Cancer-related pain and symptoms among nursing home residents: a systematic review.
BACKGROUND
Many older nursing home (NH) residents with cancer experience pain and distressing symptoms. Although some develop cancer during their time in the institution, an increasing number are admitted during their final stages of their lives. Numerous studies have evaluated various treatment approaches, but how pain and symptoms are assessed and managed in people with cancer with and without dementia is unclear.


OBJECTIVE
The objective of this review was to summarize the evidence on cancer-related symptoms among NH residents with and without dementia.


METHODS
We systematically searched the PubMed (1946-2012), Embase (1974-2012), CINAHL (1981-2012), AgeLine, and Cochrane Library (1998-2012) databases using the search terms neoplasms, cancer, tumor, and nursing home. The inclusion criteria were studies including NH residents with a diagnosis of cancer and outcome measures including pain and cancer-related symptoms.


RESULTS
We identified 11 studies (cross-sectional, longitudinal, clinical trial, and qualitative studies). Ten studies investigated the prevalence and treatment of cancer-related symptoms such as vomiting, nausea, urinary tract infections, and depression. Studies clearly report a high prevalence of pain and reduced prescribing and treatment, regardless of the cognitive status. Only one small study included people with cancer and a diagnosis of dementia. Studies of new cancer diagnoses in NHs could not be identified.


CONCLUSIONS
This review clearly reports a high prevalence of pain and reduced drug prescribing and treatment among NH residents with cancer. This issue appears to be most critical among people with severe dementia, emphasizing the need for better guidance and evidence on pain assessment for these individuals.
Faculty for Health and Social Science, Bergen University College, Bergen, Norway; Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway. Electronic address: Jorunn.Drageset@hib.no.
Jorunn
J
Drageset
Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom.
Anne
A
Corbett
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Akershus University Hospital, Lørenskog, Norway.
Geir
G
Selbaek
Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
Bettina S
BS
Husebo
D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D009513:New Hampshire / Q000453:epidemiology; D009735:Nursing Homes; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D059408:Pain Management / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D063189:Symptom Assessment / Q000706:statistics & numerical data*
Cancer; dementia; nursing home; pain; pain treatment; review; symptom management