Cancer patients not given painkillers soon enough, study finds

GPs are increasing the anguish of cancer patients by depriving them of pain relief, research has suggested.

A study found that terminal patients in the UK were often not prescribed powerful opioids such as morphine until nine weeks before their death.

Many would have been suffering pain for much longer, said the authors. Doctors were waiting too long before allowing patients with advanced cancer to have the drugs, they claimed.

Lead researcher Dr Lucy Ziegler, from the University of Leeds, said: “We have identified for the first time the relatively late onset and short duration of strong opioid treatment in cancer patients prior to death.

“This pattern of prescribing does not match population data which points to earlier onset of pain. Nine weeks before death is considered late in the course of the cancer trajectory.”

The scientists used cancer registry data and medical records to investigate the fate of 6,080 patients who died between 2005 and 2012. They found that 48% were issued prescriptions for morphine and other opioids during the last year of their lives.

Typically, the time interval between the first prescription and death was only nine weeks. Late diagnosis could not explain the delay. On average, patients were diagnosed with the disease long before receiving opioids.

Ziegler said: “Although the prevalence of pain is higher in patients with advanced cancer and towards the end of life, for many patients pain is experienced at many stages throughout the illness.

“In fact, pain is the most common presenting symptom at diagnosis. Our research highlights the need to prioritise earlier access to effective pain management for patients with advanced cancer.”

The study found that over-60s were more likely to be prescribed painkillers late. Cancer patients who died in a hospice, rather than in hospital, at home or in a care home, were more likely to have been offered the drugs earlier.

One explanation for the findings, published in the journal Pain, could be concern over the so-called opioid epidemic – the overuse of potentially addictive opioids, said the researchers.

NHS data showed that in 2000-10 opioid prescriptions soared by 466%. However, it increased by only 16% for cancer patients. Previous studies have found up to 86% of patients with advanced cancer will experience pain.

“Within the advanced cancer population there is a need to develop mechanisms to improve pain assessment and initiate a more proactive approach to prescribing, particularly for older patients,” said Ziegler.

“Effective pain control is fundamental to good quality of life. For patients who are approaching the end of their lives, it is crucially important we strive to get this right and that we help them achieve the best quality of life possible.”

Cancer patients not given painkillers soon enough, study finds