WHO cancer pain relief guidelines embodied in the “analgesic ladder” have received wide acknowledgment. However, the guidelines have not specifically referred to problems in older cancer patients. There have been very few studies that have addressed the impact of physiological, psychological and social factors on the assessment and management of cancer pain in elderly patients. In this study we tried to determine characteristics of pain management in older cancer patients.
Methods: We conducted a survey addressing the above issues in Japanese hospices and palliative care units using a questionnaire which required two kinds of answers in each of 53 clinical pain management areas. One kind of answer concerned the clinical importance of cancer pain management, and the other involved the difference between cancer pain management in elderly patients compared with younger patients.
Results: Eighteen sets of answers were returned, with 85% of clinical pain management answers being rated as either very important or important, and 30% of the same answers indicating age-related pain management differences. With respect to pain assessment, important aspects included: defining the cancer pain; assessment of pre-existing chronic pain; assessment of the patient's medical, psychological and social status; performing appropriate laboratory and radiographic tests; and developing a pain-oriented problem list. In general pain management, important aspects were: treating the underlying organic contribution to the pain by radiotherapy, chemotherapy and/or surgery; giving psychological, social and physical rehabilitation; using a multimodal approach; and considering age-related physiological changes that may influence the patient's response to any intervention. Regarding pharmacotherapy, important aspects were: choosing an appropriate drug in accordance with the WHO three-steps ladder; beginning with low doses; being aware of additive effects; continuing each drug trial for an adequate duration; using fixed schedules and “as needed” dosing appropriately; using an appropriate route of administration; and anticipating and treating side effects, especially sedation and confusion.
Conclusion: It is important to be aware of, and to respond to physiological, psychological and social factors when managing cancer pain in elderly patients.