Terminal Cancer Patients Denied Early Access to Pain Medication

On average, terminal cancer patients do not receive strong pain killers until 9 weeks before their death, despite most patients suffering long before that, a new study published in Pain found.

Researchers used data from the UK Cancer Registry to study a sample of 6080 patients who died from cancer between 2005 and 2012. They analyzed the anonymized corresponding primary care medical records of patients to learn their prescription history.

“We have identified for the first time the relatively late onset and short duration of strong opioid treatment in cancer patients prior to death,” said lead study author Lucy Ziegler. “This pattern of prescribing does not match population data which points to earlier onset of pain. Nine weeks before death is considered late in the course of the cancer trajectory.

“Although the prevalence of pain is higher in patients with advanced cancer and towards the end of life, for many patients pain is experienced at many stages throughout the illness. In fact, pain is the most common presenting symptom at diagnosis. Our research highlights the need to prioritize earlier access to effective pain management for patients with advanced cancer.”

The results of the analysis found that 48% of patients were given a prescription in primary care for a strong opioid medication, such as morphine, during the last year of their life. The median interval between the first prescription and death was 9 weeks.

“We examined whether late diagnosis could account for this, but median survival for our sample from diagnosis was 60 weeks, suggesting that most opioid prescribing in fact occurred late in the trajectory between diagnosis and death, regardless of cancer duration,” said study co-author Mike Bennett. “In addition, over 90% of all patients in the cohort had received some form of cancer treatment, therefore it was not the absence of cancer diagnosis or poor engagement with cancer services that hindered timely access to an opioid.”

Additionally, researchers found that patients above 60-years-old were more likely to be prescribed medication later than those who were younger. Those who died in hospice care, as opposed to a hospital, at home, or in a care home, were more likely to be prescribed drugs earlier.

The study authors noted that the effort to improve the treatment of cancer pain may be squashed by the growing concern of the opioid epidemic; however, prior studies have shown that up to 86% of advanced cancer patients will experience pain.

“Within the advanced cancer population there is a need to develop mechanisms to improve pain assessment and initiate a more proactive approach to prescribing, particularly for older patients,” Ziegler said. “Effective pain control is fundamental to good quality of life. For patients who are approaching the end of their lives it is crucially important we strive to get this right and that we help them achieve the best quality of life possible.

“One mechanism to achieve this may be through earlier integration of specialist palliative care and we are exploring in a related study funded by Yorkshire Cancer Research whether contact with palliative care services improves access to opioids.”