Palliative Care and Analgesic Management in Geriatric Cancer Patients
Zeliha GÜZELÖZa , Alaettin ARSLANb
aİzmir City Hospital, Clinic of Radiation Oncology, İzmir, Türkiye
bKayseri City Hospital, Clinic of Radiation Oncology, Kayseri, Türkiye
Güzelöz Z, Arslan A. Palliative care and analgesic management in geriatric cancer patients. In: Metcalfe E, ed. Radiotherapy and Current Developments in Geriatric Cancers. 1st ed. Ankara: Türkiye Klinikleri; 2024. p.65-71.
ABSTRACT
With the prolongation of life expectancy, we are witnessing an increasing number of elderly cancer patients in our daily practice. As oncologists, it is imperative for us to provide these patients with treatment options that not only encompass basic oncological therapies but also enhance their quality of life and offer support from a psychosocial perspective to both themselves and the caregivers. The aim is to support caregivers while increasing patients’ adherence to treatment through this comprehensive approach called palliative care. Pain is one of the most common symptoms observed in cancer patients that impairs the quality of life and causes polypharmacy, especially in elderly patients. In this section, palliative care in elderly cancer patients and analgesia management, which is a curucial part of it, will be discussed.
Keywords: Analgesics, opioid; cancer pain; geriatrics; palliative care; radiotherapy
Referanslar
- Chow E, Wong R, Vachon M, Connolly R, Andersson L, Szumacher E, et al. Referring physicians' satisfaction with the rapid response radiotherapy programme. Survey results at the Toronto-Sunnybrook Regional Cancer Centre. Support Care Cancer. 2000;8(5):405-9. [Crossref] [PubMed]
- Stavas MJ, Pagan JD, Varma S, Li B, Kachnic LA. Building a palliative radiation oncology program: From bedside to B.E.D. Pract Radiat Oncol. 2017;7(3):203-8. [Crossref] [PubMed]
- WHO | WHO Definition of Palliative Care. WHO; 2012. [cited: Mar 13, 2024]. Available from: [Link]
- Corn BW, Hahn E, Cherny NI. Palliative radiation medicine. In: Tepper JE, Foote RL, Michalski JM, eds. Gunderson's & Tepper's Clinical Radiatio Oncology. 5th ed. Philadelphia 2021. p. 366-82.
- Huynh L, Moore J. Palliative and end-of-life care for the older adult with cancer. Curr Opin Support Palliat Care. 2021;15(1):23-8. [Crossref] [PubMed]
- Carroll C, Ruder L, Miklosovic C, Bauhof RM, Chiec L, Owusu C, et al. Early Palliative Care for the Geriatric Patient with Cancer. Clin Geriatr Med. 2023;39(3):437-48. [Crossref] [PubMed]
- Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-42. [Crossref] [PubMed]
- Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721-30. [Crossref] [PubMed]
- Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, et al. Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. J Clin Oncol. 2015;33(13): 1438-45. [Crossref] [PubMed] [PMC]
- Alexander K, Goldberg J, Korc-Grodzicki B. Palliative Care and Symptom Management in Older Patients with Cancer. Clin Geriatr Med. 2016;32(1):45-62. [Crossref] [PubMed] [PMC]
- Balducci L, Dolan D. Palliative Care of Cancer in the Older Patient. Curr Oncol Rep. 2016;18(12):70. [Crossref] [PubMed]
- Wright DK, Ma G, Charlebois K, Gimmig K, Hodgson L. "We're Cancer Care Nurses": Perceptions About Providing Palliative Care in a Community Hospital. J Hosp Palliat Nurs. 2023;25(2):82-9. [Crossref] [PubMed]
- El-Jawahri A, Traeger L, Park ER, Greer JA, Pirl WF, Lennes IT, et al. Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer. Cancer. 2014;120(2):278-85. [Crossref] [PubMed]
- Clayton JM, Butow PN, Arnold RM, Tattersall MH. Discussing life expectancy with terminally ill cancer patients and their carers: a qualitative study. Support Care Cancer. 2005;13(9):733-42. [Crossref] [PubMed]
- [cited: Mar 13, 2024]. Available from: [Link]
- Hairon N. Patients need more information on palliative chemotherapy. Nurs Times. 2008;104(32):21-2.
