Cancer Research Lab

Many women who die of ovarian cancer do not receive high intensity pain medication in the last 6 months of life, according to a study published in the January issue of the Journal of Pain and Symptom Management.

“When patients with cancer are nearing the end of life, they need to made as comfortable and free of pain as possible,” Dr. Sharon J. Rolnick, of HealthPartners Research Foundation, Minneapolis, Minnesota, and colleagues write. “Yet, research indicates that medical care is not always optimal; many such patients are undertreated and thus suffer significant and unnecessary pain … despite the availability of analgesic drug therapies and treatment protocols.”

In their study, the researchers examined medication use for pain management during the last 6 months of life in 421 women who died of ovarian cancer, using data from three large health maintenance organizations.

Medications used during the last 6 months of life were obtained from pharmacy databases. Each medication was categorized based on the World Health Organization classification for pain management (step 1, mild; step 2, moderate; and step 3, intense).

As the women approached death, the intensity of medication increased (p < 0.001), the investigators found.

Fifty-five percent of women were either on no pain medication or were taking a step 1 medication at 5-6 months before death. Only 9% were using step 3 medications at this point. At 3-4 months before death, 22% of women were using the highest intensity regimen, and this increased only to 54% of women at 1-2 months before death.

The researchers report that older women were less likely to be prescribed the highest intensity medication. Overall, 44% of women aged 70 and older were on step 3 medications at the end of life, compared with 70% of women under age 50 years (p < 0.001).

The use of high intensity medications did not differ by race, marital status, stage at diagnosis, or comorbidity.

The team says the findings indicate “room for improvement” in end-of-life care in this patient population.

“Because it is often possible to alleviate pain as one approaches death, it is essential that adequate assessment takes place so that suffering can be reduced,” Dr. Rolnick and colleagues point out. “Taking time to communicate with the patient is important to provide the opportunity for this evaluation, as is giving the patient permission to relay this information,” they add.

Even so, “Achieving appropriate pain management … remains a challenge.”