Seniors undertreated for cancer pain

Older Cancer Patients Often Undertreated for Severe Pain

Even when suffering severe pain, one-third of older cancer patients were not taking the strongest painkillers (opiods such as morphine, oxycodone or fentanyl) that could have helped ease that pain, according to a recent large Canadian study.

The most likely reasons were that physicians were not prescribing the medicines, or that the older patients were afraid of side effects, the researchers wrote in the Journal of Clinical Oncology (April 1 2012).

“Cancer pain is common, and its undertreatment is well described,” wrote the study authors, citing multiple previous studies including a worldwide 2008 literature review showing that half of patients with cancer have pain were undertreated, even though studies also show that the vast majority of cancer patients could achieve pain relief with simple drug therapy.

In an effort to improve cancer pain management, the cancer authority in Ontario, Canada began regularly asking all cancer patients seen in clinics or home visits about their pain symptoms. The researchers also monitored how many prescriptions those cancer patients filled for opiod medications both before and right after the visit. The two-year study covered 24,000 cancer patients over age 65 being seen for all types of cancer in any stage of treatment—from cure to palliation.

Fully 20 percent of the 24,000 cancer patients studied between 2007 to 2009 reported having severe pain. But one-third of those who reported severe pain did not fill an opiod prescription, either the month before or week after the pain screening. Women were 14 percent less likely than men to fill a prescription. Significantly, people over age 85 were 30 percent less likely than  those aged 64 to 74 to fill their prescribed pain medication.

Neither cost nor access to care were likely reasons, because government health insurance pays fully for all of the patients’ medications and doctor visits.

First-author Lisa Barbera told Reuters Health News that one explanation could be physicians’ knowledge about pain management and/or willingness to spend more time on pain management. But also, she added, older patients especially could be concerned about the pain medication causing drowsiness, confusion and/or an increased chance of falling.

But cancer patients “don’t have to be in pain,” Dr. Paul Glare of Memorial Sloan Kettering Cancer Center’s Pain and Palliative Care Service told Reuters Health News. “There’s effective treatment out there.”

Older patients will need closer monitoring, Glare added. But he advised that patients should not be afraid of taking their pain medication, and, if they feel the doctor is not addressing their pain, they should ask to see a pain specialist.

PATIENT TAKE-AWAY

Colon cancer is most common in those over age 65. Yet one in five Canadian elders with cancer said they were in severe pain–and fully one-third of those patients were not using the most effective medications (morphine, oxycodone or fentanyl), even in a nation that provides full coverage for doctor visits and prescriptions. 

Being in severe pain interferes with appetite, ability to sleep or exercise or interact with family and friends–all of which are vital while living with cancer.

Anyone suffering serious cancer pain can–and should–get relief. Call the Fight Colorectal Cancer’s Answer Line (toll-free 1-877-427-2111) for more information.

Sources: Barbera et al, Journal of Clinical Oncology, April 1 2012, and Reuters Health , March 9 2012.