Pain characteristics and analgesic treatment in an aged adult population: a 4-week retrospective analysis of advanced cancer patients followed at home.

backgroundStudies of cancer pain management in older people are lacking and more information is needed.

objectivesThe aim of this study was to assess the possible differences in pain intensity, pain mechanisms, breakthrough pain (BTP) medications and use of opioids between adult cancer patients and older cancer patients.

methodsA retrospective review of computerized charts was undertaken for advanced cancer patients in the home-care setting. Pain intensity, pain mechanisms, the presence of BTP, analgesic treatments in the last 4 weeks of life, and frequency of change in opioid or route of administration were measured. Patients were divided into two groups: adults (<65 years, A), and aged (≥65 years, O). Within the latter group, three subgroups were assessed: old (65-74 years, O1), older (75-84 years, O2), and the oldest (≥85 years, O3).

resultsA total of 412 patients were available for analysis. No differences in Karnofsky status and survival in the two age groups were found (p=0.2 and p=0.09, respectively). No differences in pain intensity were observed among age subgroups. The O3 group presented a lower prevalence of BTP in comparison with other groups. Significant changes in opioid doses were reported with an inverse relationship with age (p=0.0001). Opioid switching was less frequently present in the older patients (p<0.005).

conclusionCareful opioid titration may achieve adequate analgesia in older patients by using lower doses of opioids, with a lower rate of opioid switching. The prevalence of BTP was only shown to be lower in the oldest group (O3).