Why are we not controlling cancer pain adequately in the community?

Rosalind Adam; Peter Murchie

doi:10.3399/bjgp14X681229

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RE: Why are we not controlling cancer pain adequately in the community?
Adrienne Betteley

Published on: 07 September 2014
Experience in palliative care
Trisha Sri

Published on: 02 September 2014

Published on: (7 September 2014)
Page navigation anchor for RE: Why are we not controlling cancer pain adequately in the community?
RE: Why are we not controlling cancer pain adequately in the community?
Adrienne Betteley, End-of-life Care Programme Lead
Rosalind Adam's editorial, which highlights variable OOH access to specialist palliative care, supports the need for better specialist care at home, both for people undergoing treatment for cancer and for those wanting to die at home [1].

The evaluation of the Midhurst Macmillan Specialist Palliative Care Service has shown that if people have access to a better end of life care package, including being able to ac...
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Rosalind Adam's editorial, which highlights variable OOH access to specialist palliative care, supports the need for better specialist care at home, both for people undergoing treatment for cancer and for those wanting to die at home [1].

The evaluation of the Midhurst Macmillan Specialist Palliative Care Service has shown that if people have access to a better end of life care package, including being able to access procedures such as blood product transfusions, parenteral treatments and intrathecal analgesia at home, this can reduce the frequency of A&E attendances, decrease hospital stays, and allow people the choice of dying in their own home.

Further to this, without specialist care or 24/7 nursing, pain reduction for cancer patients at home can be very difficult to manage. In some cases, cancer patients are faced with no alternative but to travel long distances to A&E for emergency medical intervention. It is unacceptable that people with cancer are forced into this position due to lack of specialist care at home.

Macmillan research shows that 73% of people with cancer would prefer to die at home, as long as they receive the right support to do so, including adequate pain relief [2]. In lieu of this, the best alternative remains the hospice. However, hospices have limited resources and not enough beds to cater for the number of people with cancer whose preference is to die there.

With significant improvement to the provision of specialist care at home, including specialist palliative care, more terminally ill people will have the choice to have palliative and life-extending treatment in their own home. This would allow people with terminal cancer a much more fundamental choice; that of where they want to die.

1. Adam R., Murchie P. Why are we not controlling cancer pain adequately in the community? Br J Gen Pract 2014; 64(626) 438-439
2. Statistic taken from Macmillan February 2010 online survey of 1,019 UK adults living with cancer. Seventy-three percent of people with cancer said they would prefer to die at home if all their concerns about dying at home (such as access to pain relief, round the clock care, and support for their family and carers) were addressed.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Published on: (2 September 2014)
Page navigation anchor for Experience in palliative care
Experience in palliative care
Trisha Sri, GP trainee
Rosalind Adam and Peter Murchie discuss the barriers to controlling cancer-related pain in the community [1]. In particular, they highlight challenges facing health professionals. Research has shown that primary care physicians feel that they lack appropriate skills and knowledge about opioid prescribing [2].
I am currently undertaking a 3 month palliative care job at a district general hospital as part of my GP...
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Rosalind Adam and Peter Murchie discuss the barriers to controlling cancer-related pain in the community [1]. In particular, they highlight challenges facing health professionals. Research has shown that primary care physicians feel that they lack appropriate skills and knowledge about opioid prescribing [2].
I am currently undertaking a 3 month palliative care job at a district general hospital as part of my GP training. I am given the independence to review patients and formulate my own management plan using local guidelines, and then discuss them with the consultant to see how they could be improved. I am given opportunities to not only review and follow patients through in hospital, but also to do sessions in the community at the local hospice and home visits with the palliative care physicians and specialist care nurses. In this way I am given insight into when it is appropriate to refer patients to a hospice and the care provided for them there. I find home visits invaluable, since I see how specific medications are altered in relation to patients' changing symptoms.
I feel that this experience has made me feel more comfortable in dealing with drugs used in cancer pain, and in particular syringe drivers. I feel that more palliative care posts should be offered to GP trainees, even if it is just for a couple of weeks during their general practice rotation. GPs should be mindful of palliative care specialists who are always on hand to discuss their patients. However, with an ageing population and the consequent increase in the number of patients with polypharmacy, it is more important than ever that GPs have adequate experience in this field of medicine.
References:
1. Adam R., Murchie P. Why are we not controlling cancer pain adequately in the community? Br J Gen Pract September 2014 64:438- 439
2. Gardiner C, Gott M, Ingleton C, et al.(2012) Attitudes of health care professionals to opioid prescribing in end-of-life care: a qualitative focus group study. J Pain Symptom Manage 44(2):206-214.
Conflict of Interest:
None declared
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Competing Interests: None declared.