One In Two Cancer Patients Suffer Moderate To Severe Pain - Of These, One In Five Are Not Receiving Treatment For Their Pain

Main Category: Cancer / Oncology
Also Included In: Pain / Anesthetics;  Lymphoma / Leukemia / Myeloma;  Breast Cancer
Article Date: 08 Jun 2007 - 1:00 PDT

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One in two (57 percent) cancer patients are enduring moderate to severe levels of pain (n=4,824) - yet of these, one in five are not receiving treatment for the management of their pain (n = 2,763). These are the interim findings, announced today, of the European Pain in Cancer survey (EPIC), the largest ever study into the prevalence, treatment and impact of cancer-related pain.

The survey, involving more than 4,000 cancer patients across Europe, is the first ever study of its type to be undertaken - covering 12 different countries and including almost all cancer types*. Its results highlight that pain is a significant factor in reducing quality of life in people with cancer, and is often inadequately controlled.

Despite the fact that almost one third of patients contacted reported that pain was the symptom leading to a diagnosis of cancer (n = 4,724), for many, whilst their cancer may be treated, their pain is sub-optimally managed.

Today's results show that of those cancer patients who experienced moderate to severe pain in the last month, pain is frequent - one in two are in daily pain - and long lasting, with almost one third having endured pain for more than a year (n = 3,059).

"The results of the EPIC survey are significant and report information about the impact and patients' perceptions of cancer pain, which will help us in our battle to improve the treatment of cancer pain. The findings highlight disappointing trends in cancer pain management; the medical community needs to get better at understanding that people with cancer are not just tumours to be treated in isolation and that the symptoms of cancer need to be managed as proactively as the disease itself. The fact that the majority of patients surveyed were being treated by oncologists yet were experiencing pain related to their cancer, demonstrates this need clearly," stated Dr Franco De Conno, MD, FRCP, Director Rehabilitation and Palliative Care Unit, National Cancer Institute (Foundation), Milan and Honorary Director of the EAPC.

A total of 4,824 patients across Europe were contacted to participate in the EPIC survey, to screen for the prevalence, severity and frequency of cancer pain. Of these patients, 57 percent (2,753) of patients screened in to the survey - these patients experienced moderate to severe pain (5 - 10 on a pain scale of 0-10) several times a month or more. Of those patients, 2,339 were eligible for the second stage of the study, and of these, 514 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 results of the in-depth survey of these 514 patients show that the majority of cancer patients are receiving prescription analgesia to help manage their pain; however, many of them reported limitations in their pain control. Nearly two thirds of patients (64 percent) report that there are times when their prescription treatment is not enough to control their pain (n = 402), with one in three patients stating that their pain is "intolerable" (n = 514). Over 60 percent of those prescribed analgesia are affected by breakthrough pain - intense short term exacerbations of pain - (n = 402); over half experience this at least once a week, and almost one in five experience this type of pain several times a day (n = 250). Despite their high levels of pain, nearly one in five of these patients were prescribed weak opioid medication, and only 31 percent were prescribed the strongest painkillers, strong opioids (n = 250).

In addition to sub-optimal use of available treatments, the EPIC survey demonstrated that the identification, ongoing evaluation and monitoring of patients' pain is not always effective. Most of the patients questioned in-depth had to proactively raise the subject of their pain for it to be discussed, with nearly a quarter stating that their physician never or only rarely asked about their pain. 24 percent of patients felt that the health professional responsible for their pain management did not know how to control their pain (n = 514).

"There is clearly a major issue here. Pain is not always easy to treat but the EPIC survey demonstrates that pain in patients with cancer is often inadequately managed. Regular communication with the patient is required and time needs to be taken to assess the level and impact of their pain," noted Dr Beverly Collett, Immediate Past-President of the British Pain Society. "The findings reveal that patients are suffering unresolved or unnecessary pain, sometimes for more than a year. Swift action needs to be taken to move to stronger alternatives when current therapy fails to achieve optimum pain control."

*The survey included almost all cancer types, solid tumour and blood-borne cancers, with the exception of skin cancers.

About the 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 a restricted 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

Methodology

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.

4,824 patients across Europe were contacted for screening interviews, to assess the prevalence, severity and frequency of cancer pain. 57 percent (2,753) of patients screened in to the survey - these patients 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. 2,071 (43 percent) patients screened out.

From those patients that screened in to the survey, 2,339 were eligible for the second stage of the study, and of these, 514 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.

You can get a copy of the European Pain in Cancer survey here.

The EPIC survey was supported by a restricted educational grant from Mundipharma International Ltd, Cambridge, England.

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