- Jordan K, Aapro M, Kaasa S, Ripamonti CI, Scotté F, Strasser F, et al. European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Ann Oncol. 2018;29(1):36-43. [Crossref] [PubMed]
- Dittrich C, Kosty MP, Jezdic S, Pyle D, Berardi R, Bergh J, et al. Global Curriculum Edition 2016: European Society for Medical Oncology/American Society of Clinical Oncology Recommendations for Training in Medical Oncology. J Clin Oncol. 2017;35(2):254-5. [Crossref] [PubMed]
- Ge L, Mordiffi SZ. Factors Associated With Higher Caregiver Burden Among Family Caregivers of Elderly Cancer Patients: A Systematic Review. Cancer Nurs. 2017;40(6):471-8. [Crossref] [PubMed]
- Lutz S, Spence C, Chow E, Janjan N, Connor S. Survey on use of palliative radiotherapy in hospice care. J Clin Oncol. 2004;22(17):3581-6. [Crossref] [PubMed]
- Gripp S, Mjartan S, Boelke E, Willers R. Palliative radiotherapy tailored to life expectancy in end-stage cancer patients: reality or myth? Cancer. 2010;116(13):3251-6. [Crossref] [PubMed]
- Jones JA, Lutz ST, Chow E, Johnstone PA. Palliative radiotherapy at the end of life: a critical review. CA Cancer J Clin. 2014;64(5):296-310. [Crossref] [PubMed]
- Lutz ST, Jones J, Chow E. Role of radiation therapy in palliative care of the patient with cancer. J Clin Oncol. 2014;32(26):2913-9. [Crossref] [PubMed] [PMC]
- Spencer K, Parrish R, Barton R, Henry A. Palliative radiotherapy. BMJ. 2018;360:k821. [Crossref] [PubMed] [PMC]
- O'Donovan A, Morris L. Palliative Radiation Therapy in Older Adults With Cancer: Age-Related Considerations. Clin Oncol (R Coll Radiol). 2020;32(11):766-74. [Crossref] [PubMed]
- Kunkler IH, Audisio R, Belkacemi Y, Betz M, Gore E, Hoffe S, et al; SIOG Radiotherapy Task Force. Review of current best practice and priorities for research in radiation oncology for elderly patients with cancer: the International Society of Geriatric Oncology (SIOG) task force. Ann Oncol. 2014; 25(11):2134-46. [Crossref] [PubMed]
- Hoskin PJ, Hopkins K, Misra V, Holt T, McMenemin R, Dubois D, et al. Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer: The SCORAD Randomized Clinical Trial. JAMA. 2019;322(21):2084-94. [Crossref] [PubMed] [PMC]
- Thirion PG, Dunne MT, Kelly PJ, Flavin A, O'Sullivan JM, Hacking D et al. Non-inferiority randomised phase 3 trial comparing two radiation schedules (single vs. five fractions) in malignant spinal cord compression. Br J Cancer. 2020;122(9):1315-23. [Crossref] [PubMed] [PMC]
- Zeng L, Chow E. The added challenges of bone metastases treatment in elderly patients. Clin Oncol (R Coll Radiol). 2013;25(5):283-9. [Crossref] [PubMed]
- Kumar A, Straka C, Courtney PT, Vitzthum L, Riviere P, Murphy JD. Cost-Effectiveness Analysis of Stereotactic Ablative Radiation Therapy in Patients With Oligometastatic Cancer. Int J Radiat Oncol Biol Phys. 2021;109(5):1185-94. [Crossref] [PubMed]
- Diplas BH, Santos PMG, Shahrokni A, Warner A, Iyengar P, Yang JT, et al. The Role of Ablative Radiotherapy in Older Adults With Limited Metastatic Disease. Semin Radiat Oncol. 2022;32(2):135-41. [Crossref] [PubMed] [PMC]
- Pignon T, Fernandez L, Ayasso S, et al. Impact of radiation oncology practice on pain: a cross-sectional survey. Int J Radiat Oncol Biol Phys 2004;60:1204-10. [Crossref] [PubMed]
- Rietman J, Dijkstra P, Debreczeni R, et al. Impairments, disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery. Disabil Rehabil. 2004;26:78-84. [Crossref] [PubMed]
- Lin MH, Wu PY, Tsai ST, et al. Hospice palliative care for patients with hepatocellular carcinoma in Taiwan. Palliat Med. 2004;18:93-9. [Crossref] [PubMed]
- Stromgren AS, Groenvold M, Petersen MA, et al. Pain characteristics and treatment outcome for advanced cancer patients during the first week of specialized palliative care. J Pain Symptom Manage. 2004;27:104-13. [Crossref] [PubMed]
- Di Maio M, Gridelli C, Gallo C, et al. Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer. Br J Cancer. 2004; 90:2288-296. [Crossref] [PubMed] [PMC]
- Green CR, Hart-Johnson T, Loeffler DR. Cancerrelated chronic pain. Examining quality of life in diverse cancer survivors. Cancer. 2011;117(9):1994-2003. [Crossref] [PubMed]
- Deandrea SM, Montanari M, Moja L, Apolone G. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 2008;19(12):1985-91. [Crossref] [PubMed] [PMC]
- Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer. 1997;80:1273-83. [Crossref]
- Wang N, Dong Y, Zhao L, Zhao H, Li W, Cui J. Factors associated with optimal pain management in advanced cancer patients. Current Problems in Cancer. 2019;43(1):77-85. [Crossref] [PubMed]
- Urban D, Cherny N, Catane R. The management of cancer pain in the elderly. Critical reviews in oncology/hematology. 2010;73(2):176-83. [Crossref] [PubMed]
- Gloth FM, 3rd. Geriatric pain. Factors that limit pain relief and increase complications. Geriatrics. 2000;55:46-8, 51-4.
