MANAGEMENT OF PAIN IN ELDERLY PATIENTS WITH CANCER

Context.-Cancer pain can be relieved with pharmacological agents as in dicated by the World Health Organization (WHO). All too frequently pai n management is reported to be poor. Objective.-To evaluate the adequa cy of pain management in elderly and minority cancer patients admitted to nursing homes. Design.-Retrospective, cross-sectional study. Setti ng.-A total of 1492 Medicare-certified and/or Medicaid-certified nursi ng homes in 5 states participating in the Health Care Financing Admini stration's demonstration project, which evaluated the implementation o f the Resident Assessment Instrument and its Minimum Data Set. Study P opulation.-A group of 13 625 cancer patients aged 65 years and older d ischarged from the hospital to any of the facilities from 1992 to 1995 , Data were from the multilinked Systematic Assessment of Geriatric Dr ug Use via Epidemiology (SAGE) database. Main Outcome Measure.-Prevale nce and predictors of daily pain and of analgesic treatment. Pain asse ssment was based on patients' report and was completed by a multidisci plinary team of nursing home personnel that observed, over a 7-day per iod, whether each resident complained or showed evidence of pain daily . Results.-A total of 4003 patients (24%, 29%, and 38% of those aged g reater than or equal to 85 years, 75 to 84 years, and 65 to 74 years, respectively) reported daily pain. Age, gender, race, marital status, physical function, depression, and cognitive status were all independe ntly associated with the presence of pain. Of patients with daily pain , 16% received a WHO level 1 drug, 32% a WHO level 2 drug, and only 26 % received morphine. Patients aged 85 years and older were less likely to receive either weak opiates or morphine than those aged 65 to 74 y ears (13% vs 38%, respectively). More than a quarter of patients (26%) in daily pain did not receive any analgesic agent. Patients older tha n 85 years in daily pain were also more likely to receive no analgesia (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.13-1.73), Oth er independent predictors of failing to receive any analgesic agent we re minority race (OR, 1.63; 95% CI, 1.18-2.26 for African Americans), low cognitive performance (OR, 1.23; 95% CI, 1.05-1.44), and the numbe r of other medications received (Oc, 0.65; 95% CI, 0.5-0.84 for 11 or more medications). Conclusions.-Daily pain is prevalent among nursing home residents with cancer and is often untreated, particularly among older and minority patients.