Palliative care in the management of lung cancer: Analgesic utilization and barriers to optimal pain management

Charles B. Simone II, MD; Neha Vapiwala, MD; Margaret K. Hampshire, BSN; James M. Metz, MD

doi:10.5055/jom.2012.0091

Authors

Charles B. Simone II, MD
Neha Vapiwala, MD
Margaret K. Hampshire, BSN
James M. Metz, MD

DOI:

https://doi.org/10.5055/jom.2012.0091

Keywords:

lung cancer, analgesics, pain management, pain, quality of life

Abstract

Objective: Little data exist on assessing pain medication utilization among lung cancer patients or on the reasons they fail to receive optimal analgesic treatment. This study evaluates those reasons and investigates perceived causes of pain among individuals with lung cancer.
Design: An institutional review board-approved Internet-based questionnaire was posted on http://www.oncolink.org that included 22 queries evaluating analgesic utilization, pain control, and attitudes regarding analgesics.
Patients and participants: Between November 2005 and July 2008, 90 respondents with lung malignancies participated. Respondents were Caucasian (89 percent), male (54 percent), and had non-small-cell lung cancer (79 percent), smallcell lung cancer (12 percent), or mesothelioma (9 percent).
Results: Respondents underwent surgery (48 percent), chemotherapy (58 percent), and radiotherapy (44 percent). Most respondents (92 percent) reported experiencing pain, with 52 percent attributing pain directly to cancer, 38 percent to cancer treatment, and 67 percent unsure of the primary cause. Among respondents experiencing pain, 33 percent did not use analgesics. Analgesic utilization was less in men (p = 0.050) but did not differ by minority status (p = 0.127), education level (p = 0.37), or lung cancer histology (p = 0.134). Analgesic use was higher in subjects receiving radiotherapy (p = 0.002) and chemotherapy (p = 0.013) but not surgery (p = 0.16). Reasons for not taking analgesics included fear of addiction/dependence (76 percent), healthcare providers not recommending medications (71 percent), and inability to pay for analgesics (56 percent). Participants pursued physical therapy (76 percent) and other complementary modalities (24 percent) for pain control.
Conclusions: Many individuals with lung cancer perceive pain from both their disease and their cancer treatment. However, some study respondents did not use analgesics due to concerns of addiction, cost, or their healthcare providers not recommending analgesics. Medical professionals providing medical management for lung cancer patients should make pain management a priority and regularly discuss pain symptoms and pain management with patients.

Author Biographies

Charles B. Simone II, MD

Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Neha Vapiwala, MD

Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Margaret K. Hampshire, BSN

Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

James M. Metz, MD

Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

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