Cancer pain and the side effects associated with its treatment are having a significant impact on the quality of life of many cancer patients across Europe and Israel, according to findings published in the Annals of Oncology.1 Results from the European Pain in Cancer survey (EPIC) reveal the emotional and physical impact of cancer pain, with over a third of patients (36 percent) describing their pain as intolerable (n=573) and over two thirds (69 percent) experiencing difficulties in performing normal activities in daily life as a result of their pain (n=5,084).
The survey highlights the extent to which cancer pain affects the everyday lives of patients, but also its impact on their relationships with family, friends and work colleagues. Almost a third of patients (30 percent) are in too much pain to care sufficiently for themselves or others and four in ten (43 percent) feel that their pain makes them an increased burden to others (n=573). Half (51 percent) say their pain stops them concentrating or thinking (n=573) and of those still in employment, half (52 percent) report that their pain impacts on their work performance (n=136).
Findings reveal that many patients are not receiving optimal treatment for their pain, with almost two thirds of patients (63 percent) on prescribed medication reporting breakthrough pain or inadequate pain relief (n=441). However, of those who are prescribed opioid medication for their pain, many patients are experiencing further problems as a result of the side effects of their treatment. Of those patients prescribed opioid medication (n=266), nearly three quarters (74 percent) experience side effects, of which constipation is the most commonly reported (37 percent). Of the patients who experience opioid-induced constipation, a quarter (25 percent) are not being co-prescribed a laxative by their clinician (n=266). In addition, other frequently reported side effects include nausea and vomiting (33 percent), whilst one in five (20 percent) experience sedation (n=266).
"The results of the EPIC study underline the impact of cancer pain on the day-to-day lives of patients but also strongly highlight that side effects of pain treatments can cause further problems. Many patients must choose between endure their pain, or suffer the side effects from their pain medication," commented Professor Harald Breivik, Faculty of Medicine, University of Oslo. "Clinicians need to adhere to pain management guidelines, specifically the World Health Organisation's pain relief ladder2, in order to improve access to the appropriate level of pain medication for patients. Keeping a close track of the pain relief obtained and the side effects of these medications, and adjusting therapy to both aspects, are mandatory in order to improve pain patients' quality of life."
The survey demonstrates that cancer pain and its management issues can affect the relationship between healthcare professionals and their patients. When asked about their healthcare professional's understanding of pain and its impact, one in two patients (50 percent) believe their healthcare professional does not consider their quality of life as an important aspect of their overall care plan (n=573) and over a third (38 percent) believe that their clinician would rather treat their cancer than the accompanying pain (n=573). Over a quarter (26 percent) believe their clinicians do not know how to treat moderate-to-severe cancer pain (n=573).
"These findings demonstrate a need for improved communication between patients and their clinicians," said Dr Beverly Collett, Past-President of the British Pain Society. "Patients need to make clinicians more aware of the impact of their pain and clinicians need to be better prepared to assess, discuss and understand cancer pain and its impact on their patients."
The EPIC survey was conducted across 12 countries* between 2006 and early 2007 and aimed to explore the burden of cancer pain, current pain treatment practices across Europe and Israel and their effects in all cancer types** and cancer stages. 5084 adult patients were contacted for screening interviews. Of these, 2864 patients completed the screening interview, rated their pain to be 5 or above on a pain scale and had experienced recurrent pain several times a month or more in the last month. Following this phase, 573 patients were then randomly selected to complete in-depth attitudinal questionnaires.
About the EPIC Survey
The EPIC survey was conducted by an independent market research company under the auspices of the European Association of Palliative Care (EAPC) and with the help of a Steering Panel comprising of the European Oncology Nursing Society (EONS), the Lance Armstrong Foundation and OPEN Minds - a group of leading experts from across Europe specialising in research and the management of persistent pain - and sponsored by an educational grant from Mundipharma International Limited.
The objectives of the survey were to:
- Investigate the impact of pain on cancer patients
- Establish the prevalence of pain for patients across all cancer stages in Europe
- Understand current treatment practices and levels of satisfaction, and identify the gaps in the existing provision of effective pain management for cancer patients across Europe
- Explore the impact of pain on sufferers' quality of life
The EPIC survey was conducted in 11 European countries: Czech Republic, Denmark, Finland, France, Ireland, Italy, Norway, Romania, Sweden, Switzerland, UK; and Israel.
Patients were recruited from a broad cross section of the population, including patients with all stages of disease (early, locally advanced, advanced and metastatic). In each country as many potential routes of recruitment as possible were undertaken, including recruitment via physicians in both primary and secondary care, patient groups, online patient panels and newspaper advertisements. However, methods of recruitment were to a certain extent limited by individual country's regulations. Specialist pain units and palliative care centres were not approached to avoid bias in the collection of data.
5,084 patients across Europe and Israel were contacted for screening interviews to assess the prevalence, severity and frequency of cancer pain. 56 percent (2,864) of the patients contacted completed the screening interview, rated the intensity of their pain to be 5 or above (on a scale of 0 to 10, where 0 means no pain at all, and 10 is the worst pain imaginable) and had experienced recurrent pain several times a month or more in the last month. All patients who screened in were aged 18 or above and were suffering from a solid or blood borne tumour. 2,220 (44 percent) patients screened out.
From those patients that screened in to the survey, 573 patients were randomly selected to complete an in-depth attitudinal questionnaire. These patients were suffering from recurrent pain in the last month with a frequency greater than several times per week.
The EPIC survey was supported by an educational grant from Mundipharma International Ltd, Cambridge, England
*Czech Republic, Denmark, Finland, France, Ireland, Israel, Italy, Norway, Romania, Sweden, Switzerland and the UK.
** The survey included almost all cancer types, solid tumour and blood-borne cancers, with the exception of skin cancers.