The aim of this study was to contrast two opposed groups, namely palliative
cancer patients who were suffering significant
pain (VAS> or =4) and palliative
cancer patients with no
pain (VAS = 0) in hospital-based home care and, retrospectively, to study possible differences in relation to demographic, biological and treatment factors. The ESAS (Edmonton Symptom Assessment Scale) was used to assess 191 palliative
cancer patients on admission and after 1 week of home care. Fifty-two (27%) had
pain (mean 5.5+/-1.7) and 72 (38%) had no
pain on admission [the middle group (n=67) had VAS 1-3]. Activity was more severely affected (5.4 vs 4.2, p<0.01) and
nausea less well controlled in patients with
pain (2.3 vs 0.7, P<0.0001).
Pain was associated with the diagnosis of
prostate cancer (P<0.01) and the presence of skeletal
metastases (P<0.001), whereas
pain-free patients, with or without
analgesics, more often had
colorectal cancer (P<0.01) or
melanoma (P<0.05). The medication profiles differed between the two groups: 22 (42%) of the 52 patients with
pain were on step 3 of the WHO
analgesic ladder and 24 of 51 (47%) were receiving
antiemetics, whereas 42 (58%) of the 72 patients with no current
pain had no
analgesic prescribed and only 25% of them had
antiemetics prescribed, indicating biological differences. If
pain was present on admission a
pain analysis was formally documented in 23 (44%) of the 52 cases and the medication was changed in 27 of the 52 (52%). The patients improved after 1 week (5.4+/-1.6 vs 3.9+/-2.3, P<0.001), and the improvement was significant even when a
pain analysis was not documented or when medication was not changed. In conclusion, the results of this study indicate biological differences in
pain alleviation and the need for a more structured way of working.