It will be interesting to see how the CDC and PROP handle the increasing number of cancer patients with chronic pain. The CDC guidelines specifically exclude cancer-related pain, but not pain after the cancer is “cured”.
Cancer pain is the key reason for a significant number of hospital admissions in the United States, according to a national epidemiological study.
A retrospective review of data from the National Inpatient Sample hospital discharge database for the years 2007 to 2012 found that an estimated 121,902 patients with a primary diagnosis of cancer pain were admitted during that time period
In addition, 76% of patients had cancer pain associated with secondary malignancy, with the two most common being neoplasms in the bone and bone marrow (43.9%) and liver (26.8%).
Overall, 57% of patients were admitted from the emergency department, and the average hospital stay for those younger than 65 years of age was 5.5 versus 4.9 days for those over the age of 65. Most patients had either a routine discharge (46.6%) or discharge to home health care (26.7%).
“Pain is one of the most common and feared symptoms of cancer, experienced by
- 30% to 50% of patients with cancer receiving treatment and
- 70% to 90% of patients with advanced disease.”
Dr. Taherian noted that cancer-related pain among hospitalized patients is often underdiagnosed and undertreated.
“A number of studies have found that opioid use [i.e. high level of pain, ed.], younger age, lower health literacy and, most importantly, inconsistent analgesic adherence are predictors of hospitalizations in patients with cancer pain.”
Dr. Taherian said all physicians who care for cancer patients should pay more attention to pain management. “Comprehensive pain assessment and evidence-based analgesic decision-making processes do enhance usual pain outcomes,” he said. “Therefore, current approach to pain control should be individualized for every patient
Incorporating a multidimensional approach to cancer pain management “is important to achieve optimal quality of life for all cancer patients and prevent future admissions or decrease the length of hospital stay,” Dr. Taherian said.
“Oncologists can prevent admissions for palliation through earlier detection by making sure to question patients at every visit regarding their pain symptoms,” he said. “For cancers that we know will have a higher incidence of painful sequelae, anticipating the pain symptoms earlier is vital.”