Pain treatment and outcomes for patients with advanced cancer who receive follow-up care at home.
BACKGROUND
A small sample size, a high rate of exclusions, inadequate follow-up in different settings, and a lack of comparison with previous levels of analgesia have recently been reported to be the principal limitations of the World Health Organization (WHO) guidelines regarding cancer pain.


METHODS
A total of 3678 consecutive patients with advanced cancer referred to a home palliative care program were enrolled in an open prospective study over a 9-year period, from June 1988 to June 1997, to determine the effectiveness, safety, and feasibility of implementing the WHO guidelines. Age, gender, Eastern Cooperative Oncology Group performance status, pain mechanism at referral, pain and symptom intensity, and doses and days of drug administration during the course of the treatment were recorded at regular intervals.


RESULTS
Therapy was required for 70.3% of patients for a mean duration of 64 days. The mean duration periods of the 3 steps were 18, 27, and 19 days, respectively. At referral, most patients received inadequate treatment. In the last week of life, 16%, 49%, and 35% of patients were taking nonopioid drugs, moderate opioids, and strong opioids, respectively. A significant improvement in pain and symptom intensity was achieved after referral. Symptom intensity worsened in the last week of life. A minority of patients (2.65%) underwent invasive procedures.


CONCLUSIONS
This study demonstrates that a managed home care system enables patients to receive adequate pain treatment, according to WHO guidelines, in the comfort of their own homes.
Mercadante
S
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Pain Relief and Palliative Care, SAMOT, Palermo, Italy.
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods* / Q000706:statistics & numerical data; D000700:Analgesics / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006738:Hospices / Q000458:organization & administration / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D007558:Italy; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D009369:Neoplasms / Q000503:physiopathology / Q000628:therapy*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use; D013727:Terminal Care / Q000706:statistics & numerical data; D014944:World Health Organization
D000305:Adrenal Cortex Hormones; D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006993:Hypnotics and Sedatives; D009294:Narcotics; D011619:Psychotropic Drugs