Clinicians could be doing a better job of helping cancer patients manage their pain, according to a Science News Daily release published online in September.
The brief referenced a University of Leeds study which sampled more than 6,000 patients from the UK Cancer Registry. The research revealed that 48% of patients were issued opioids such as morphine during their last year of life, with a median interval of nine weeks between prescription and death.
“This pattern of prescribing does not match population data, which points to earlier onset of pain,” Lucy Ziegler, lead study author and senior research fellow in palliative care, said in the release.
“Nine weeks before death is considered late in the course of the cancer trajectory. Although the prevalence of pain is higher in patients with advanced cancer and towards the end of life, for many patients pain is experienced at many stages throughout the illness.”
Specifically, the study found that patients over 60 years old were more likely to be prescribed drugs than younger people, and patients in hospice tended to receive drugs earlier. The study, published in the July issue of the medical journal, Pain, stated that cancer pain treatment may be hindered by the concern of an “opioid epidemic.”
The release said researchers cited NHS data showing overall opioid prescriptions increased by 466% between 2000 and 2010, but increased only 16% in patients with cancer.
“Within the advanced cancer population there is a need to develop mechanisms to improve pain assessment and initiate a more proactive approach to prescribing, particularly for older patients,” Ziegler said in the release. “Effective pain control is fundamental to good quality of life. For patients who are approaching the end of their lives it is crucially important we strive to get this right and that we help them achieve the best quality of life possible.”
The American Society of Addiction Medicine stated that drug addiction is being driven by opioid addiction with “…18,893 overdose deaths related to prescription pain relievers and 10,574 overdose deaths related to heroin in 2014.”
Pain prevalence occurs in 2% to 50% of patients, with roughly 80% of patients with advanced-stage cancer experiencing moderate to severe pain, according to the National Cancer Institute. Among several steps, the NCI recommends “proper characterization of the pain to identify underlying pathophysiology, which could significantly influence treatment options.”
Steps include regular screening to ensure patient’s pain is recognized early; determining whether the pain requires pharmacologic and/or other treatment modalities; identifying optimal treatment options including referrals to specialists; and considering issues such as previous pain treatments, patient prognosis, predictive factors for pain control, impact on function, comorbidities, risk of misuse or addiction and patient preference.
The CDC Guideline for Prescribing Opioids for Chronic Pain – U.S. 2016 stated, “Primary care clinicians report having concerns about opioid pain medication misuse, find managing patients with chronic pain stressful, express concern about patient addiction, and report insufficient training in prescribing opioids.”
In part, it recommends physicians begin with the lowest dosage and discuss side effects with patients including benefits vs. harms and tolerance.
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