Abstract
Goals of work
We wanted to examine whether older cancer patients living at home experienced poorer pain management than younger patients, and if so, what were the potential explanations for this.
Materials and methods
We interviewed 90 new referrals to community palliative care services who were aged 75 years and above or aged 60 years and below. We asked about pain intensity, pain relief and pain quality, access to and type of analgesic medication and, finally, sources of support and self-management strategies.
Main results
Older and younger cancer patients who were living at home had very similar experiences of pain, pain relief, access to and use of analgesia, contact with health care professionals and use of additional pain management strategies. As a whole, participants had more frequent contact with family members, community nurses and pharmacists than with general practitioners.
Conclusions
In this sample, the experience and management of pain in older cancer patients was no different from that in younger patients. This suggests that delivering improvements in cancer pain management in the community is appropriate for all age groups. In addition, focussing efforts on patients, carers and non-medical health care professionals may prove to be the most successful strategy.
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References
Allen RS, Haley WE, Small BJ, McMillan SC (2002) Pain reports by older hospice cancer patients and family caregivers: the role of cognitive functioning. Gerontologist 42(4):507–514
Bennett MI, Smith BH, Torrance N, Potter J (2005) The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinic and postal research. J Pain 6(3):149–158 doi:10.1016/j.jpain.2004.11.007
Bernabei R, Gambassi G, Lapane K, Landi F, Gatsonis C, Lipsitz L et al (1998) Management of pain in elderly patients with cancer. JAMA 279(23):1877–1882 doi:10.1001/jama.279.23.1877
Cleary JF, Carbone PP (1997) Palliative medicine in the elderly. Cancer 80(7):1335–1347 doi:10.1002/(SICI)1097-0142(19971001)80:7<1335::AID-CNCR21>3.0.CO;2-7
Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA et al (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330:592–596 doi:10.1056/NEJM199403033300902
Cleeland CS, Ryan KM (1994) Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 23:129–137
Collins SL, Moore RA, McQuay HJ (1997) The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 72(1–2):95–97 doi:10.1016/S0304-3959(97)00005-5
Delgado-Guay MO, Bruera E (2008) Management of pain in the older person with cancer. Oncology (Williston Park) 22(1):56–61
Gagliese L, Weizblit N, Ellis W, Chan VWS (2005) The measurement of post-operative pain: a comparison of intensity scales in younger and older surgical patients. Pain 117:412–420 doi:10.1016/j.pain.2005.07.004
Grundy E, Mayer D, Young H, Sloggett A (2004) Living arrangements and place of death of older people with cancer in England and Wales: a record linkage study. Br J Cancer 91:907–912
Hall S, Gallagher RM, Gracely E, Knowlton C, Weschules D (2003) The terminal cancer patient: effects of age, gender and primary tumour site on opioid dose. Pain Med 4(2):125–134 doi:10.1046/j.1526-4637.2003.03020.x
Klepstad P, Loge JH, Borchgrevink PC, Mendoza TR, Cleeland CS, Kaasa S (2002) The Norwegian Brief Pain Inventory Questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manage 24(5):517–525 doi:10.1016/S0885-3924(02)00526-2
Landi F, Onder G, Cesari M, Gambassi G, Steel K, Russo A et al (2001) Pain management in frail, community-living elderly patients. Arch Intern Med 161(22):2721–2724 doi:10.1001/archinte.161.22.2721
Lin CC, Ward SE (1995) Patient related barriers to cancer pain management in Taiwan. Cancer Nurs 18:16–22 doi:10.1097/00002820-199502000-00003
Loick G, Radbruch L, Sabatowski R, Siessegger M, Grond S, Lehmann KA (2000) Morphine dose and side effects: a comparison of older and younger patients with tumor pain. Dtsch Med Wochenschr 125(41):1216–1221 doi:10.1055/s-2000-7726
Mercadante S, Arcuri E (2007) Pharmacological management of cancer pain in the elderly. Drugs Aging 24(9):761–776 doi:10.2165/00002512-200724090-00004
Mercadante S, Ferrera P, Villari P, Casuccio A (2006) Opioid escalation in patients with cancer pain: the effect of age. J Pain Symptom Manage 32(5):413–419 doi:10.1016/j.jpainsymman.2006.05.015
Mercadante S, Roila F, Berretto O, Labianca R, Casilini S (2008) Prevalence and treatment of cancer pain in Italian oncological wards centres: a cross-sectional survey. Support Care Cancer 16(11):1203–1211
Russell PB, Aveyard SC, Oxenham DR (2006) An assessment of methods used to evaluate the adequacy of cancer pain management. J Pain Symptom Manage 32:581–588 doi:10.1016/j.jpainsymman.2006.05.024
The EuroQol group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208 doi:10.1016/0168-8510(90)90421-9
Thomason TE, McCune JS, Bernard SA, Winer EP, Tremont S, Lindley CM (1998) Cancer pain survey: patient-centered issues in control. J Pain Symptom Manage 15(5):275–284 doi:10.1016/S0885-3924(98)00016-5
Till LT, Voris JC, Horst JB (2003) Assessment of clinical pharmacist management of lipid-lowering therapy in a primary care setting. J Manag Care Pharm 9(3):269–273
Viganó A, Bruera E, Suarez-Almazor ME (1998) Age, pain intensity and opioid dose in patients with advanced cancer. Cancer 83(6):1244–1250 doi:10.1002/(SICI)1097-0142(19980915)83:6<1244::AID-CNCR26>3.0.CO;2-4
Wells N, Hepworth JT, Murphy BA, Wujcik D, Johnson R (2003) Improving cancer pain management through patient and family education. J Pain Symptom Manage 25:344–356 doi:10.1016/S0885-3924(02)00685-1
Yates PM, Edwards HE, Nash RE, Walsh AM, Fentiman BJ, Skerman HM et al (2002) Barriers to effective cancer pain management: a survey of hospitalised cancer patients in Australia. J Pain Symptom Manage 23(5):393–405 doi:10.1016/S0885-3924(02)00387-1
Yeager KA, Miaskowski C, Dibble S, Wallhagan M (1997) Differences in pain knowledge in cancer patients with and without pain. Cancer Pract 5(1):39–45
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370 doi:10.1111/j.1600-0447.1983.tb09716.x
Acknowledgements
This study was supported by a research grant from the Big Lottery Fund (RG/1/010136487). We are very grateful to the community nursing team members of St. Gemma’s Hospice and Sue Ryder Care Wheatfields for their help in the recruitment.
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Bennett, M.I., Closs, S.J. & Chatwin, J. Cancer pain management at home (I): do older patients experience less effective management than younger patients?. Support Care Cancer 17, 787–792 (2009). https://doi.org/10.1007/s00520-008-0549-3
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DOI: https://doi.org/10.1007/s00520-008-0549-3