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Does a regional comprehensive palliative care program improve pain in outpatient cancer patients?

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Abstract

Context

Pain is still a major problem for cancer patients, and the effect of a population-based approach on patients’ experience of pain is not fully understood.

Aims

The primary aim of this study was to clarify the changes in pain intensity in outpatients before and after a regional palliative care program. The secondary aim was to clarify the prevalence of patients who had unmet needs for pain treatment and to clarify the reasons for not wanting pain treatment.

Subjects and methods

A regional palliative care program was implemented in four regions of Japan. A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings took part in questionnaire surveys before and after the regional intervention. Responses were obtained from 859 from 1,880 and 857 from 2,123 in the preintervention and postintervention surveys, respectively.

Results

After a regional palliative care program, neither worst, average, nor least pain levels in outpatients changed significantly. A total of 134 patients (16 %) reported that they needed more pain treatment. There were various reasons for not wanting pain treatment, namely, minimum interference with daily life, general nonpreference for medicines, longstanding symptoms before the diagnosis of cancer, concerns about tolerance and addiction, and experienced neuropsychiatric symptoms under current medications.

Conclusion

The regional palliative care program failed to demonstrate improvement of the pain intensity of cancer outpatients. One possible interpretation is that they are less likely to be regarded as target populations and that the study population experienced generally well-controlled pain. Future study including patients with more severe pain is needed, but to improve pain levels of cancer outpatients, intensive, patient-directed intervention seems to be more promising than region-based intervention.

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Conflict of interest

This study was funded by the Third Term Comprehensive Control Research for Cancer Health and Labor Sciences Research Grants in Japan. The authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Tatsuya Morita

  2. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Kazuki Sato & Mitsunori Miyashita

  3. Department of Community Health Care, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Akemi Yamagishi

  4. Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Yoshiyuki Kizawa

  5. Department of Palliative Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba City, Ibaraki, 305-8558, Japan

    Yasuo Shima

  6. Department of Palliative Medicine, National Cancer Center Hospital, East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Hiroya Kinoshita

  7. Department of Surgery, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan

    Satoshi Suzuki

  8. Shirahige Clinic, 1-13-28 Katafuchi, Nagasaki, 850-0003, Japan

    Yutaka Shirahige

  9. Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Takuhiro Yamaguchi

  10. Division of Internal Medicine and Medical Oncology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

    Kenji Eguchi

Authors
  1. Tatsuya Morita
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  2. Kazuki Sato
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  3. Mitsunori Miyashita
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  4. Akemi Yamagishi
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  5. Yoshiyuki Kizawa
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  6. Yasuo Shima
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  7. Hiroya Kinoshita
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  8. Satoshi Suzuki
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  9. Yutaka Shirahige
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  10. Takuhiro Yamaguchi
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  11. Kenji Eguchi
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Corresponding author

Correspondence to Tatsuya Morita.

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Morita, T., Sato, K., Miyashita, M. et al. Does a regional comprehensive palliative care program improve pain in outpatient cancer patients?. Support Care Cancer 22, 2445–2455 (2014). https://doi.org/10.1007/s00520-014-2232-1

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  • DOI: https://doi.org/10.1007/s00520-014-2232-1

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