open access

Vol 17, No 2 (2021)
Review paper
Published online: 2021-04-20
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Cancer patients and their caregivers in the face of opioid analgesic treatment — opportunities and threats to the treatment process

Maria Wysocka, Jerzy Jarosz, Anna Klimkiewicz, Tomasz Pasierski, Martyna Hordowicz, Jakub Klimkiewicz
DOI: 10.5603/OCP.2021.0015
·
Oncol Clin Pract 2021;17(2):59-66.

open access

Vol 17, No 2 (2021)
REVIEW ARTICLES
Published online: 2021-04-20

Abstract

Failure to alleviate cancer pain may deteriorate mental functioning, increase depression symptoms, result in the clinical diagnosis of demoralization syndrome nonadherence of treatment, functioning discipline, which together, may precipitate desire for euthanasia. Increased incidence of pain in patients with advanced or terminal disease has been reported to range from 39% to 66.4% depending on the stage of the cancer being experienced. Further, the progressive aging of societies and increased life expectancy in cancer patients has changed the dynamics of modern treatment processes. Despite their efficacy, the use of opioids as an analgesic treatment during terminal disease has been affected by the quality, availability, and negative reputation of these scheduled drugs. This review aims to describe the specific factors and limitations of opioid pain management from the perspective of patients and their caregivers. Further, we aim to identify and discuss the key factors which determine the success or failure of opioid use for the treatment of pain with links to internationally recognized recommendations and current research.

Abstract

Failure to alleviate cancer pain may deteriorate mental functioning, increase depression symptoms, result in the clinical diagnosis of demoralization syndrome nonadherence of treatment, functioning discipline, which together, may precipitate desire for euthanasia. Increased incidence of pain in patients with advanced or terminal disease has been reported to range from 39% to 66.4% depending on the stage of the cancer being experienced. Further, the progressive aging of societies and increased life expectancy in cancer patients has changed the dynamics of modern treatment processes. Despite their efficacy, the use of opioids as an analgesic treatment during terminal disease has been affected by the quality, availability, and negative reputation of these scheduled drugs. This review aims to describe the specific factors and limitations of opioid pain management from the perspective of patients and their caregivers. Further, we aim to identify and discuss the key factors which determine the success or failure of opioid use for the treatment of pain with links to internationally recognized recommendations and current research.

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Keywords

analgesics, pain management, opioid, advanced cancer, palliative care

About this article
Title

Cancer patients and their caregivers in the face of opioid analgesic treatment — opportunities and threats to the treatment process

Journal

Oncology in Clinical Practice

Issue

Vol 17, No 2 (2021)

Article type

Review paper

Pages

59-66

Published online

2021-04-20

DOI

10.5603/OCP.2021.0015

Bibliographic record

Oncol Clin Pract 2021;17(2):59-66.

Keywords

analgesics
pain management
opioid
advanced cancer
palliative care

Authors

Maria Wysocka
Jerzy Jarosz
Anna Klimkiewicz
Tomasz Pasierski
Martyna Hordowicz
Jakub Klimkiewicz

