Does a regional comprehensive palliative care program improve pain in outpatient cancer patients?
BACKGROUND
Pain is still a major problem for cancer patients, and the effect of a population-based approach on patients' experience of pain is not fully understood.


OBJECTIVE
The primary aim of this study was to clarify the changes in pain intensity in outpatients before and after a regional palliative care program. The secondary aim was to clarify the prevalence of patients who had unmet needs for pain treatment and to clarify the reasons for not wanting pain treatment.


METHODS
A regional palliative care program was implemented in four regions of Japan. A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings took part in questionnaire surveys before and after the regional intervention. Responses were obtained from 859 from 1,880 and 857 from 2,123 in the preintervention and postintervention surveys, respectively.


RESULTS
After a regional palliative care program, neither worst, average, nor least pain levels in outpatients changed significantly. A total of 134 patients (16 %) reported that they needed more pain treatment. There were various reasons for not wanting pain treatment, namely, minimum interference with daily life, general nonpreference for medicines, longstanding symptoms before the diagnosis of cancer, concerns about tolerance and addiction, and experienced neuropsychiatric symptoms under current medications.


CONCLUSIONS
The regional palliative care program failed to demonstrate improvement of the pain intensity of cancer outpatients. One possible interpretation is that they are less likely to be regarded as target populations and that the study population experienced generally well-controlled pain. Future study including patients with more severe pain is needed, but to improve pain levels of cancer outpatients, intensive, patient-directed intervention seems to be more promising than region-based intervention.
Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan, tmorita@sis.seirei.or.jp.
Tatsuya
T
Morita
Kazuki
K
Sato
Mitsunori
M
Miyashita
Akemi
A
Yamagishi
Yoshiyuki
Y
Kizawa
Yasuo
Y
Shima
Hiroya
H
Kinoshita
Satoshi
S
Suzuki
Yutaka
Y
Shirahige
Takuhiro
T
Yamaguchi
Kenji
K
Eguchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000592:standards; D003191:Comprehensive Health Care / Q000379:methods / Q000592:standards; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D010045:Outpatients / Q000706:statistics & numerical data; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000592:standards; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D015995:Prevalence; D011795:Surveys and Questionnaires; D055815:Young Adult