Journal of Clinical Oncology, Vol 10, 149-155, Copyright © 1992 by American Society of Clinical Oncology
Pain, opioid use, and survival in hospitalized patients with advanced cancer
FJ Brescia, RK Portenoy, M Ryan, L Krasnoff and G Gray
Calvary Hospital, Bronx, NY 10461.
PURPOSE: Pain is a common and feared symptom for patients with incurable
cancer. Comprehensive assessment provides the foundation for effective pain
management, and data that clarify the relationship between pain and other
relevant factors also facilitate this process. The main objective of the
study was to develop a clinical data base for advanced cancer patients and
to survey data to determine (1) pain severity at admission, (2) opioid use
at admission, (3) change in opioid use during the hospital stay, and (4)
survival in the hospital. PATIENTS AND METHODS: Information was collected
prospectively on 1,103 patients admitted and on 1,017 patients who died
within 6 months of the study's end. Demographic and clinical data were
recorded 72 hours after admission and soon after death or discharge.
RESULTS: Seventy-three percent of patients had pain at admission. Cancer of
the cervix was frequently (68%) associated with severe pain, as were
prostate (52%) and rectal/sigmoid tumors (49%). Severe pain was more
probable in those with bone metastasis, those admitted from home, and in
those younger than 55 years of age. The majority (71.7%) of patients had a
stable dosing pattern, and only 4.2% of the patients required dose
increases of at least 10% per day. CONCLUSION: This study demonstrated the
wide variability in opioid doses required. No reliable predictor of opioid
requirement was identified, and this lack of predictability of cancer pain
severity underscores the need for ongoing assessment.
