title: Pain characteristics and analgesic treatment in an aged adult population: a 4-week retrospective analysis of advanced cancer patients followed at home.
abstract: BACKGROUND
  Studies of cancer pain management in older people are lacking and more information is needed.
  
  
  OBJECTIVE
  The aim of this study was to assess the possible differences in pain intensity, pain mechanisms, breakthrough pain (BTP) medications and use of opioids between adult cancer patients and older cancer patients.
  
  
  METHODS
  A retrospective review of computerized charts was undertaken for advanced cancer patients in the home-care setting. Pain intensity, pain mechanisms, the presence of BTP, analgesic treatments in the last 4 weeks of life, and frequency of change in opioid or route of administration were measured. Patients were divided into two groups: adults (<65 years, A), and aged (≥65 years, O). Within the latter group, three subgroups were assessed: old (65-74 years, O1), older (75-84 years, O2), and the oldest (≥85 years, O3).
  
  
  RESULTS
  A total of 412 patients were available for analysis. No differences in Karnofsky status and survival in the two age groups were found (p=0.2 and p=0.09, respectively). No differences in pain intensity were observed among age subgroups. The O3 group presented a lower prevalence of BTP in comparison with other groups. Significant changes in opioid doses were reported with an inverse relationship with age (p=0.0001). Opioid switching was less frequently present in the older patients (p<0.005).
  
  
  CONCLUSIONS
  Careful opioid titration may achieve adequate analgesia in older patients by using lower doses of opioids, with a lower rate of opioid switching. The prevalence of BTP was only shown to be lower in the oldest group (O3).
authors.affiliation: Anesthesia and Intensive Care and Pain Relief and Supportive Care, La Maddalena Cancer Center and University of Palermo, Via San Lorenzo 312, 90146, Palermo, Italy, terapiadeldolore@lamaddalenanet.it.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.forename: Federica
authors.initials: F
authors.lastname: Aielli
authors.forename: Francesco
authors.initials: F
authors.lastname: Masedu
authors.forename: Marco
authors.initials: M
authors.lastname: Valenti
authors.forename: Corrado
authors.initials: C
authors.lastname: Ficorella
authors.forename: Giampiero
authors.initials: G
authors.lastname: Porzio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059390:Breakthrough Pain / Q000188:drug therapy; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
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