Should We Treat Pain in the Elderly Palliative Care Cancer Patients Differently?

Opioidi se smatraju jednim od osnovnih lijekova u liječenju boli u palijativnoj skrbi. Dostupni podaci ukazuju na to da stariji bolesnici uzimaju drukčije analgetike uz niže doze opioida u usporedbi s mlađim bolesnicima. Međutim, nije razjašnjeno utječe li takvo doziranje opioida na lošije liječenje razine boli ili kraće preživljenje u uvjetima palijativne skrbi. Analizirali smo odnos razine boli, kvalitete života, doze opioida i preživljenja u palijativnih onkoloških bolesnika koji su bili hospitalizirani u hospiciju. Ukupno je 137 palijativnih bolesnika analizirano prospektivno. Bolesnici su podijeljeni u dvije skupine pri čemu se dob od 65 godina uzimala kao granica između skupina. Mlađi bolesnici su izražavali višu razinu boli prilikom dolaska u hospicij (5,14 prema 3,59, p=0,01), iako su stariji bolesnici koristili gotovo 20 mg manje oralnog morfij ekvivalenta (OME) na dan dolaska te čak 55 mg OME manje na dan tijekom zadnjeg tjedna (p=0,03). Nije bilo razlika u preživljenju između dviju skupina bolesnika (17,36 prema 17,58 dana). Starija skupina bolesnika također je nesteroidne antireumatike uzimala rjeđe, a paracetamol češće od mlađe skupine. Uzimanje nižih doza opioida u starijih onkoloških bolesnika u palijativnoj skrbi nije rezultiralo lošijom razinom boli pa bi to mogao biti razuman pristup liječenju boli u ovoj skupini bolesnika.Opioids are considered the cornerstone of pain management in palliative care. Available data suggest that older patients use different analgesics and lower opioid doses compared to younger patients. However, it has not been elucidated yet whether such dosing is associated with worse pain levels or shorter survival in the palliative care setting. We evaluated the relationship among pain scores, quality of life, opioid dose, and survival in palliative care cancer patients in a hospice setting. A total of 137 palliative care cancer patients were analyzed prospectively. We divided patients into two groups using the age of 65 as a cut-off value. Younger patients exhibited significantly higher pain ratings (5.14 vs. 3.59, p=0.01), although older patients used almost 20 mg less oral morphine equivalent (OME) on arrival (p=0.36) and 55 mg OME/day less during the last week (p=0.03). There were no differences in survival between the two groups (17.36 vs. 17.58 days). The elderly patients also used nonsteroidal analgesics less often and paracetamol more often. Hence, using lower opioid doses in older palliative care cancer patients does not result in worse pain rating, and could be a plausible approach for pain management in this patient group