This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Nauck, F. Search for Related Content PubMed PubMed Citation Articles by Nauck, F. Social Bookmarking                         What's this?

Drugs in palliative care: results from a representative survey in Germany

Christoph Ostgathe

Eberhard Klaschik

Department of Anaesthesiology and Palliative Medicine, Malteser Hospital, University Bonn, Bonn

Claudia Bausewein

Interdisciplinary Department of Palliative Care, University of Munich, Munich

Martin Fuchs

Palliative Care Unit, Department of Internal Medicine, St. Elisabeth Hospital, Neuwied

Gabriele Lindena

Clinical Analysis, Research and Application, Kleinmachnow

Karl Neuwöhner

Palliative Care Unit, Dr Hancken Hospital, Stade

Dieter Schulenberg

German Cancer Society

Lukas Radbruch

Department of Palliative Medicine, University of Aachen, Aachen

Working Group on the Core Documentation for Palliative Care Units in Germany

The development of palliative medicine in inpatient units in Germany has been impressive in the last years. As a first step of quality assurance, a core documentation form was developed in 1996. In 2001, 55 of the 83 palliative inpatient units in Germany and one unit each in Switzerland and Austria participated in the third phase of the evaluation of the core documentation. A total of 1304 patients were documented consecutively in the 57 units for a period of up to three months. This study investigates the frequency of drugs used in palliative care units in Germany. During inpatient treatment, the most common drug classes were strong opioids (68% of the patients), nonopioids (59%), corticosteroids (32%), laxatives (31%), antiemetics (27%), gastric protection agents (24%), neuroleptics (19%), sedatives/anxiolytics (18%), antidepressants (16%) and diuretics (15%). These ten drug classes made up for 72% of all prescriptions in the palliative care units. The substances used most frequently were dipyrone (47% of the patients), morphine (42%), fentanyl (28%), dexamethasone (27%), metoclopramide (21%), sodium picosulfate (15%), haloperidol (13%), pantoprazole (11%), macrogol (11%), amtriptyline (11%), furosemide (10%), omeprazole (9%), lactulose (8%), rofecoxib (8%) and lorazepam (7%). The 15 most commonly used drugs accounted for 54% of the prescriptions in the palliative care units in Germany. Drug treatment was related to sex, age and functional status of the patients. Patients who died in a palliative care unit had received significantly more frequent doses of neuroleptics (PB ^/ 0.001), corticosteroids (PB ^/ 0.001), sedatives/anxiolytics (PB ^/ 0.001) and strong opioids (PB ^/ 0.001). This study is the first representative and systematic evaluation of drug treatment in palliative care units in a European country. Many of the ’top 15‘ drugs were drugs included in the list of essential drugs of the World Health Organisation though availability and cultural differences have an effect on the use of drugs, e.g., the high usage of dipyrone in Germany. Age and sex-related differences in drug therapy were seen, and more research is needed to recognize possible undertreatment of symptoms in subgroups of patients, e.g., treatment of depression in older or male patients.

Key Words: drugs • nonopioids • opioids • palliative care units • survey • symptom management

Palliative Medicine, Vol. 18, No. 2, 100-107 (2004)
DOI: 10.1191/0269216304pm852oa


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S Lundstrom, C. Furst, M Friedrichsen, and P Strang The existential impact of starting corticosteroid treatment as symptom control in advanced metastatic cancer Palliative Medicine, March 1, 2009; 23(2): 165 - 170. [Abstract] [PDF]

				I. E. Haines and R. M. Stanley Perspective on "Chemotherapy for Advanced Prostate Cancer: 25 Years Later": Is It a Mirage or an Oasis? J. Clin. Oncol., August 20, 2008; 26(24): 4049 - 4050. [Full Text] [PDF]