Sufficient cancer pain relief may mean frequent follow up

Jun 20 2012

By Sarah Guy

US study findings show that just over half of cancer patients receiving outpatient palliative care who have mild or moderate pain intensity at initial consultation (baseline), report an increase to moderate or severe pain intensity by first follow up.

Furthermore, after the median 15 days between consult and follow up, more than half of patients showed no pain treatment response at all, defined as at least a 2-point or 30% reduction on the Edmonton Symptom Assessment System (ESAS), report the researchers.

"These results provide preliminary data for the necessity of more frequent follow-up visits, phone calls, or adjusting follow-up visit time to optimize cancer pain treatment in outpatient palliative care," suggest Eduardo Bruera (The University of Texas MD Anderson Cancer Center, Houston) and colleagues.

Thorough assessment and reassessment of cancer patients' pain are essential in light of the complexity of such pain, therefore the findings "have important implications for ongoing pain research and pragmatic practice," they add, in the Journal of Pain and Symptom Management.

Overall, the mean pain intensity scores of the 1612 patients in the study fell from 5.36 to 4.59 between baseline and first follow up.

However, intensity increased to a moderate or severe level in 32% of patients with mild pain at baseline, and to severe in 27% of patients with moderate baseline pain intensity.

"These results suggest that cancer pain intensity can change in a short period resulting in rapid worsening of mild pain experienced at the initial visit," write the researchers.

Furthermore, while 45% of patients achieved a pain-treatment response, 31% of responders still had a pain level of at least 4 on the ESAS-derived numeric rating scale at first follow up.

Bruera et al assessed predictors of a pain treatment response at first follow up, and found that baseline pain intensity increased the chances of a response 1.40-fold per point increase, and that fatigue and symptom burden (graded using a composite symptom score) both increased the chances 1.01-fold.

Indeed, all symptom scores, including those for nausea, depression, anxiety, and sleep, improved significantly between baseline and follow up, except anorexia, which decreased from 3.83 to 3.10.

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