Pain control at the end of life: a comparative study of hospitalized cancer and noncancer patients

Abstract

Pain is a common symptom in dying patients. Previous studies have paid little attention to pain and pain control in terminally ill patients with diseases other than cancer. This study investigated whether there were differences in healthcare workers' documentation of pain characteristics in cancer and noncancer patients. We investigated what types of analgesics were administrated to dying patients, and if there were differences in the administration routes of opiates in cancer patients compared to noncancer patients in the last 3 days of life. Data were collected retrospectively in a cross-sectional comparative study at a hospital. The sample included 220 deceased patients (110 died of cancer and 110 died of other causes). Data were extracted from patients' medical records using the Resident Assessment Instrument of Palliative Care. Healthcare workers consistently documented more pain in cancer patients during their last 3 days of life than in noncancer patients. The odds for having severe to excruciating pain was four times higher in cancer patients compared to noncancer patients. Morphine was the most frequently administrated analgesic for all dying patients; however, the odds ratio of cancer patients compared to noncancer patients receiving morphine plus scopolamine was 0.27. The odds of a cancer patient receiving analgesics classified as fentanyl, ketobemidone and oxycodone was more than 4-5 times higher than for noncancer patients. Opiates were more frequently administered transdermally or by oral administration on an as-need basis in cancer patients; 10% in both groups did not receive adequate pain control. Pain is a highly prevalent symptom among dying hospitalized patients. Healthcare workers consistently documented more pain in cancer patients and also assessed that the intensity of pain was more severe in these patients than in noncancer patients. The dying patients' intensity of pain was poorly documented.