Adherence to opioid treatment in patients with chronic cancer pain

Abstract

Background: On average, 30-75% of patients with early or advanced stages of cancer experience moderate to severe pain. Despite the availability of guidelines for health-care professionals, and the fact that as many as 90% of patients with cancer pain can be treated effectively through pharmacological therapies-even at home-the undertreatment of cancer pain is a widely recognized, well-documented health-care problem. Unrelieved pain is a serious and neglected public health problem, causing unjustified suffering for patients. For most people, adequate pain relief relies on the appropriate use of opiod drug. Moreover, even when legislation has been modified in favor of the use of analgesic, cultural barriers and lack of knowledge remain limiting factor for the appropriate use of opioids .Finally, patients and relatives often hamper treatment because of similar misconceptions regarding opioids, nonadherence to treatment regimens, and poor communication of their concerns. Material and methods:We collected data of 150 patients, opioid naive, with advanced cancer disease treated for chronic pain with opioid from february 2010 to january 2015. Neoplasm's histological findings were : head and neck cancer (30), lung cancer (45), breast cancer (40), colon-rectal cancer (20), pancreatic cancer ( 15). To ensure greater adherence to therapy with opioids we tried to involved the patient and caregiver in the therapeutic decision. During the ambulatory visit we evaluated the presence of pain, pain has been quantified with numerical rating scale (NRS), we informed the patient and /or caregiver about therapy for pain and about more frequently adverse events (nausea, costipation). The patient, in addiction, has been invited to make a phone call to our 24 hours after visit to assess the efficacy of treatment and adherence to it. Then every patient has been revalue every week with medical examination until conclusion of treatment. Results: During the whole period with opioid drugs a reduction of pain has been found out in patients in comparison with phone call (65%) o first clinical examination (35%), mean change of NRS scale from 8 to 2. The adherence to opioid treatment and the satisfaction level has been 100%.In the 10% of cases the pain control also allowed the continuation of antiblastic treatment. Conclusion: The patients have better adherence to therapy if properly informed and followed up at home in the first phase of therapy.