title: Analgesic Use and Pain in Robust, Pre-Frail and Frail Older Outpatients with Cancer.
abstract: BACKGROUND
  Pain management can be challenging in frail older people with cancer due to drug-drug interactions and heightened susceptibility to adverse drug events.
  
  
  OBJECTIVE
  To investigate the relationship between analgesic use and pain by frailty status in older outpatients with cancer.
  
  
  METHODS
  A total of 385 consecutive patients aged 70 years and over who presented to an outpatient oncology clinic between January 2009 and July 2010 completed structured assessments of analgesic use (opioids, paracetamol or non-steroidal anti-inflammatory drugs), pain (10-point visual analogue scale) and clinical factors. Frailty was derived using modified Fried's frailty phenotype. Logistic regression was used to compute adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for the relationship between analgesic use and pain for each frailty group (robust, pre-frail or frail).
  
  
  RESULTS
  For robust outpatients (n = 101), there was weak evidence for a 30 % relative increase in the adjusted odds of analgesic use between outpatients who differed by one unit of pain score (95 % CI 0.995-1.71, p = 0.0532). For pre-frail outpatients (n = 190), there was evidence for a negative quadratic relationship (adjusted OR for the quadratic coefficient: 0.952, 95 % CI 0.910-0.993, p = 0.0244). For frail outpatients (n = 94), there was an 8 % relative increase in the adjusted odds of analgesic use between outpatients who differed by one unit of pain score, but no statistical evidence for association (95 % CI 0.934-1.26; p = 0.298).
  
  
  CONCLUSIONS
  These findings can be considered for the ongoing development of safe, effective strategies for analgesic use in older outpatients with cancer.
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia. kris.jamsen@monash.edu.|Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia. kris.jamsen@monash.edu.
authors.forename: Kris M
authors.initials: KM
authors.lastname: Jamsen
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Turner
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Shakib
authors.affiliation: University of Adelaide and Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Nimit
authors.initials: N
authors.lastname: Singhal
authors.affiliation: University of Adelaide and Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Hogan-Doran
authors.affiliation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Prowse
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Johns
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia.|Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell