Study of Morphine Administration Frequency in Patients with Terminal Cancer in Greek Public Hospitals

Background: Morphine is regarded as a first choice drug in the treatment of mild and intensive acute cancer pain. The total (in mg) consumption per capita per year of morphine constitutes a quality index in the management of acute cancer pain. Accumulated solid data have confirmed the effectiveness and the safety of morphine in cancer patients. Nevertheless there is also evidence that morphine is underused worldwide, which results in ineffective pain treatment in an unjustified great percentage of cancer patients. The main reasons for this phenomenon called oliganalgesia in cancer pain have its roots in a number of myths surrounding morphine. Aim: This audit was designed to investigate the frequency of morphine administration in patients with acute cancer pain admitted or hospitalized in clinics of the Greek National Health System. Method: Questionnaires about the frequency of morphine administration in cancer pain patients and the availability of pain treatment protocols were sent to the departments of oncology, internal and emergency medicine and to hospital pharmacies of the 96 Greek National Health System Hospitals as well. Results: The response rate was 100%. Morphine, the first choice analgesic in acute cancer pain, is ordered and administered in only 2 % of the Hospitals of the Greek National Health System. The main reasons to withhold the administration of morphine in cancer patients were related to mythological fears about this opiod: the vast majority of the doctors reported reluctance to morphine administration founded in fear of lethal complications, legal implications, drug addiction and lack of experience. None of the Greek hospitals has a pain treatment protocol, and not a single hospital pharmacy was in position to offer morphine in form of tablets. Conclusion: There is a major issue regarding the management of cancer pain in the daily practice of Greek Hospitals, requiring well grounded efforts from the state, but also from the hospitals, in order not only to simplify the access to morphine, but also to incorporate this opiod as a first choice drug for the treatment of acute cancer pain.