References (72)
  1. van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, et al. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007; 18(9): 1437–1449.
  2. IASP 2008-2009 Global Year Against Cancer Pain (2008). https://www.iasp-pain.org/GlobalYear/CancerPain (15.12.2020).
  3. https://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf.
  4. Dzierżanowski T, Ciałkowska-Rysz A. Accessibility of opioid analgesics and barriers to optimal chronic pain treatment in Poland in 2000-2015. Support Care Cancer. 2017; 25(3): 775–781.
  5. Duthey B, Scholten W. Adequacy of opioid analgesic consumption at country, global, and regional levels in 2010, its relationship with development level, and changes compared with 2006. J Pain Symptom Manage. 2014; 47(2): 283–297.
  6. van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, et al. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016; 51(6): 1070–1090.e9.
  7. van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, et al. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007; 18(9): 1437–1449.
  8. Deandrea S, Montanari M, Moja L, et al. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol. 2008; 19(12): 1985–1991.
  9. Scholten WK, Christensen AE, Olesen AE, et al. Quantifying the Adequacy of Opioid Analgesic Consumption Globally: An Updated Method and Early Findings. Am J Public Health. 2019; 109(1): 52–57.
  10. Dzierżanowski T, Ciałkowska-Rysz A. Accessibility of opioid analgesics and barriers to optimal chronic pain treatment in Poland in 2000-2015. Support Care Cancer. 2017; 25(3): 775–781.
  11. Cleary JF, Maurer MA. Pain and Policy Studies Group: Two Decades of Working to Address Regulatory Barriers to Improve Opioid Availability and Accessibility Around the World. J Pain Symptom Manage. 2018; 55(2S): S121–S134.
  12. Graczyk M, Borkowska A, Krajnik M. Why patients are afraid of opioid analgesics: a study on opioid perception in patients with chronic pain. Pol Arch Intern Med. 2018; 128(2): 89–97.
  13. Skolnick P. The Opioid Epidemic: Crisis and Solutions. Annu Rev Pharmacol Toxicol. 2018; 58: 143–159.
  14. Coussens NP, Sittampalam GS, Jonson SG, et al. The Opioid Crisis and the Future of Addiction and Pain Therapeutics. J Pharmacol Exp Ther. 2019; 371(2): 396–408.
  15. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127(12): 2893–2917.
  16. Agency for Health Care Policy and Research. Clinical Practice Guideline for Cancer Pain Management. Department of Health and Human Services, Rockville 1994.
  17. Paice JA, Ferrell B. The management of cancer pain. CA Cancer J Clin. 2011; 61(3): 157–182.
  18. Gunnarsdottir S, Sigurdardottir V, Kloke M, et al. A multicenter study of attitudinal barriers to cancer pain management. Support Care Cancer. 2017; 25(11): 3595–3602.
  19. Coulter A, Jenkinson C. European patients' views on the responsiveness of health systems and healthcare providers. Eur J Public Health. 2005; 15(4): 355–360.
  20. Makhlouf SM, Pini S, Ahmed S, et al. Managing Pain in People with Cancer-a Systematic Review of the Attitudes and Knowledge of Professionals, Patients, Caregivers and Public. J Cancer Educ. 2020; 35(2): 214–240.
  21. Frank A. The Wounded Storyteller: Body, Illness, and Ethics. University of Chicago Press, Chicago 1995.
  22. Frank AW. Asking the right question about pain: narrative and phronesis. Lit Med. 2004; 23(2): 209–225.
  23. Radbruch L, Jaspers B. Quality of Life. Textbook of Palliative Care. 2018: 1–12.
  24. Kroenke K, Theobald D, Wu J, et al. The Association of Depression and Pain with Health-Related Quality of Life, Disability, and Health Care Use in Cancer Patients. J Pain Symptom Manage. 2010; 40(3): 327–341.
  25. Robinson S, Kissane DW, Brooker J, et al. A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research. J Pain Symptom Manage. 2015; 49(3): 595–610.
  26. Kissane D. The Contribution of Demoralization to End of Life Decisionmaking. Hastings Cent Rep. 2004; 34(4): 21.
  27. Kotlińska-Lemieszek A. Pain in a patient with cancer can be relieved effectively in the majority of cases, but not always. Why do we encounter difficulties? Medycyna Paliatywna/Palliative Medicine. 2009; 1(1): 11–21.
