(248) - Profile of the pharmacological approach needed in order to achieve the best pain control in a population of advanced cancer patients

Abstract

Pain is still a challenging symptom in advanced cancer patients. The World Health Organisation set up the three-step analgesic ladder in order to better clarify the optimal pharmacological approach in order to achieve a good balance between pain control and adverse related effects. The objective of this study is to analyse the changes observed in the use of the WHO analgesic ladder drugs in relation of pain intensity in a population of advanced cancer patients attended in the out-patient clinic (OPC).The study was carried out on a consecutive sample of advanced cancer patients attended at the OPC. Inclusion criteria: age >18 years, diagnosis of advanced cancer, lack of cognitive impairment (Pfeiffer test ≤ 4), pain with VAS > 3 on first evaluation and agreed to participate. Variables recorded: Categorical variables were summarized as percentages (absolute numbers). The sample was divided according to pain intensity on the first evaluation (VAS < 7 vs ≥7) and the analgesic regime used according to the WHO analgesic ladder (first/second/third step). The third step was further divided in long acting opioid (LAO), short acting opioids (SAO) and rapid onset opioids (ROO).We used the chi-squared test to compare groups. For the significative differences (P < 0,05) the McNemar test was applied. A total of 211 patients were included in the study. Mean of age 64, 0 ± 14 years. Men 87, 2%. Lung cancer 41, 2%; Upper-digestive 15, 6%. 136 patients with an initial VAS ≥ 7 (64,45%). Differences were found in the second step of the WHO on pain control (P = .045). Regarding the third step, the differences were related to the first evaluation: third step (global) P = .002, LAO (P = .028) and ROO (P = .043). Those data suggest that significative differences can be found between the use of the different analgesics the WHO ladder and pain intensity.