The Relationships among Pain, Nonpain Symptoms, and Quality of Life Measures in Older Adults with Cancer Receiving Hospice Care

Abstract

Gathering first hand or reported information about patients in the final stages of terminal cancer is difficult due to patient frailty, cognitive impairment, excessive fatigue and severity of illness, as well as gatekeeping by hospice providers and caregivers, and highly variable documentation practices. Objective We sought to further understand and elucidate end-of-life experiences in older cancer patients through the application of validated tools employed in the hospice setting. This paper summarizes data collected about pain, non-pain symptoms, and other aspects of quality of life (QOL) as reported by older hospice patients or their caregivers during the first two weeks of hospice care. Design Data was collected from an ongoing IRB approved research project with 94 older adults with cancer or their caregivers receiving service in a home setting from 14 Midwestern hospices. Participants completed one or two telephone interviews. Instruments used to gather information include the Brief Pain Inventory (BPI) and the Brief Hospice Inventory (BHI). Results Data analysis showed mean “worst pain” ratings significantly decreased from interview 1 to interview 2 and pain reports were significantly correlated with fatigue, anxiety, appetite, comfort, symptom control and overall QOL. Conclusions Our findings reinforce previously held views that older patients with cancer experience pain and non-pain symptoms. And both pain and non-pain symptoms can impact and confound the treatment of other symptoms and interfere with the patient's overall QOL. The results of this study support the assertion that hospice care can have a positive impact on pain severity and related suffering, as well as patient QOL as death approaches.

Cancer pain assessment and management in ambulatory patients at a tertiary hospital in Ghana

“…4,5 Although, originally developed to access cancer-related pain, the BPI has also been used to assess pain in patients with chronic non-cancerous pain syndromes such as AIDS, low back pain, and osteoarthritis. 7,8 The BPI has been validated across cultures and in several languages and is sensitive to changes in pain intensity. 4,6 The BPI has the advantage of being easy to understand and can be self or interviewer administered.…”

Quality of Life (QOL) Assessment among Advance Cancer Patient Undergoing Palliative Treatment in Malaysia: A Social Work Perspective

“…Possibly of the lowest score of bodily pain domain in this study might be due to the side effect of their treatment. This possibility was supported by Black, et al, (2011) andPooja, Mahesh, Muninarayana, Sagayaraj &Anil (2016). He states that pain was significantly correlated with appetite, mood, quality of sleeping, fatigue, pain intensity, daily activity, side effect, general appearance, and support from family.…”

Adequacy of pain management in oncology patients at a tertiary hospital in Ghana

“…2 Cancer pain is multidimensional and multifaceted and can have detrimental effects on the functioning of patients and adversely affect their quality of life. 3,4 Suboptimal cancer pain control can be very debilitating. The World Health Organization (WHO) in 1986 published the Cancer Pain Relief report which emphasized the right of patients to optimal pain management with effective pain treatment modalities.…”

“…5 It is estimated that one-third of all cancer patients and 60%-90% of patients with advanced cancer experience chronic or recurrent cancer related pain. 4,6 Pain Management Index (PMI) is a well-validated and widely used method for assessing the adequacy of pain management developed by Cleeland. 2 PMI is modelled on the concept of the cancer pain treatment guidelines established by the World Health Organization (WHO).…”