Assessment of pain control in cancer patients during the last week of life: comparison of health centre wards and a hospice

Hinkka, Heikki; Kosunen, Elise; Kellokumpu‐Lehtinen, Pirkko; Lammi, Ulla-Kaija

doi:10.1007/s005200100245

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…12,13 More than 80% of patients with advanced cancer will receive opioids during the course of their disease, frequently in high doses. 14 It is not possible to effectively manage cancer-related pain without using these potentially addictive medications. Identifying patients at risk for chemical coping could lead to increased awareness about the potential risks involved in opioid prescribing, and ultimately more effective pain management by including counseling and preventing opioid dose escalation in patients at increased risk.…”

Section: Introductionmentioning

confidence: 99%

Alcoholism Screening in Patients with Advanced Cancer: Impact on Symptom Burden and Opioid Use

Parsons

Delgado-Guay

Osta

et al. 2008

Journal of Palliative Medicine

100

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Purpose: Alcoholism is a devastating disease that can cause patient and family suffering and is frequently underdiagnosed. Preliminary studies suggest that it is associated with increased symptom expression and opioid dose escalation. The CAGE questionnaire is a widely used tool for alcoholism screening. The purpose of this study was to determine the frequency and characteristics of patients who screen positive for alcoholism in a palliative care outpatient clinic (PCOC). Methods: We reviewed 665 consecutive charts of patients referred to the PCOC and collected data regarding age, gender, and type of cancer. For the first 100 consecutive CAGE positive (CAGEϩ) and 100 consecutive CAGE negative (CAGEϪ) patients, time from advanced cancer diagnosis (AC) to PCOC was calculated, and symptoms (Edmonton Symptom Assessment Scale, ESAS) and Morphine Equivalent Daily Dose (MEDD) were collected. Results: CAGE was available for 598 of 665 (90%) patients. Of 598 patients, 100 (17%) were CAGEϩ. CAGEϩ patients were younger (58 versus 60 years, p Ͻ 0.05), predominantly male (68% versus 47%, p Ͻ 0.0001), and with head/neck malignancies (24% versus 9%, p Ͻ 0.05). CAGEϩ patients were referred earlier (5 Ϯ 19 versus 13 Ϯ 27 months after AC, p Ͻ 0.0001). At baseline, pain, sleep, dyspnea, well-being, and total symptom distress were significantly worse among CAGEϩ patients. Both groups showed similar improvement in symptoms. CAGEϩ patients were more frequently on opioids upon referral (47/100 versus 29/100, p Ͻ 0.05) and followup (27/65 versus 16/68, p Ͻ 0.05). At follow-up, opioid doses did not show significant changes. Conclusion: Seventeen percent of the patients were CAGEϩ. These patients were referred earlier to palliative care, had more symptom expression, and were more frequently on opioids. The palliative care team successfully improved symptom control in both groups without opioid dose escalation.

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Section: Introductionmentioning

confidence: 99%

Alcoholism Screening in Patients with Advanced Cancer: Impact on Symptom Burden and Opioid Use

Parsons

Delgado-Guay

Osta

et al. 2008

Journal of Palliative Medicine

100

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“…Evidence about whether opioid prescribing in hospices is higher than in other settings is conflicting (Brooks et al. 1995; Hinkka et al . 2001; Bortolussi et al .…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, although those receiving specialist palliative care input often have their opioid dose changed while under their care (Brooks et al 1995), those who have their opioid doses increased at the end of life do not have a shorter survival than those who do not (Thorns & Sykes 2000). Evidence about whether opioid prescribing in hospices is higher than in other settings is conflicting (Brooks et al 1995;Hinkka et al 2001;Bortolussi et al 2004;Panico & Manfredi 2004). These differences may be due to variation in where (Finland, Italy, the USA and the UK) and when these studies were undertaken.…”

Section: Introductionmentioning

confidence: 99%

Opioid use in dying patients in hospice and hospital, with and without specialist palliative care team involvement

Brown

2007

Eur J Cancer Care

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Newspapers claim that patients in hospices have their opioid doses increased to a point at which doctors know that they will die. However, research has produced conflicting results about whether hospice patients receive higher doses of opioids. This study investigated the differences in opioid prescribing between cancer patients dying in hospice and hospital with and without hospital palliative care team (HPCT) involvement and non-cancer patients dying in hospital, in Dundee, UK. The only statistically significant difference in the mean dose of opioids was that the cancer patients were prescribed and received higher doses of opioids than non-cancer patients. There was no statistically significant difference in the mean dose of opioids prescribed to and given to the different groups of cancer patients dying in different settings, indicating that the claims of the press are untrue. The cancer patients dying in hospital who were not on the HPCT records more commonly received Tramadol, which may indicate a reluctance of hospital doctors to move from weak opioids to strong opioids.

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“…Although several studies have been published on the impact of hospice and end-of-life care on clinical outcomes [15][16][17], the effect of admission to hospice on pain control has not produced uniformly positive results. Our retrospective chart-review study aimed to assess the relationship between inpatient palliative care and pain intensity in a population of cognitively competent cancer patients admitted to a hospice.…”

Section: Introductionmentioning

confidence: 99%

Impact of admission to hospice on pain intensity and type of pain therapies administered

Petracci

Nanni

Maltoni

et al. 2015

Support Care Cancer

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Mean ± SD pain NRS values of the entire group were 2.58 ± 2.61 on day 1 and 1.40 ± 1.72 on day 7 (P = 0.002). Restricting the analysis to patients with moderate to severe pain at the time of hospice admission, results were even more significant. In fact, mean ± SD pain NRS was 5.51 ± 1.24 for patients with pain ≥4 at admission and 1.76 ± 1.91 for the same patients after 7 days (P < 0.001). A significant increase in the number of patients receiving morphine was observed from day 1 to day 7 (24 to 41, respectively, P = 0.001) and in those receiving drugs via parenteral routes (subcutaneous or intravenous) from 10 to 27 (P = 0.002) CONCLUSIONS: Admission to a hospice and the hospice environment led to a significant reduction in reported pain intensity for the patients included in this study, mainly those with moderate to severe pain at the time of admission. This decrease in pain was accompanied by a significant increase in the use of morphine, especially via parenteral routes, but not by a higher mean equivalent daily dose of oral morphine per patient.

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Assessment of pain control in cancer patients during the last week of life: comparison of health centre wards and a hospice

Cited by 10 publications

References 24 publications

Alcoholism Screening in Patients with Advanced Cancer: Impact on Symptom Burden and Opioid Use

Alcoholism Screening in Patients with Advanced Cancer: Impact on Symptom Burden and Opioid Use

Opioid use in dying patients in hospice and hospital, with and without specialist palliative care team involvement

Impact of admission to hospice on pain intensity and type of pain therapies administered

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