Assessment and Management of Cancer Pain in Older Adults: Strategies for Success

Brant, Jeannine M.

doi:10.4103/apjon.apjon_11_18

Cited by 20 publications

(6 citation statements)

References 24 publications

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“…One of the biggest challenges is that most older adults and health-care practitioners perceive that pain is a normal part of aging, which impede history taking and pain expression [ 14 ]. Communication may be another challenge for memory failure, impaired cognition, sensory impairment (visual, hearing, and circulation problems), and stoicism with aging that can impact both assessment and management of pain older adults [ 39 ]. For elderly, prioritizing pain assessment so as to decrease the chance of inadequate analgesia is important.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Observational Study on the Characteristics of Pain and Associated Factors of Breakthrough Pain in Advanced Cancer Patients

Fan

Yang

et al. 2022

Pain Research and Management

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Objective. This study aimed to conduct a retrospective observational study to understand the status of characteristics of pain and identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP) in advanced cancer patients. Methods. Advanced cancer patients over 18 years of age; diagnosed with cancer of any type and stage III or IV in the palliative care ward with available data were enrolled between 2018 and 2020. Demographic data and pain-related information were collected by using structured electronic extraction form from Hospital Information System (HIS). Patients who had well-controlled background pain with an intensity ≤4 on a 0–10 numerical scale for >12 hours/day, the presence of transient exacerbations of pain with moderate-severe intensity (≧5), and clearly distinguish from background pain were regarded to have suffered BTP. Spearman correlation was conducted to explore the relationship between pain score and demographics characteristics. Factors significant in univariate analysis were included in the multiple regression model to explore independent predictive factors associated with the BTP. Results. Of 798 advanced cancer patients, the mean age was 56.7 (SD = 11.84) years. Lung cancer (29.95%) was the most common cancer, and pain (93%) was the most common symptom. More than half (n = 428, 53.6%) of the patients experienced BTP. The median number of BTP episodes was 4 (IQR = 2, 7, range: 1–42). The median intensity of BTP was 6 (IQR = 6, 7, range 5–10). Patients with severe background pain or BTP had longer hospital stay and more symptoms. Besides, more severe background pain was related to higher activity of daily living. Intramuscular injection of hydromorphone hydrochloride was the main medication for BTP onset. Younger age, background pain, anorexia, and constipation were independently associated with the presentation of BTP. BTP pain intensity was independently associated with bloating. Symptom numbers were an independent factor and positively associated with BTP episodes. Conclusions. BTP resulted in poor prognosis, which has a variable presentation depending on interdependent relationships among different characteristics. Good controlling of background pain and assessment of pain-related symptoms are essential for BTP management. BTP should be managed individually, especially the invisible pain among aged patients. Furthermore, BTP-related education and training were still needed.

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Section: Discussionmentioning

confidence: 99%

Retrospective Observational Study on the Characteristics of Pain and Associated Factors of Breakthrough Pain in Advanced Cancer Patients

Fan

Yang

et al. 2022

Pain Research and Management

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“…Interestingly, despite young–old subjects experiencing a smaller number of irruptive pain episodes than patients aged ≥ 75 years, they needed either a dose increase or a change of treatment more frequently than older patients. Although differences were not significant, these results outline one of the biggest challenges in cancer pain management, which is that most older patients usually perceive pain as a normal part of aging and they tend to be more satisfied with their pain treatment as they grow older [21]. These perceptions may have interfered with both the assessment and management of pain and could explain the differences observed between age groups in terms of treatment adjustment.…”

Section: Discussionmentioning

confidence: 88%

“…It is well known that geriatric patients can respond differently from younger patients to drug therapy, since age-related physiological changes can affect pharmacokinetics and pharmacodynamics of the drug [20]. Older adults also have a greater risk for drug-related toxicities and drug–drug interactions because of the use of multiple medications [21]. Polypharmacy is recognized as an increasingly serious problem in the management of elderly patients with cancer, and requires balancing the risks and benefits of multiple drug therapies.…”

