부산대학교 도서관

Background: Despite medical advancements, pain is a major source of suffering at the end of life for patients with a solid metastatic cancer. We aimed to assess the trajectory of pain prevalence, severity, interference, and inadequacy of analgesia during the last year of life. Methods: We analysed data from the last year of life of 345 decedents from a prospective cohort study of 600 patients with a solid metastatic cancer in Singapore. Patients were surveyed every 3 months and their pain outcomes (prevalence, severity, and interference) and inadequacy of analgesia were analysed. We used mixed-effects regressions to assess the association of pain outcomes with patients' time from death, demographics, and planned or unplanned hospitalisations. Results: Prevalence of pain was higher in the last 2 months (65%) compared to 11 to 12 months (41%) before death. Pain severity and interference scores (mean [+ or -] SD) were also higher in the last month (severity: 2.5[+ or -]2.6; interference: 2.6[+ or -]3.0) compared to 12 months before death (severity: 1.4[+ or -]2.0; interference: 1.4[+ or -]2.0). At any time during the last year of life, 38% of the patients were prescribed nonsteroidal anti-inflammatory drugs, 11% were prescribed weak-opioids and 29% were prescribed strong opioids. These analgesics were prescribed through either oral, topical or injectable route. Pain outcomes were significantly worse (p-value Conclusion: Findings highlight the need for greater attention in monitoring and treatment of pain even earlier in the disease trajectory, and increased attention to patients discharged from an unplanned hospitalisation. Keywords: pain prevalence, severity, interference, inadequate analgesia
Introduction Despite medical advancements, more than 60% of patients with a solid metastatic cancer experience pain, with about one-third receiving inadequate analgesia. (1-6) Studies also show that pain prevalence among [...]