Adherence to Analgesics Among Outpatients Seriously Ill With Cancer

Background Adherence to prescribed analgesics for patients seriously ill with cancer pain is essential for comfort. Objective The objective of this study was to determine the analgesic adherence in seriously ill patients with cancer and its association with clinical and demographic characteristics. Methods This is a cross-sectional study. At home, 202 patients with cancer (mean age, 59.9 +/- 14.2 years; 58% female, 48% Black, and 42% White) admitted to hospice/palliative care completed measures on a pen tablet: PAINReportIt, Symptom Distress Scale, mood state item, Pittsburgh Sleep Quality Index item, and Pain Management Index. Results The mean current pain intensity was 4.4 +/- 2.9, and the mean worst pain in the past 24 hours was 7.2 +/- 2.7. More than one-half of participants were not satisfied with their pain level (54%) and reported their pain was more intense than they wanted to tolerate for 18 hours or longer in the last 24 hours (51%). Only 12% were not prescribed analgesics appropriate for the intensity of their pain. Adherence rates were variable: nonsteroidal anti-inflammatory drugs (0.63 +/- 0.50), adjuvants (0.93 +/- 0.50), World Health Organization step 2 opioids (0.63 +/- 0.49), and step 3 opioids (0.80 +/- 0.40). With setting/clinical/demographic variables in the model, dose intervals of less than 8 hours were associated with less adherence (P < .001). Conclusion Little progress has been made toward improving analgesic adherence even in settings providing analgesics without cost. Research focused on targeting analgesic dose intervals and barriers not related to cost is needed. Implication for Practice Dose intervals of 8 hours or longer were significantly associated with higher adherence rates; therefore, use of longer-acting analgesics is one strategy to improve pain control at the end of life.

Automated summary

This study found that adherence to analgesics for seriously ill patients with cancer pain was low. More than half of the participants were unsatisfied with their pain level and reported pain intensity exceeding their tolerance for a significant portion of the previous 24 hours. Dose intervals of less than 8 hours were associated with lower adherence rates.