Background and Objective Anecdotal experience of palliative medicine physicians suggests that adolescent and young adult patients with cancer require higher doses of end-of-life medications, in comparison with older adults with cancer. This has been difficult to quantify given the paucity of specialist AYAH hospices. This information could aid in resource management for staff and medications.

This pilot study aimed to quantify the doses of end-of-life medications given over the last 48 hours of life in patients with cancer at the Adolescent and Young Adult Hospice (AYAH) in Manly, NSW and adults with cancer in the nearby located adult palliative care unit (PCU) at Mona Vale Hospital.

Methods A retrospective analysis of eMR (electronic medical records) medication charts was performed. Inclusion criteria were all patients who had died from cancer at AYAH since opening in February 2023. An equal number of the most recent patients to die at PCU from cancer were included.

Exclusion criteria were no diagnosis of cancer, died in the community, inpatient for under 48 hours. This identified 7 AYAH patients and 7 PCU patients.

Demographics including age, sex, diagnosis, renal function and liver function (LFT) were recorded. The total doses of the following medications were calculated and compared:

• Opioids (converted to morphine equivalents using MDCalc opioid conversion)

• Benzodiazepines (which were converted into oral midazolam equivalents using ClinCalc)

• Levomepromazine

• Phenobarbitone

• Dexamethasone

• Gabapentinoids (converted using a ratio of gabapentin:pregabalin 6:1)

• Lidocaine

• Ketamine

Average doses over the last 48 hours of life were calculated and compared.

Results The average age of the AYAH patients was 25.2 years and PCU patients was 78.2 years. Four out of seven patients at AYAH had sarcoma, compared to a range of cancer types in the PCU patients.

Each unit had 2/7 patients with moderately deranged LFTs, and 2/7 with mildly deranged LFTs. A single patient at PCU had moderately deranged renal function.

There were significantly higher average doses of opioids in the AYAH population (2.5x higher), as compared to the PCU population. Data pertaining to average benzodiazepine doses showed they were 1.96x higher in AYAH patients.

The average doses of levomepromazine were 8x higher in AYAH patients compared to PCU. 5/7 AYAH patients required levomepromazine compared to 2/7 PCU patients.

2/7 patients at AYAH required phenobarbitone averaging 2100mg in 48 hours. 0/7 patients at PCU required phenobarbitone. A single patient at AYAH required systemic lidocaine infusion, none at PCU. No patients at either site received ketamine.

Discussion This pilot study suggests that the adolescent and young adult cancer patient population require significantly higher doses of all the end-of-life drugs reviewed. This is likely due to high symptom prevalence as reported in previous studies, as well as better renal and liver function than PCU patients.

This data may impact on medication budgets, and time allocation for staffing. Further investigation is ongoing, including data collection on PRN use which significantly impacts nursing time.