The aim of this study was to evaluate the influence of age and gender on pain characteristics and opioid response in advanced cancer patients followed at home. A perspective study was carried out in a sample of 181 consecutive advanced cancer patients who required opioids in the last 4 weeks before death. Pain intensity and symptoms associated with opioid therapy at weekly intervals for 4 weeks were recorded, as were the previous oncological treatments. Opioid doses increased over time, but remained stable in the last 2 weeks of life, while pain intensity decreased over time despite unchanged use of NSAIDs. A considerable increase in symptom intensity was observed in the last weeks of life, except for nausea and vomiting. Visceral pain was more often reported in women. Male patients more often presented somatic pain mechanisms. Neuropathic pain was associated with higher mean VAS intensity and was equally reported in male and female patients and in the different age groups. Very old patients, who received less chemotherapy, required less opioid doses and reported a lower intensity of some symptoms, while reporting similar pain relief. Dry mouth was more frequent in adults than in very old patients. The identification of specific factors and pain characteristics may be useful in suggesting the likelihood of response in terms of analgesia and opioid-related adverse effects. Age and gender analysis should be included in all cancer pain and symptom control studies, as they may have an influence on cancer pain prognosis.

The role of nonsteroidal anti-inflammatory drugs (NSAIDs) is well established in the treatment of cancer pain. This class of drugs is considered particularly effective in pain due to somatic mechanisms, although proof of this observation is lacking. To ascertain whether NSAIDs are more effective in specific nociceptive forms of cancer pain, they were administered alone or added to opioids in 32 patients with a sole pain mechanism, somatic pain due to bone metastases (17 patients) or visceral pain (15 patients), respectively. Pain intensity, mean doses of opioids used, and symptoms were recorded after starting NSAID. A significant reduction in pain intensity was found at 3, 7, and 14 days. No differences in pain intensity between the two groups were observed. However, patients with a visceral mechanism required higher opioid doses after a week of treatment. No differences in adverse effects were reported. NSAIDs may be useful drugs in the management of cancer pain, regardless of the mechanism of pain involved. The incidence of adverse effects during prolonged administration should be assessed in future studies.

The aim of this study was to evaluate the influence of the primary cancer on pain characteristics and opioid response, in terms of analgesia and adverse effects, in advanced cancer patients followed at home. A prospective study was carried out in a sample of 434 consecutive advanced cancer patients who required opioids during the last four weeks of life. One hundred eighty-one patients received opioids for longer than the four weeks and were considered for this analysis. Demographic data, primary diagnosis, and pain mechanisms were recorded, and mean opioid doses, pain intensity, and symptoms were assessed at weekly intervals during the last four weeks of life. In the group of 181 patients, somatic pain was associated with lung, head and neck, breast, and prostate cancer (p < 0.0005), while visceral pain was associated with colorectal, gastric, liver, pancreatic, and uterine cancer (p < 0.0005). Considering all primary diagnoses, there was a significant increase in the mean opioid dose (p < 0.0005) across the four weekly periods. There was a significant decrease in pain intensity scores (p < 0.0005) in all cases. A significant dose increase was observed only for mesothelioma (p = 0. 027) when compared with other types of cancer. In all 181 cases, a significant worsening in symptom intensity was observed during the last two weeks of life (p < 0.01). This study shows that primary cancer may have an influence on pain characteristics and opioid response. Patients with some kinds of cancer may be at risk of developing severe pain syndromes or more adverse effects.

There continues to be controversy concerning the optimal use of the epidural route in cancer pain. Although spinal opioids undoubtedly give long-lasting analgesia with low doses, indiscriminate use cannot be recommended. Inappropriate indications for the epidural route are reported in three patients who required home palliative care. In contrast to epidural treatment, which caused severe clinical problems, simpler measures, including oral and subcutaneous opioids, were able to give adequate analgesia and a better quality of life. Education of nursing staff and family is necessary when using opioid epidural analgesia at home. Wide dissemination of World Health Organization (WHO) guidelines among doctors and health-care workers can avoid the use of unnecessary and complicated techniques and improve the treatment of terminally ill patients suffering from cancer pain.