- Herr K, Garand L. Assessment and measurement of pain in older patients. Clin Geriatr Med. 2001;17:457-78. [Crossref] [PubMed]
- American Society of Geriatrics Position Papers: The Management of Persistent Pain in Older Persons 2002. [cited: Mar 13, 2024]. Available from: [Link]
- Wilkie D, Lovejoy N, Dodd M, Tesler M. Cancer pain intensity measurement: concurrent validity of three tools-finger dynamometer, pain intensity number scale, visual analogue scale. Hospice J. 1990;6:1-13. [Crossref] [PubMed]
- Herr KA, Mobily PR. Comparison of selected pain assessment tools for use with the elderly. Appl Nurs Res. 1993;6:39-46. [Crossref] [PubMed]
- Melzack R. The McGill pain questionnaire: major properties and scoring methods. Pain. 1975;1:277e99. [Crossref] [PubMed]
- Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract. 2003;3:310e6. [Crossref] [PubMed]
- Dudgeon D, Raubertas RF, Rosenthal SN. The short-form McGill Pain Questionnaire in chronic cancer pain. J Pain Symptom Manage. 1993;8:191-5. [Crossref] [PubMed]
- Fishman B, Pasternak S, Wallenstein SL, Houde RW, Holland JC, Foley KM. The Memorial Pain Assessment Card. A valid instrument for the evaluation of cancer pain. Cancer. 1987;60:1151-8. [Crossref] [PubMed]
- Gronlund B, Hogdall C, Hansen H, Engelholm S. Performance status rather than age is the key prognostic factor in second line treatment of elderly patients with epithelial ovarian cancer. Cancer. 2002;94:1961-7. [Crossref] [PubMed]
- Elderly Lung Cancer Vinorelbine Italian Study Group. Effects of vinorelbine on quality of life and survival of elderly patients with advanced non-small cell lung cancer. JNCI. 1999;91:66-72. [Crossref] [PubMed]
- Popescu R, Norman A, Ross P, Parikh B, Cunningham D. Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. JCO. 1999;17(8):2412-8. [Crossref] [PubMed]
- Sze W, Shelley M, Held I, Wilt T, Mason M. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy-a systematic review of randomised trials. Clin Oncol. 2003;15:345-52. [Crossref] [PubMed]
- Turner N, Muers M, Haward R, Mulley G. Do elderly people with lung cancer benefit from palliative radiotherapy? Lung Cancer. 2005;49(August (2)):193-202. [Crossref] [PubMed]
- Rao A, Cohen HJ. Symptom management in the elderly cancer patient: fatigue, pain, and depression. JNCI Monographs. 2004;32:150-7. [Crossref] [PubMed]
- AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50(Suppl 6):S205-24. [Crossref] [PubMed]
- Malec M, Shega JW. Pain management in the elderly. Medical Clinics. 2015; 99(2):337-50. [Crossref] [PubMed]
- Pickering G, Loriot MA, Libert F, Eschalier A, Beaune P, Dubray C. Analgesic effect of acetaminophen in humans: first evidence of a central serotonergic mechanism. Clinical Pharmacology & Therapeutics. 2006;79(4):371-8. [Crossref] [PubMed]
- Larson AM, Polson J, Fontana RJ, et al. Acute Liver Failure Study Group. Acetaminophen-induced acute liver failure: results of a US multicenter prospective study. Hepatology. 2005;42(6):1364-72. [Crossref] [PubMed]
- U.S Food and Drug Administration. FDA Drug Safety Communication: Prescription acetaminophen products to be limited to 325 mg per dosage unit; boxed warning will highlight potential for severe liver failure. January 13, 2011. [cited: Dec 11, 2014]. Available from: [Link]
- American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331-46. [Crossref] [PubMed]
- Pilotto A, Franceschi M, Leandro G, et al. The risk of upper gastrointestinal bleeding in the elderly users of aspirin and other nonsteroidal anti-inflammatory drugs: the role of gastroprotective drugs. Aging Clin Exp Res. 2003;15: 494-9. [Crossref] [PubMed]
- Grond S, Zech D, Schug SA, Lynch J, Lehmann KA. Validation of World Health Organization guidelines for cancer pain relief during the last days and hours of life. J Pain Symptom Manage. 1991;6:411-22. [Crossref] [PubMed]
- Pasero C, Reed BA, McCaffery M. Pain in the elderly. In Pain: clinical Manual. 2nd ed. St. Louis (MO): Mosby; 1999. p. 674-710.
- Herr K. Chronic pain in the older patient: management strategies. 2. J Gerontol Nurs. 2002;28:28-34; quiz 54-5. [Crossref] [PubMed]
- Portenoy RK. Pain management in the older cancer patient. Oncology (Huntingt). 1992;6:86-98.
- Irving GA. Contemporary assessment and management of neuropathic pain. Neurology. 2005;64(12 Suppl 3):S21-S7. [Crossref] [PubMed]