Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Abstract

Pain is a highly distressing symptom for patients with advanced cancer. WHO analgesic ladder is widely accepted as a guideline for its treatment. Our aim was to describe pain prevalence among patients diagnosed with advanced non-small-cell lung cancer (NSCLC), impact of pain on quality of life (QoL) and adequacy of pain management. Data of 1021 Italian patients enrolled in three randomised trials of chemotherapy for NSCLC were pooled. QoL was assessed by EORTC QLQ-C30 and LC-13. Analgesic consumption during the 3 weeks following QoL assessment was recorded. Adequacy of pain management was evaluated by the Pain Management Index (PMI). Some pain was reported by 74% of patients (42% mild, 24% moderate and 7% severe); 50% stated pain was affecting daily activities (30% a little, 16% quite a bit, 3% very much). Bone metastases strongly affected presence of pain. Mean global QoL linearly decreased from 64.9 to 36.4 from patients without pain to those with severe pain (Po0.001). According to PMI, 616 out of 752 patients reporting pain (82%) received inadequate analgesic treatment. Bone metastases were associated with improved adequacy and worst pain with reduced adequacy at multivariate analysis. In conclusion, pain is common in patients with advanced NSCLC, significantly affects QoL, and is frequently undertreated. We recommend that: (i) pain self-assessment should be part of oncological clinical practice; (ii) pain control should be a primary goal in clinical practice and in clinical trials; (iii) physicians should receive more training in pain management; (iv) analgesic treatment deserves greater attention in protocols of anticancer treatment.

The Characteristics and the Pharmacological Management of Cancer Pain and Its Effect on the Patients’ Daily Activities and their Quality of Life: A Cross – Sectional study from Malaysia

“…Approximately 40.5% of the patients with mild pain had not received any analgesic medications,as was recommended by the WHO analgesic guidelines. This finding concurred with the findings of Maio et al, (2004) which reported that more than 80% of the patients with mild pain, 42% of patients with moderate pain, 24% of patientswith severe pain and 7% of the patients who suffered from some degree of pain had received inadequate analgesic medications [18]. However, the study of Maio et al, had consisted of 752 patients with non -small cell lung cancer,unlike our study, which consisted of patients of various cancer types.…”

“…Movement was the pain aggravator in 57.1% (24) of the patients, while 42.9% (18) of the patients were vulnerable to anything. Sweating was the most common symptom which accompanied the pain, which was seen in 33.33% (14) of the patients, followed by shortness of breath (SOB) in 16.7% (7) and abdominal discomfort in 9.5% (4) of the patients.…”

Distress screening in a multidisciplinary lung cancer clinic: Prevalence and predictors of clinically significant distress

“…Physicians cite lack of time and lack of confidence as barriers to detecting certain physical and psychosocial symptoms [20]. Symptoms that practitioners may under-or misidentify include depression, pain, fatigue, and overall quality of life concerns [21][22][23][24][25][26]. Patients may be embarrassed or reluctant to report psychological problems, such as depressive symptoms [27].…”

Modified Pro-Self Pain Control to Increase Activity in Patients with Colorectal Cancer

“…These activities are focused on increasing muscle strength and reducing fatigue in the cancer patient. Regarding activity, some factors are found influential; one of which is pain (Di Maio, 2004). Pain serves as a factor affecting the occurrence of fatigue, which impacts on activity (Wagner & Cella, 2004).…”

“…Based on the data from the cancer patients undergoing chemotherapy in Italy, 50% of patients reported that the pain affected their activities of daily living (Di Maio et al, 2004). Furthermore, Lowery et al (2013) stated that increased pain in patients with colorectal cancer undergoing chemotherapy is caused by a number of factors; one of which is the physical activity such as climbing stairs or walking, lifting, overextending, standing, urination/defecation, sleep and some other things like diet, stress, and weather.…”