Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology

Abstract

Most patients with advanced cancer develop diverse symptoms that can limit the efficacy of pain treatment and undermine their quality of life. The present study surveys symptom prevalence, etiology and severity in 593 cancer patients treated by a pain service. Non-opioid analgesics, opioids and adjuvants were administered following the WHO-guidelines for cancer pain relief. Other symptoms were systematically treated by appropriate adjuvant drugs. Pain and symptom severity was measured daily by patient self-assessment; the physicians of the pain service assessed symptom etiology and the severity of confusion, coma and gastrointestinal obstruction at each visit. The patients were treated for an average period of 51 days. Efficacy of pain treatment was good in 70%, satisfactory in 16% and inadequate in 14% of patients. The initial treatment caused a significant reduction in the average number of symptoms from four to three. Prevalence and severity of anorexia, impaired activity, confusion, mood changes, insomnia, constipation, dyspepsia, dyspnoea, coughing, dysphagia and urinary symptoms were significantly reduced, those of sedation, other neuropsychiatric symptoms and dry mouth were significantly increased and those of coma, vertigo, diarrhea, nausea, vomiting, intestinal obstruction, erythema, pruritus and sweating remained unchanged. The most frequent symptoms were impaired activity (74% of days), mood changes (22%), constipation (23%), nausea (23%) and dry mouth (20%). The highest severity scores were associated with impaired activity, sedation, coma, intestinal obstruction, dysphagia and urinary symptoms. Of all 23 symptoms, only constipation, erythema and dry mouth were assessed as being most frequently caused by the analgesic regimen. In conclusion, the high prevalence and severity of many symptoms in far advanced cancer can be reduced, if pain treatment is combined with systematic symptom control. Nevertheless, general, neuropsychiatric and gastrointestinal symptoms are experienced during a major part of treatment time and pain relief was inadequate in 14% of patients. Cancer pain management has to be embedded in a frame of palliative care, taking all the possibilities of symptom management into consideration.

Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

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“…Despite this recent increase in treatment options, a significant proportion of patients will eventually develop symptoms of bone progression during the course of the disease [6]. In fact, overall, bone metastases and their skeletal-related events are not controlled in approximately 20-40% of cancer patients [7][8][9], and the current therapeutic regimens leave B45% of patients with inadequate or undermanaged pain control [10,11].…”

Intravenous Flurbiprofen Axetil Enhances Analgesic Effect of Opioids in Patients with Refractory Cancer Pain by Increasing Plasma β-Endorphin

“…The EORTC QLQ-C30 questionnaire is a tool used to measure quality of life and consists of 30 items rated on a 1 to 4 scale (two questions are rated between 1 and 7) (Meuser et al, 2001). This instrument has been translated in many countries and adapted for use transculturally.…”

AAV for pain: steps towards clinical translation

“…Studies report rates of failure to control pain in cancer patients of 12-66%. [5][6][7][8] The lower analgesic failure rates (12-14%) apply to 'all comers'; the higher analgesic failure rates apply to patients with advanced solid tumors referred to pain specialists. Public interest in this health issue is considerable.…”

“…Recent studies in cancer pain patients report failure rates of 12-66% for medical pain therapy. [5][6][7][8] To elucidate causes of pain treatment failure, Weiss et al 8 studied the attitude of patients with severe pain (including cancer-and noncancer pain states) towards their prescribed opioid doses. Of 514 patients treated for pain, 73% experienced moderate to severe pain.…”