Section: Introductionmentioning

confidence: 99%

Effects of Age Among Elderly Cancer Patients on Breakthrough Pain Management with Sublingual Fentanyl Tablets

et al. 2019

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IntroductionSublingual fentanyl tablets (SFTs) have been shown to be a safe and effective option in controlling breakthrough cancer pain (BTcP). However, further examination is required to investigate the use of SFTs among the elderly. The aim of this study was to examine the influence of age in BTcP management with SFTs in the elderly population.MethodsWe performed subgroup analyses of a recently completed trial in two subsets of individuals: patients aged 65–74 years (low age group) and patients ≥ 75 years (high age group). Pain intensity (PI), onset of pain relief, frequency and duration of BTcP episodes, and adverse events (AEs) were assessed at 3, 7, 15, and 30 days. Health status instruments used were the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) and the Short Form 12, version 2 (SF-12v2) questionnaire.ResultsLevels of PI at the end of the study improved significantly as compared with baseline in both the low and the high age groups (30.0% and 27.7% reduction, respectively). The onset of analgesia at the end of the study began in < 10 min in 85.0% of young–old subjects and in 62.5% of patients ≥ 75 years, but no significant differences were found. BTcP episodes lasted < 15 min in 75.0% of patients in the low age group and 58.3% in the high age group (p = 0.24). Most of patients in both groups experienced one to five BTcP daily episodes, at all assessment points. HADS-D decreased from 10.78 (± 4.33) to 8.21 (± 3.57) in the low age group, and from 10.96 (± 4.26) to 9.36 (± 3.35) in the high age group (p = 0.02). Significant differences in HADS-A scores from baseline to the end of the study were also observed in both subgroups (p < 0.05). Patients in the low age group had less favorable mental component summary (MCS) and physical component summary (PCS) scores than patients in the high age group. At the end of the study, 10.0% of young–old patients and 29.2% of patients aged ≥ 75 years reported AEs related to their treatment. The most commonly reported AEs included nausea, vomiting, constipation, somnolence, and skin disorders and they were generally mild to moderate in severity.ConclusionsThe results of this study showed that SFTs provided safe and clinically meaningful pain relief in both elderly subgroups. Clinical implications of these findings await validation in large, confirmatory studies to identify age subgroup divergences among elderly cancer patients treated with SFTs.

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“…19 Specialized scales are also available for sub-populations (e.g. older adults with comorbidities and polypharmacy, 16,20 non-verbal patients, 21,22 and patients with substance use disorders [23][24][25] ). Clinicians should identify the most suitable scale for an individual patient, using that same scale at each subsequent assessment to track changes in pain intensity over time.…”

Section: Reviewmentioning

confidence: 99%

Multidisciplinary approach, continuous care and opioid management in cancer pain: case series and review of the literature

Porzio¹,

Capela²,

Giusti³

et al. 2023

DIC

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Underlying cancer pain has heterogenous aetiologies and mechanisms. It requires detailed and comprehensive pain assessment, combined with personalized treatment. A multidisciplinary team is essential to providing the best management of cancer pain at every disease stage, improving the quality of life and outcomes in patients with cancer. This narrative literature review emphasizes the value of providing all patients with multidisciplinary pain management in their preferred care setting. Real-life experiences are also reported to witness the efforts of physicians to properly manage cancer pain.

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Assessment and Management of Cancer Pain in Older Adults: Strategies for Success

Cited by 20 publications

References 24 publications

Retrospective Observational Study on the Characteristics of Pain and Associated Factors of Breakthrough Pain in Advanced Cancer Patients

Retrospective Observational Study on the Characteristics of Pain and Associated Factors of Breakthrough Pain in Advanced Cancer Patients

Effects of Age Among Elderly Cancer Patients on Breakthrough Pain Management with Sublingual Fentanyl Tablets

Multidisciplinary approach, continuous care and opioid management in cancer pain: case series and review of the literature

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