Narcotic analgesic use of hospitalized patients with lung cancer in palliative care service
Introduction: Greater than half of cancer patients suffer from the pain, which is the one of the major problems that disrupt the quality of life at, any time during the disease. Pain should be decreased as soon as possible and the maintenance treatment should be planned in these groups of patients. The World Health Organization (WHO) suggests the use of a three-step analgesic ladder approach including non-opioid, weak opioid and strong opioids according to the severity of the pain. However, the pain palliation can’t be accomplished in more than 80% of patients because of the wrong thoughts of health professionals, patients and patients’ relatives about narcotic analgesics.
Methods: In this study 72 lung cancer patients, hospitalized between 29 July 2013 to 31 December 2015 at Izmir Katip Çelebi University Atatürk Education and Research Hospital Palliative Care and Support Service were assessed retrospectively about pain palliation.
Results: Patients mean ages 61.2 ± 8.2 and 77.8% (56) were male, and 22.2% (16) were female. Patients applied with different complaints such as Inability to feed, pain, general condition disorders, shortness of breath and nausea and 27.8% (20) of patients had only admitted with pain. The median duration of hospital stay was 7 (2-45) days, which is the 18.1% of patients were not given any analgesics. 49.2% (29) of patients have second line treatment, 50.8% (30) had received third line treatment. Hospitalization indication and discharge status of the patients was statistically significant association between analgesic use (p = 0.002; p = 0.03).
Conclusion: Cancer pain is the most common symptom affecting the quality of life negatively. Pain management should be well known by clinicians. Success in the treatment of pain patients linked to multidisciplinary approach include the whole psychological and social environment will be possible with the treatment applied by step approach.
Full Text:PDF (Türkçe)
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
Brambilla E, Travis WD. Lung cancer. In: World Cancer Report, Stewart BW, Wild CP (Eds), World Health Organization, Lyon 2014.
Türkiye Kanser İstatistikleri, Ankara, 2015. Erişim yeri: http://kanser.gov.tr/Dosya/kayitcilik/ANA_rapor_2012sooonn.pdf Erişim tarihi: 06.05.2016
Meier DE, Bishop TF. Palliative care; benefits, services, and models of care. www.uptodate.com, version19.2, last updated: May 13, 2011.
World Health Organization definition of palliative care, avaliable online at http:/www.who.int/cancer/palliative/definition/en (Accessed on October 20, 2011).
M Costantini M, Ripamonti C, Beccaro M, et al. Prevalence, distress, management, and relief of pain during the last 3 months of cancer patients’ life. Results of an Italian mortality follow-back survey. Ann Oncol 2009;20:729-35.
Sarihan E, Kadioglu E, Igde FA. Kanser agrisi, tedavi prensipleri ve Dünya Saglik Orgutu agri basamak tedavisi. Nobel Med 2012;8:5-15.
Breivik H, Cherny N, Collet F et al. Cancer related pain: A pan European survey of prevelance, treatment andpatient attitudes. Ann Oncol 2009;20:1420-33.
World Health Organization. Access to controlled medications programme: Framework. Geneva, Switzerland: WHO Document Production Services; 2007. Available at: http://www.who.int/medicines/areas/quality_safety/Framework_ACMP_withcover.pdf Accessed May,6,2016.
Von Roen JH, Cleeland CS, Gonin R, et al. Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group. AnnIntern Med 1993;119:121-6.
Ward SE, Goldberg N, Miller- McCaulay V, et al. Patient related barriers to management of cancer pain. Pain 1993;52:319-24.
Caraceni A, Cherny N, Fainsinger R, et al. The Steering Committee of the EAPC Research. Pain measurement tools and methods in clinical research in palliative care: recommendations of an expert working group of the European Network. Association of Palliative Care. J PainSymptom Manage 2002;23:239–55.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7.
Scottish Inter collegiate Guidelines Network. Control of Pain in adults with cancer: A National Clinical Guideline. SIGN-Scottish Intercollegiate Guidelines Network. Edinburgh, November 2008. ISBN 978 1 905813 38 4
Michael H, Levy MD. Pharmacologic treatment of cancer pain. N Engl J Med 1996; 335(15):1124-31.
Francis OJ, Minerva PC. Opioid use in the Philippines-20 years after the introduction of WHO Analgesic Ladder. Eur J Pain 2007;1:19–22.
Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 2010;56:514–7.
Mcquay HJ, Moore RA. Opioid problems and morphine metabolism and excretion. In: Dickenson AH, Besson J-M(eds) The Pharmacology of Pain, Berlin Heidelberg:Springer-Verlag;1997:335-360.
Deandrea S, Montanari M, Moja L, et al. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 2008;19:1985–91.
Cherny NI, Baselga J, De Conno F, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative. Ann Oncol 2010;21:615–26.
Turkish Thoracic Society, Lung and Pleural Malignancies Study Group. Pattern of lung cancer in Turkey 1994-1998. Respiration2002;69:207-10.
Kayhan GE, Gulhas N, Aslan A, et al. Algoloji Poliklinigine Başvuran Onkolojik Hastalarda Tedavi ve Komplikasyon Yonetimi: Retrospektif Degerlendirme. J Turgut Özal MedCent2013:20(1):50-54
Zech DF, Grond S, Lynch J, et al. Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain 1995;63(1):65-76.
Orhan ME, Bilgin F, Ergin A, et al. Pain treatment practice according to the WHO analgesic ladder in cancer patients: eight years experience of a single center. Agri 2008;20(4):37-43.
Kursun YZ, Yildiz F, Kaymaz O, Onal SA. Agrili Kanser Hastalarinin Tedavisinde Analjezik Basamak Tedavisinin Yeri. Agri 2015;27(1):26-34.
Porter J, Jick H. Addictionrare in patients treated with narcotics. N Engl J Med 1980;302:123.
Fishbain DA, Rosomoff HL, Rosomoff RS. Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain1992;8:77-85.
McQuay HJ. Opioid use in chronic pain. Acta Anaesthesiol Scand 1997;41:175-83.
Kuzeyli Yildirim Y, Uyar M. Etkili Kanser Agri Yonetimindeki Bariyerler. Agri 2006;18:12-9.