This article is more than 5 years old. Information may no longer be current.
Palliative care at home leads to greater pain relief in patients with cancer
Click Here to Manage Email Alerts
Specialist palliative care at home during the last 3 months of life appeared associated with greater pain relief among patients with life-limiting conditions, especially progressive cancer, according to study results published in BMC Medicine.
Researchers also observed associations between effective end-of-life pain management and having a recorded preference for place of death.
Approximately two-thirds of patients who died within the home and received specialist palliative care reported “good” pain relief compared with 37.5% who did not receive this type of care.
“This is the largest study that shows a significant association between receiving specialist palliative care at home and improved pain relief within routine clinical services,” Yousuf ElMokhallalati, MD, of the Leeds Institute of Health Sciences at the University of Leeds in the U.K., and colleagues wrote. “Previous research has found an inconclusive relationship between palliative care support and improved pain relief.”
ElMokhallalati and colleagues examined the relationship between pain relief at home during the last 3 months of life and palliative care using data from the National Survey of Bereaved People, or VOICES, in England.
The VOICES survey is mailed to the person who reported the death, typically a close friend or family member. A total of 110,311 completed surveys were received during the study period from 2011 to 2015, and the study investigators included data from 43,509 surveys (39.3%) after applying their inclusion criteria. Investigators excluded survey responses if the decedent did not spend any time at home during the last 3 months of life, did not have any pain during this period, died suddenly or was not ill before dying.
The study’s primary outcome was to determine variables affecting the efficacy of pain relief for those who died within their homes during the last 3 months of life. The researchers evaluated the outcome as a binary variable, with “good pain relief” defined as pain that was relieved completely all or some of the time, and “poor pain relief” defined as pain that was relieved partially or not at all.
A total of 35.7% of those who died received palliative care in the home and 24.6% had recorded their preferred location for end-of-life care. Those who died of cancer were far more likely to have specialist palliative care within the home during the last 3 months of life than those who died of noncancer-related illness (66.2% vs 9.9%); they also were more likely to have a documented place-of-death preference (36.6% vs 13.1%).
Those with noncancer-related diseases accounted for 51.2% of the respondents, with slightly less than half (47.8%) of all decedents reported as having good pain relief.
Notably, the researchers found a significant association between cancer and pain relief, with 56.4% of those who died of cancer reported as having good pain relief compared with 39.6% of those who died of other causes (P < .001).
The study also showed a significant association between good pain relief and receiving specialist palliative care services at home; 66.2% of those who received palliative care during the study period were reported as experiencing good pain relief compared with 37.5% for those who did not (multivariate adjusted OR = 2.76; 95% CI, 2.62-2.72).
There was also a significant association between good pain relief and patients who had a recorded preference for place of death (adjusted OR = 1.87; 95% CI, 1.84-1.9). A spouse or partner was also significantly more likely to report the patient as receiving good pain relief compared with a son or daughter (adjusted OR = 1.5; 95% CI, 1.47-1.53).
“We need to ensure that all people, whether they have cancer, heart or lung diseases, or any other life-limiting condition, are being offered appropriate support towards the end of their lives,” ElMokhallalati said in a press release.
“Future research is needed to explore the reasons behind these variations,” he told HemOnc Today, adding that his group is currently conducting research they hope will help explain these disparities.
The researchers acknowledged a few study limitations. The pain-relief evaluations are based on observations by a family member, spouse, friend or caregiver — which may not be an accurate assessment. Nevertheless, researchers noted that “without this proxy measure, there are only a few, poorly powered studies to inform important policy documents and the practice of end-of-life care.”
The study is also susceptible to recall bias, because survey forms were sent out 4 to 11 months after the patient died.
Although the study showed significant associations between pain relief and specialist palliative care and preferred place of death, the researchers cautioned that they cannot demonstrate causality.
“However, it is entirely plausible that contact with specialist palliative care or discussing and recording preferred place of death results in better pain relief, particularly because of the emphasis by specialist palliative care clinicians on symptom management and expertise in use of opioid analgesia,” they wrote. “These findings have contributed to evidence supporting the need for, and the benefits of, specialist palliative care and recording preferences for place of death for patients with advanced disease.” – by Drew Amorosi
For more information: Yousuf ElMokhallalati , MD, can be reached at 1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Room 10.39, Level 10, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK; email: y.elmokhallalati@leeds.ac.uk.
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts