Hospice cancer patients adhere well to pain meds

Aug 8 2012

By Sarah Guy, MedWire Reporter

Study results from the midwest USA indicate that hospice-treated older individuals with cancer are highly adherent to pain medication, but that as they become more comfortable, adherence wanes.

Indeed, almost all patients (96.2%) in the analysis exhibited adherence to their medication, measured using the Patient Adherence Tool (PAT), within 72 hours of admission (T1), and 7-10 days after their initial report (T2).

Furthermore, when pain was adequately controlled for at least three-quarters of the 24 hours before being assessed, patients were 30% more likely to have perfect PAT scores compared with those who reported fewer hours of pain control.

By contrast, a 1-point increase in comfort levels reduced the chances for patients having a perfect PAT score, by 68.4%.

"Pain is a common occurrence in many advanced illnesses and adherence to an assessment-based pain management plan, consistent with a patient's goals of care, is essential to ensure comfort at all stages of the disease," say Keela Herr, from the University of Iowa in Iowa City, USA, and colleagues.

The researchers conducted T1 and T2 interviews with 65 hospice-care patients with cancer aged 55 years or above, or with their caregivers when the patients were unable to complete the interview. The patients' medical records were also analyzed.

At both time points, patient- and proxy-reported pain levels were mild, at 3.34 or less on the Brief Pain Inventory, where 10 is the maximum score. Levels of patient-reported comfort, quality of life (QoL), and symptom control - measured using the Brief Hospice Inventors - decreased between T1 and T2, but not significantly so.

Out of a possible PAT score of 9, which accounts for opioid, non-steroidal antiinflammatory drugs/acetaminophens, and neuropathic pain medication adherence, the overall mean adherence was 8.43 at T1 and 8.38 at T2, a nonsignificant difference, report Herr et al.

Hours of controlled pain over the previous day and level of comfort were the only variables that retained significance in logistic regression analysis, they add.

The team concludes, in the Journal of Pain and Symptom Management, that although pain medication adherence among older cancer receiving hospice care is high, "hospices must be alert to the fact that even as patients become more comfortable, adherence must continue to be emphasized to ensure that pain does not redevelop or exacerbate, if pain relief is a patient priority."

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