  28. Quintero Garzón L, Koranyi S, Engelmann D, et al. Perceived doctor-patient relationship and its association with demoralization in patients with advanced cancer. Psychooncology. 2018; 27(11): 2587–2593.
  29. Robinson JD, Hoover DR, Venetis MK, et al. Consultations between patients with breast cancer and surgeons: a pathway from patient-centered communication to reduced hopelessness. J Clin Oncol. 2013; 31(3): 351–358.
  30. Jarosz J, Kieszkowska-Grudny A, Jasińska D. 2015 Właściwe leczenie przeciwbólowe, a poziom lęku i rodzaje obaw przed stosowaniem przeciwbólowych leków opioidowych u chorych na nowotwory na przykładzie pacjentów leczonych w oddziałach hospicyjnych i lekarzy hospicjum oraz lekarzy rodzinnych. Materiał własny. Dostępny u autora oraz w raporcie badania w zasobach PAN.
  31. Graczyk M, Borkowska A, Krajnik M. Why patients are afraid of opioid analgesics - study on opioid perception in patients treated for chronic pain. Pol Arch Intern Med. 2017.
  32. Smith TJ, Temin S, Alesi ER, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol. 2012; 30(8): 880–887.
  33. Cherny NI, Catane R, Kosmidis P, et al. ESMO Taskforce on Supportive and Palliative Care. ESMO takes a stand on supportive and palliative care. Ann Oncol. 2003; 14(9): 1335–1337.
  34. Jordan K, Aapro M, Kaasa S, et al. European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Ann Oncol. 2018; 29(1): 36–43.
  35. Zimmermann C, Swami N, Krzyzanowska M, et al. Perceptions of palliative care among patients with advanced cancer and their caregivers. CMAJ. 2016; 188(10): E217–E227.
  36. Ferrell BR, Temel JS, Temin S, et al. Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017; 35(1): 96–112.
  37. Bennett MI, Eisenberg E, Ahmedzai SH, et al. Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain. Eur J Pain. 2019; 23(4): 660–668.
  38. Luckett T, Davidson PM, Green A, et al. Development of a cancer pain self-management resource to address patient, provider, and health system barriers to care. Palliat Support Care. 2019; 17(4): 472–478.
  39. https://www.nice.org.uk/guidance/cg140/chapter/1-Recommendations#communication.
  40. Desveaux L, Saragosa M, Kithulegoda N, et al. Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study. BMC Fam Pract. 2019; 20(1): 59.
  41. Desveaux L, Saragosa M, Kithulegoda N, et al. Family Physician Perceptions of Their Role in Managing the Opioid Crisis. Ann Fam Med. 2019; 17(4): 345–351.
  42. Boström B, Sandh M, Lundberg D, et al. Cancer patients' experiences of care related to pain management before and after palliative care referral. Eur J Cancer Care (Engl). 2004; 13(3): 238–245.
  43. Yamada M, Matsumura C, Jimaru Y, et al. Effect of Continuous Pharmacist Interventions on Pain Control and Side Effect Management in Outpatients with Cancer Receiving Opioid Treatments. Biol Pharm Bull. 2018; 41(6): 858–863.
  44. Bennett MI, Eisenberg E, Ahmedzai SH, et al. Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain. Eur J Pain. 2019; 23(4): 660–668.
  45. Miaskowski C, Dodd MJ, West C, et al. Lack of adherence with the analgesic regimen: a significant barrier to effective cancer pain management. J Clin Oncol. 2001; 19(23): 4275–4279.
  46. Nguyen LMT, Rhondali W, De la Cruz M, et al. Frequency and predictors of patient deviation from prescribed opioids and barriers to opioid pain management in patients with advanced cancer. J Pain Symptom Manage. 2013; 45(3): 506–516.
  47. Ward SE, Goldberg N, Miller-McCauley V, et al. Patient-related barriers to management of cancer pain. Pain. 1993; 52(3): 319–324.
  48. Cleeland CS, Gonin R, Hatfield AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994; 330(9): 592–596.
  49. Oldenmenger WH, Sillevis Smitt PAE, van Dooren S, et al. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer. 2009; 45(8): 1370–1380.
  50. Deandrea S, Montanari M, Moja L, et al. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol. 2008; 19(12): 1985–1991.
  51. Meghani SH, Bruner DW. A pilot study to identify correlates of intentional versus unintentional nonadherence to analgesic treatment for cancer pain. Pain Manag Nurs. 2013; 14(2): e22–e30.
