Impact of dementia on cancer discovery and pain

Abstract

Background: Dementia is clinically noted to influence both reporting and experience of cancer pains. However, no systemic evaluation of this aspect has been reported. The aim of the present study was to retrospectively evaluate how dementia modified the cancer discovery process, frequency of cancer pain reports and analgesic-narcotic use at a large psychiatric hospital. Methods:We reviewed all the records of cancer patients with and without dementia treated at the surgical ward of Matsuzawa Hospital from 1993 to 2004. Psychiatric diseases other than dementia, brain metastasis and alcoholism, as well as leukaemia and skin cancer, were excluded. Patients' communicativeness as to pain was ascertained from nursing records. Results: A total of 134 cancer patients with and without dementia (50 demented and 84 non-demented) were included. Demented patients were accidentally discovered to have cancer (48%) or by an unexpected unfolding of clinical signs (44%), whereas most non-demented patients (63%) voluntarily sought medical evaluation (P = 0.000). Overall, 76% of non-demented patients had cancer pains (stages I and II, 64%; stages III and IV, 84%), whereas just 22% of demented patients had cancer pains (stages I and II, 16%; stages III and IV, 26%; P = 0.000). Non-demented patients showed stage-dependent requirements for both non-narcotic analgesics (stages I and II, 64%; stages III and IV, 84%) and narcotics (stages I and II, 0%; stages III and IV, 41%). Demented patients required much less analgesics (stages I and II, 11%; stages III and IV, 13%), with only one stage IV patient requiring narcotics (P = 0.000). Conclusion: Dementia greatly modifies the cancer discovery process, reduces prevalence of cancer pain and analgesic requirement.

Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

“…As 24-38% of cancer patients with dementia experienced cancer-related pain, clinicians should focus on cancer pain management. 3,6 This study had several limitations. First, patients' data were based on primary nurses' evaluations; therefore, we cannot comment on family members' preferences for end-of-life care or their evaluation on quality of death.…”

“…The difficulty of assessing the pain of those cancer patients with dementia could be a major obstacle, because of patient's cognitive and communication ability decline. As 24–38% of cancer patients with dementia experienced cancer‐related pain, clinicians should focus on cancer pain management …”

“…Table 1 presents the differences in patient characteristics per whether they had dementia. Patient characteristics differed significantly: cancer patients with dementia were older (χ 2 [3] = 42.5, P < 0.001) and more likely to be female (χ 2 [1] = 6.0, P = 0.016). Cancer patients both with/ without dementia tended to die at home (χ 2 [2] = 10.3, P = 0.006), and cancer patients with dementia had less opioid use (χ 2 [1] = 10.7, P = 0.001), and less pain (χ 2 [1] = 6.2, P = 0.014) and less fatigue (χ 2 [1] =7.4, P = 0.008) compared with cancer patients without dementia ( Table 1).…”

“…The number of cancer patients with dementia has seen marked increases in accordance with aging societies . Approximately 7–30% of cancer patients have dementia . Palliative care, which focuses on symptom management, psychosocial support and assistance with decision‐making, has the potential to improve the quality of care .…”

“…1 Approximately 7-30% of cancer patients have dementia. [2][3][4] Palliative care, which focuses on symptom management, psychosocial support and assistance with decision-making, has the potential to improve the quality of care. 5 To have a meaningful effect on patients' quality of life and end-of-life care, palliative care services must be provided until death; however, cancer patients with dementia are less likely to receive optimal palliative care.…”