BETTER PAIN CONTROL NEEDED IN CANCER [Новость добавлена - 30.09.2007]

Author: Dr Franco de Conno, Honorary Director of the European Association for Palliative Care (EAPC), Honorary Chairman of the EAPC Research Network , Director of the school of education of the National Cancer Institute (Foundation), Milan, and Past Director of Rehabilitation and Palliative Care Unit, Milan, Italy

BETTER PAIN CONTROL NEEDED IN CANCER

 Pain is the key symptom leading to cancer diagnosis, yet over half of diagnosed patients are experiencing mild to moderate pain on a daily basis, according to the European Pain in Cancer (EPIC) survey.

EPIC was conducted under the auspices of the European Association for Palliative Care (EAPC), together with the help of a steering panel comprising of the European Oncology Nursing Society,the Lance Armstrong Foundation and OPEN Minds, and was sponsored by an educational grant from Mundipharma International Limited.

The EPIC survey is the first study of its type to be undertaken,involving more than 4,000 cancer patients from 12 countries: the Czech Republic, Denmark, Finland, France, Ireland, Israel, Italy, Norway, Romania, Sweden, Switzerland and the UK. The objectives of the survey were:

•  to establish the prevalence of pain in Europe

•  to establish the impact of pain on patients across all

• cancer stages in Europe

•  to investigate the impact of pain on cancer patients

•  to understand current treatment practices

•  to explore the impact of pain on sufferers’ quality of life.

Patients involved in EPIC were recruited by a variety of methods – from primary and secondary care, via patient groups and associations, advertising in national media, and from panels of consumers. To avoid bias in the data collected, patients were not recruited through pain or palliative care units.

Results of screening patients

Patients with cancer (n=4,824) and aged over 18 were contacted for screening  interviews to assess the prevalence,severity and frequency of pain.Patients were screened into the first stage of the study if they had current, frequent and intense pain (measured as five or more on a scale of 0 to 10). All cancer types, including solid tumours and bloodborne cancers bear - ????? (except skin cancers) and all disease stages were included.

The results show that, of those patients who experienced moderate to severe pain in the last month, pain is frequent – one in two are in daily pain – and long lasting, with almost one-third having endured pain for more than one year (n=3,059).

The survey found that more than two-thirds of cancer patients experience pain that they attribute to their cancer. The percentages of patients experiencing pain varies widely between European countries (see Figure 1).

Of the 2,763 patients with a pain score of five or above on the pain scale, only 78 per cent are receiving treatment for the pain.

This means that 22 per cent of patients reporting moderate to severe daily pain are not receiving any treatment.

Results of the interviews

Of the 2,753 patients screened in to the first stage of the study, 514 took part in an in-depth telephone interview. Oncologists and GPs are the healthcare professionals (HCPs) most often responsible for the management of cancer pain in patients involved in EPIC.  More than half of patients asked at each consultation said they proactively tell their HCP that they are in pain.

Forty-two per cent of the remaining patients said that their doctor does not always ask them about their pain. A third of cancer patients do not feel that their doctor has enough time to discuss pain with them.  Patients find cancer-related pain very distressing, so communication with them and proactive treatment is vital and HCPs should take the time to discuss issues surrounding pain with the patient.

Patient satisfaction with treatment received from HCPs is low. Half of the 514 patients interviewed said their HCP does not consider the value and importance of their quality of life and the impact that pain has on their ability to function. Pain has a huge impact on quality of who reported difficulty in performing everyday activities due to pain.

Patients’ concern over quality of life negatively impacts on their relationships with family and friends.Many said that their friends and family do not really understand what they are going through (for example 42 per cent felt pain affected their relationship with their family),and as a result feel isolated. These feelings affect patients’ everyday lives.Two-thirds of the patients interviewed thought that people do not understand how much pain they are in and a quarter felt that people treat them differently because of their pain.

Focus on pain relief

Despite receiving treatment for their cancer, EPIC results show that pain in cancer patients is often sub-optimally managed and that breakthrough pain is a common and significant problem.

Opioids are very effective in the treatment of cancer related pain; however, only 36 per cent of the 402 patients on prescription analgesia were on strong opioids,with 31 per cent taking weak opioids. The use of strong opioids was greater in Italy (70 per cent), Switzerland (66 per cent) and Sweden (49 per cent) than the other European countries studied. France, Israel, Norway and Romania used weak opioids more frequently than other pain medications. The most commonly reported side-effect was constipation, yet laxatives were not prescribed in almost half of patients.

About a third of patients with cancer-related pain (n=144) were taking non-prescription medication, most commonly paracetamol (24 per cent), ibuprofen (16 per cent) and aspirin (14 per cent). One-third of patients reported that the non-prescription medication was quite ineffective. Breakthrough pain is a serious problem in cancer-related pain, with 62 per cent of patients using prescription analgesia being affected, many on a weekly basis.

One-third of patients described their pain as ‘intolerable’. Episodes of breakthrough pain were greatest in Norway (87 per cent) and France (82 per cent) and lowest in Israel (42 per cent) and the Czech Republic (44 per cent). In patients who experience breakthrough pain, only 34 per cent were prescribed additional painkillers, of which 84 per cent of patients find ‘very’ or ‘quite’ effective.

Conclusion

The EPIC survey results are significant and report information about the impact and patients’ perceptions of cancer pain, which will help HCPs in the battle to improve

the treatment of cancer pain. The interim results of the EPIC survey are available online at www.EPICsurvey.com.

The findings highlight disappointing trends in cancer pain management; the medical community needs to develop its understanding that tumours should not be treated in isolation and that the symptoms of cancer need to be managed as proactively as the disease itself.

Regular communication with the patient is required and time needs to be taken to assess the level and impact of their pain. When current therapy fails to achieve optimum pain control, treatment should be reviewed swiftly and rapidly progressed to stronger alternatives.

Key learning points:

•  EPIC surveyed 4,824 patients with cancer from 12

• different countries.

•  Sixty-three per cent of patients (n=3,059) had experienced pain in the last month and almost a third of these patients (n=944) had experienced pain for more than one year.

•  Almost a fifth of the 2,763 patients reporting moderate to severe daily pain had not received treatment for it.

• Of those interviewed in depth (n=514), 250 patients were on pain medication, however 155 (62 per cent) had experienced breakthrough pain.

• Cancer-related pain impacts on patients’ quality of life so communication and proactive treatment of pain as well as the cancer is vital.

  From the PainEurope Journal, 2007: Issue 3.