A single institution survey on prevalence and management of severe cancer pain in patients with cancer of different sites

Abstract

Background: Pain is one of the most frequent and disabling symptoms of cancer especially in advanced stage. This survey focused on prevalence and management of severe cancer pain in patients ( pts) referred to Medical Oncology Unity of Cagliari, ESMO designated center of integrated oncology and palliative care. Patients and methods: From June 03 2014 to July 03 2014, we conducted a single institution survey in pts with cancer of different sites. The study's main objective was the evaluation of severe pain prevalence in pts receiving opioid treatments, secondary objectives were: evaluation of clinical characteristics of pain, therapies for chronic and breakthrough pain, pain therapy efficacy. For pain assessment we used a numeric rate scale. Results: We enrolled 1382 pts (1255 inpatient and 127 outpatient). Pts with severe pain treated with opioid were 78/1382 (5.6%) with the following clinical characteristics: mean age 65.2 years (range: 37-84), M/F: 38/40. Site of cancer were: colorectal (29.4%), urogenital (19.2%), breast (17,9%), lung (17.9%), gastro-intestinal-pancreatic (12.8%), soft tissue and head-neck (1.2%), respectively. Ninety-four percent of pts had stage IV disease with the following metastatic sites: lung (47.4%), bone (43.6%), liver (41.0%) and lymph nodes (29.5%). Nociceptive and neuropathic pain were both reported by 44.9% of pts, nociceptive alone in 51,3% (23.1% somatic, 15.4% visceral, 12.8% somatic/visceral) and neuropathic alone in 2.6%. Opioid therapy for chronic pain was administered with oral (66.7%), transdermal (30.8%) and subcutaneous (s.c.) (1,3%) formulation and in the 60.2% of pts it was associated with adjuvant drugs (psychotropic/ neuromodulators, anti-edema). Breakthrough pain was reported by 58.9% of pts and treated with trans mucosal fentanyl (23.9%), oral, s.c. and intravenous morphine (23.9%) and 9% with non-opioid drugs (NSAIDs, acetaminophen). Twenty-four percent of pts underwent local therapies for pain: 84.2% radiotherapy; 10,5% celiac plexus block; 5.3% bone surgery. Forty-two percent of pts reported inadequate pain control and uncontrolled pain was the main reason hospitalization for 12.8% of them. Conclusions: This study shows a high prevalence of severe cancer pain in our pts. Nearly half of them don't reach adequate pain relief despite of tailored pain treatment. These data are in agreement wiht literature and suggest the need of new clinical research to improve pain management and patient's quality of life.