News From the End of Life: Study: Cancer patients need more services

A new study reports that patients who suffer from breakthrough pain in cancer, which affects as many as two-thirds of cancer patients, require increased medical services that result in higher medical costs than cancer patients without breakthrough pain.

The research, published in the Journal of Pain, found that patients with breakthrough pain are more likely to be hospitalized more frequently and have more doctor visits — two markers for increased medical costs — than cancer patients without breakthrough pain.

Patients who suffered from breakthrough pain incurred costs of approximately $12,000 a year on medical services specific to their pain (hospitalizations, emergency room and physician visits), while patients who did not have breakthrough pain, but still experienced pain, incurred costs of approximately $2,400 a year.

"Breakthrough pain is an often overlooked consequence of cancer. We know that it can significantly impact quality of life and recovery, but this is one of the first studies to demonstrate a relationship between breakthrough pain and the increased need for medical attention, resulting in higher medical costs," explains lead investigator Barry Fortner, PhD, of the department of psychology and cancer symptom research at the West Clinic in Memphis, TN, and adjunct professor at the University of Memphis.

Breakthrough pain is a flare-up of pain characterized by rapid onset, severe intensity, and short duration. It occurs despite effective control of pain with scheduled analgesics used to control pain around the clock.

While data are limited on the prevalence of breakthrough pain, it is estimated that as many as 67% of those being treated for cancer pain experience breakthrough pain. The pain can be spontaneous and unprompted, or it can be brought on by an action as simple as swallowing, coughing, or moving. Breakthrough pain generally has the same source as persistent pain; causes can range from the cancer itself to cancer treatments.

According to the findings, more than half of the patients surveyed (53%, 527 patients) had experienced pain since being diagnosed with cancer. Of these, 49% (256 patients) had taken an analgesic on a regular schedule to treat their pain, 63% (160 patients) of whom suffered from breakthrough pain (BTP).

All patients who experienced pain were asked about the need for any of three medical services because of pain: hospitalization, emergency room visits, and doctor visits. On average, BTP patients were significantly more likely to experience pain-related hospitalizations and physician office visits than non-BTP patients. Thirty-seven percent of BTP patients (59 patients) vs. 23% of non-BTP patients (20 patients) reported pain-related hospitalizations. Fifty-six percent of BTP patients (90 patients) vs. 37% of non-BTP patients (33 patients) visited their doctor because of pain.

"Less than one-third of cancer patients in the study reported taking medication on a regular basis to treat their pain, and of these individuals, more than half reported suffering from breakthrough pain," says Fortner. "This situation is of major concern, especially since we have widely accepted treatment strategies to effectively control cancer pain, including one particular treatment designed to help manage breakthrough pain," he adds.

While the authors note that patients who reported having breakthrough pain may actually have been suffering from uncontrolled cancer pain in general, Fortner says the study results signal a need to look more carefully at how breakthrough pain is being assessed and managed among cancer patients.