Changing pattern in the treatment of pain and other symptoms in advanced cancer patients

We reviewed the charts of 100 consecutive patients admitted to the Cross Cancer Institute during 1980 and of 100 patients admitted during 1984 in order to assess changes in the pattern of prescription of pharmacologic and non-pharmacologic treatments for cancer pain. The average daily dose of parenteral morphine per patient was 23–31mg in 1980, v 34–38 mg in 1984 (P < 0.05). The number of patients receiving medication with an interval greater than four hours decreased from 29 in 1980 to 12 in 1984 (P < 0.02). Ten patients had orders for extra doses of analgesics for “break through pain” in 1980, v 44 in 1984 (P < 0.01). Both in 1980 and 1984 only 22% of the analgesics were ordered “around the clock,” approximately half of the patients were prescribed antiemetics and two thirds of the patients were prescribed laxatives. Fifty patients were prescribed non-narcotic analgesics and two non-pharmacological treatments in 1980, v 77 and 19 respectively in 1984 (P < 0.01 for both variables). The use of meperidine and pentazocine (drugs considered not indicated for the treatment of cancer pain), decreased from 19 of 162 drugs used in 1980 (12%) to 11 of 183 in 1984 (6%; P = 0.06). There have been significant changes in the modality of treatment of pain in these patients during the last four years. The results of this study may be applied to most North American cancer centers, and they identify some areas where more instruction and discussion are needed.