  52. Makhlouf SM, Pini S, Ahmed S, et al. Managing Pain in People with Cancer-a Systematic Review of the Attitudes and Knowledge of Professionals, Patients, Caregivers and Public. J Cancer Educ. 2020; 35(2): 214–240.
  53. Elliott BA, Elliott TE, Murray DM, et al. Patients and family members: the role of knowledge and attitudes in cancer pain. J Pain Symptom Manage. 1996; 12(4): 209–220.
  54. Jacobsen R, Møldrup C, Christrup L, et al. Patient-related barriers to cancer pain management: a systematic exploratory review. Scand J Caring Sci. 2009; 23(1): 190–208.
  55. Valeberg BT, Miaskowski C, Paul SM, et al. Comparison of Oncology Patients' and Their Family Caregivers' Attitudes and Concerns Toward Pain and Pain Management. Cancer Nurs. 2016; 39(4): 328–334.
  56. Yates PM, Edwards HE, Nash RE, et al. Barriers to effective cancer pain management: a survey of hospitalized cancer patients in Australia. J Pain Symptom Manage. 2002; 23(5): 393–405.
  57. Aranda S, Yates P, Edwards H, et al. Barriers to effective cancer pain management: a survey of Australian family caregivers. Eur J Cancer Care (Engl). 2004; 13(4): 336–343.
  58. Ho JF, Yaakup H, Low GS, et al. Morphine use for cancer pain: A strong analgesic used only at the end of life? A qualitative study on attitudes and perceptions of morphine in patients with advanced cancer and their caregivers. Palliat Med. 2020; 34(5): 619–629.
  59. Adam R, Bond C, Murchie P. Educational interventions for cancer pain. A systematic review of systematic reviews with nested narrative review of randomized controlled trials. Patient Educ Couns. 2015; 98(3): 269–282.
  60. Reid CM, Gooberman-Hill R, Hanks GW. Opioid analgesics for cancer pain: symptom control for the living or comfort for the dying? A qualitative study to investigate the factors influencing the decision to accept morphine for pain caused by cancer. Ann Oncol. 2008; 19(1): 44–48.
  61. Marie N, Luckett T, Davidson PM, et al. Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis. Support Care Cancer. 2013; 21(12): 3529–3537.
  62. Leppert W, Pyszkowska J, Stachowiak A, et al. Access to the treatment with opioid analgesics in Poland – on the basis of a Conference “ATOME: Polish National Symposium on Access to Opioid Medication”. Medycyna Paliatywna/Palliative Medicine. 2015; 7(1): 84–89.
  63. Krajnik M, Sobański P. Leczenie farmakologiczne i radioterapia bólu nowotworowego u dorosłych i młodzieży. Omówienie wytycznych Światowej Organizacji Zdrowia 2018 w kontekście problemów ze stosowaniem opioidów. Med Prakt. 2019; 10: 75–87.
  64. Leppert W, Wordliczek J, et al. Recommendations for assessment and management of pain in cancer patients. Oncol Clin Pract. 2018; 14: 1–14.
  65. Wordliczek J, Kotlińska-Lemieszek A, Leppert W, et al. Farmakoterapia bólu u chorych na nowotwory – zalecenia Polskiego Towarzystwa Badania Bólu, Polskiego Towarzystwa Medycyny Paliatywnej, Polskiego Towarzystwa Onkologicznego, Polskiego Towarzystwa Medycyny Rodzinnej, Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii. Ból. 2017; 18(3): 11–53.
  66. Ciałkowska-Rysz A, Dzierżanowski T. Artykuły poglądowe i wytyczne
    Podstawowe zasady farmakoterapii bólu u chorych na nowotwory i inne przewlekłe, postępujące, zagrażające życiu choroby. Medycyna Paliatywna/Palliative Medicine. 2014; 6(1): 1–6.
  67. Krajnik M, Malec-Milewska M, Wordliczek J. Cancer patient-compendium of Pain Management. Medical Education. 2013.
  68. Jarosz J, Kaczmarek Z, Kowalski DM. Postępowanie w bólach nowotworowych. In: Krzakowski M, Warzocha K. ed. Zalecenia postępowania diagnostyczno-terapeutycznego w nowotworach złośliwych. Via Medica, Gdańsk 2013.
  69. Fallon M, Giusti R, Aielli F, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org, ESMO Guidelines Committee. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018; 29(Suppl 4): iv166–iv191.
  70. https://www.who.int/publications/i/item/who-guidelines-for-the-pharmacological-and-radiotherapeutic-management-of-cancer-pain-in-adults-and-adolescents.
  71. NICE clinical guideline 140. 2012. http://www.nice.org.uk/nicemedia/live/13745/ 59285/59285.pdf.
  72. Bennett MI, Eisenberg E, Ahmedzai SH, et al. Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain. Eur J Pain. 2019; 23(4): 660–668.

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