Abstract
BackgroundCancer-related pain is a complicated symptom that often coincides with fatigue, depression, and anxiety. Although many safe treatments are available, inadequate control of Cancer-related pain continues to lead to suffering in cancer patients. This study’s aim is to describe pain control, and the pattern of change in opioid and adjuvant medication prescriptions, before and after referral to the Palliative Care Center.MethodsWe conducted a prospective cohort study in adult cancer patients the Palliative Care Center between January 1, 2016 and December 30, 2017. We measured pain intensity and other associated symptoms via the Revised Edmonton Symptom Assessment System (ESAS-r) and documented detailed analgesics and adjuvant medication history before starting any palliative care and on days 0, 3, 6, and 14.ResultsThe analysis included 240 patients whose cancer-related pain, anxiety, and depression scores meaningfully improved by day 6. The changes in the median (interquartile ranges) of Cancer-related pain, anxiety, and depression scores from day 0 to day 6 were: 6 (4–8) to 3 (1–4); 6 (4–9) to 2 (1–4); and 3 (2–6) to 2 (1–4), respectively, with p < 0.001 for all. Morphine was the most common opioid administered; the percentage using it increased from 20.4% (n = 49) before referral to 49.6% (n = 119) on day 6 (p < 0.001). The median morphine equivalent daily dose decreased from a median (interquartile ranges) of 60(31–93) mg/day before referral to 34(22–66) mg/day on day 6 (p < 0.001). There was also a statistically significant increase in the percentage of patients taking adjuvant medications, from 38.8% before referral to 84.2% on day 6 (p < 0.001). Comparing D0 to D6, the number of patients using Gabapentinoids significantly increased from 57(23.75%) to 79(32.9%) (p < 0.001), amitriptyline dramatically increased from 14 (5.8%) to 44 (18.3%) (p < 0.001), and other antidepressant drugs increased from 15 (6.2%) to 34 (14.1%) (p < 0.001).ConclusionAfter referral to the Palliative Care Center, patients’ pain and other symptoms scores decreased significantly, even with lower median morphine equivalent daily doses, arguably through more appropriately directed opioid use. This is evidence for the effectiveness of the comprehensive program at the Palliative Care Center in Kuwait.
Highlights
Cancer-related pain is a complicated symptom that often coincides with fatigue, depression, and anxiety
Guidelines published by various organizations, such as the World Health Organization [5, 6], the European Association for Palliative Care [7], the European Society of Medical Oncology [8], and, recently, the American Society of Clinical Oncology [9], have emphasized the importance of the appropriate assessment and management of Cancer-related pain (CRP), including through the use of opioids [5,6,7,8,9,10,11]
Several relatively safe treatment modalities are available, many cancer patients are still suffering from inadequate CRP control [12]
Summary
Cancer-related pain is a complicated symptom that often coincides with fatigue, depression, and anxiety. Many safe treatments are available, inadequate control of Cancer-related pain continues to lead to suffering in cancer patients. In a systematic review of 52 studies, the prevalence of CRP was 59% in patients undergoing anticancer therapy, and 64% in those with advanced or metastatic disease [1, 2]. Several relatively safe treatment modalities are available, many cancer patients are still suffering from inadequate CRP control [12]. A systematic review that included 26 studies reported that the prevalence of CRP undertreatment had reached 82% [13]. In a more recent review of 20 studies published in 2014, the prevalence of undertreatment had decreased to 31.8%, but remained relatively high [14]
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