Abstract
The population of older patients is growing with a rising prevalence of cancer diagnoses and cancer-related pain syndromes. Older patients are also vulnerable to misleading pain evaluations and under treatment with opioids. Barriers to the effective and safe management of analgesics include pain assessments and the complex management of the best analgesic choice and dose-titration while achieving the fewest side effects. In this review, we will provide an overview of the challenges present in assessment and treatment choices, along with practical tips for routine clinical practice.
Highlights
Cancer risk increases with age, and a rapidly growing older population will increase the demand for cancer care
Geriatric oncology has become an independent speciality that deals with a population that is quite different from the patients included in most published clinical trials
There is a lack of randomised clinical trials studying cancer-related pain management, which have been performed exclusively in older adults [4]
Summary
Cancer risk increases with age, and a rapidly growing older population will increase the demand for cancer care. Denosumab has been demonstrated to prevent the progression of pain severity and pain interference in HrQOL in the integrated analysis of patient-reported outcomes and analgesic use from three randomised trials of denosumab and zoledronic acid [61] These agents are not considered the best option, as they are associated with an increased risk of confusion and alterations in the mental status of older patients. Ҽҽ For non-communicating patients, an empiric analgesic trial should be initiated where there are pathologic conditions or procedures that are likely to cause pain or if pain behaviours continue after attention has been paid to basic needs and comfort measures ҽҽ Take into account the frequent presence of poly-pathology, which sometimes makes it difficult to understand the underlying problems causing the painful complaints, often requiring a targeted approach towards the identification of several potential aetiologies. Ҽҽ Consider that pain is a medical emergency since it is often accompanied by rapid functional decline and a reduction in quality of life. ҽҽ Integrate pain screening and management systematically into the comprehensive geriatric assessment. ҽҽ For non-communicating patients, an empiric analgesic trial should be initiated where there are pathologic conditions or procedures that are likely to cause pain or if pain behaviours continue after attention has been paid to basic needs and comfort measures ҽҽ Take into account the frequent presence of poly-pathology, which sometimes makes it difficult to understand the underlying problems causing the painful complaints, often requiring a targeted approach towards the identification of several potential aetiologies. ҽҽ Account for geriatric characteristics, with respect to age-related pharmacokinetics and pharmacodynamics. ҽҽ Screen for potentially inappropriate prescriptions (under-, mis- and over-prescription) in general, and for pain medication (e.g., avoid tricyclics, suppress concomitant opioid prescriptions of the second and third step, do not forget the case of prescribing drugs for neuropathic pain and recognise side effects, etc.)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
