Factors Related to Substantial Pain in Terminally Ill Cancer Patients

Purpose: Pain is the most common and influential symptom in cancer patients. Few studies concerning pain intensity in the terminally ill cancer patients have been done. This study aimed to identify factors related with more than moderate pain. Methods: This study used secondary data of 162 terminal cancer inpatien ts at the palliative ward of six training hospitals in Korea. Physician-assessed pain assessment was by 10 point numeric rating scale. Substantial pain was defined more than moderate intensity by the Korean National Guideline for cancer pain. The Korean version of the MD Anderson Symptom Inve ntory was self-administered to assess symptoms. Survival prediction was estimated by the attending physicians at the time of admission. Results: Less than six weeks of predicted survival and more than numeric rating of six for worst drowsiness in the previous 24 h were significantly related to substantial pain (P=0.012 and P=0.046, respectively). The dose of opioid analgesics was positively related to substantial pain (P=0.004). Conclusion: Factors positively related to substantial pain were less than six weeks of predicted survival and considerable drow siness. Careful monitoring and active preparation for pain are required in terminal cancer patients having those factors. (Korean J Hosp Palliat Care 2011;14:197-203)Key Words: Cancer pain, Predicted survival, DrowsinessINTRODUCTIONSurvival rates and life expectancies of cancer patients have increased with advances in modern medicine. One consequence has been an increase in the numbers of terminally-ill cancer patients. The symptoms occur together in most cancer patients (1). Especially cancer pain has the top priority to be controlled among the various symptoms (2), because the pain is the most distressing debilitating one (3).Despite the abundant research on cancer pain, cancer pain still is a major problem; its prevalence was calculated to be as high as 64% in a meta-analysis (2). The World Health Organization pain ladder is used globally; appropriate drugs and dosages following WHO ladder recommendation could be adequately relieved cancer pain about 70∼90% of patients (4). Nevertheless, cancer pain remains challenging issue for the physicians to manage and factors related to cancer pain need further investigation (5).For other health issues, identification and preferential management of those at high-risk has been proven to be prudent, both in terms of patient care and allocation of limited medical resources. A similar strategy seems germane for those experiencing cancer related pain. The simplest and most reliable assessment tool of pain is patient self-assessmen t using a 10-point numerical rating scale (NRS) (6). Substantial pain is defined as more than moderate pain (7). Moderate pain is usually 4∼6 on the NRS, however, in South Korea, national guidelines for cancer pain define moderate pain 5 or