Pain and pain alleviation in hospital-based home care: demographic, biological and treatment factors

Abstract

The aim of this study was to contrast two opposed groups, namely palliative cancer patients who were suffering significant pain (VAS≥4) and palliative cancer patients with no pain (VAS = 0) in hospital-based home care and, retrospectively, to study possible differences in relation to demographic, biological and treatment factors. The ESAS (Edmonton Symptom Assessment Scale) was used to assess 191 palliative cancer patients on admission and after 1 week of home care. Fifty-two (27%) had pain (mean 5.5±1.7) and 72 (38%) had no pain on admission [the middle group (n=67) had VAS 1-3]. Activity was more severely affected (5.4 vs 4.2, p<0.01) and nausea less well controlled in patients with pain (2.3 vs 0.7, P<0.0001). Pain was associated with the diagnosis of prostate cancer (P<0.01) and the presence of skeletal metastases (P<0.001), whereas painfree patients, with or without analgesics, more often had colorectal cancer (P<0.01) or melanoma (P<0.05).The medication profiles differed between the two groups: 22 (42%) of the 52 patients with pain were on step 3 of the WHO analgesic ladder and 24 of 51 (47%) were receiving antiemetics, whereas 42 (58%) of the 72 patients with no current pain had no analgesic prescribed and only 25% of them had antiemetics prescribed, indicating biological differences. If pain was present on admission a pain analysis was formally documented in 23 (44%) of the 52 cases and the medication was changed in 27 of the 52 (52%). The patients improved after 1 week (5.4±1.6 vs 3.9±2.3, P<0.001), and the improvement was significant even when a pain analysis was not documented or when medication was not changed. In conclusion, the results of this study indicate biological differences in pain alleviation and the need for a more structured way of working.

Components That Influence Assessment and Management of Cancer-Related Symptoms: An Interdisciplinary Perspective

“…unstructured assessments must be regarded as a major barrier to optimal symptom management because an unrecognized symptom is an untreated symptom. multiple studies imply the importance of using assessment tools (Heedman & strang, 2003;stromgren et al) and the need to ask about symptoms (Passik et al).…”

The glimmering embers: Experiences of hope among cancer patients in palliative home care

“…Instead, the goal of the ESAS is practical: to identify a few active symptoms using a consistent listing and scoring system across patients (Richardson & Jones, 2009). The Swedish version of ESAS (Heedman & Strang, 2003) consists of a nine visual analog scale (VAS) (0 -10) used for assessments of pain, activity, nausea, depression, anxiety, drowsiness, appetite, sensation of well-being, and dyspnea. Low values, irrespective of the scale, represent good function.…”

Significant improvement in quality of life of patients with incurable cancer after designation to a palliative homecare team

“…Nausea is highly prevalent in cancer patients, and palliative care interventions have been shown to impact positively on this symptom after designation (Mercandante et al 2000;Higginson et al 2003). Activity level and nausea have also been shown to be related to pain intensity; specifically, if VAS-pain are >4, these symptoms have higher values for patients with pain than for patients without pain (Heedman & Strang 2003). In the present study, the significant improvement in hours recumbent during the day could be interpreted to mean that if nausea is effectively controlled it enables the patients to be more active and less confined to bed.…”