2015. The figure is based on total annual sales of strong opioid analgesics and on the number of deaths from cancer per year.

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Figure 1Average 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 accompanying Figure 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.

 

2011

2012

2013

2014

2015

Medicine (ATC code), stated in grams

 

 

 

 

 

Morphine (N02AA01)

158,372

150,796

150,352

146,913

137,448

Hydromorphone (N02AA03)

493

861

1480

2,087

1547

Oxycodone (N02AA05)

201363

228,601

252,159

263,513

278,639

Oxycodone and Naloxone (Oxycodone only) (N02AA55)

13,498

20,790

27,006

31168

34,479

Ketobemidone (N02AB01)

15,430

15,039

14,329

13,460

13,065

Pethidine (N02AB02)

23,961

23,807

24,233

23,469

22,113

Fentanyl (N02AB03)

2,669

2,697

2,806

2,675

2,621

Ketobemidone and Dimethylamino Diphenyl Butene Chloride (N02AG02)

2,296

2,307

2,257

2,476

2,235

Conversion formula for morphine equivalents:

 

 

 

 

 

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

674936.61

717430.02

768851.37

777955.39

785455.98

Cancer death from malignant tumour, from the Cause of Death Registry

10,842

10,809

10,792

10,880

10,762

 

 

 

 

 

 

Morphine per cancer death

62

66

71

72

73

Table 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. 

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 has provided statistics on sales of opioids from the ATC groups N02AA, N02AB and N02AG, stated in grams of opioid, during the period 2011-2016. The data include sales of medicines with marketing licences and unregistered medications. ATC/DDD version 2017 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 provides 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. 

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 Non-communicable Diseases at the Norwegian Institute of Public Health.