Evaluation of the quality of care of elderly patients with chronic and breakthrough pain treated with opioids: SAND study

Abstract

Objective: The objective of this study was to evaluate the quality of care of elderly patients with treatment for chronic pain (CP) and breakthrough pain (BTP).

Methods: A cross-sectional observational study was conducted in 20 pain units, selecting patients aged 70 years or older with baseline controlled CP in treatment with opioids and a diagnosis of BTP. Patients were classified as first episode of BTP or patient in follow-up. The patients completed the SF-12 quality of life questionnaire, Brief Pain Inventory, Lattinen Index, and Edmonton Symptoms Assessment Scale. The patient’s satisfaction with the treatment was evaluated through a visual analogue scale (VAS).

Results: A total of 199 patients were included with 67.7% women (132). There were 28.5% (55) attending the first visit for BTP and 71.5% (138) were on follow-up visits. On the physical component of the SF-12, 95% had a score below the mean for the Spanish general population and 44% had a score below the mean on the mental component. Worse scores were observed for women in the bodily pain dimension (p = .032) and in the overall physical component (p = .045). There were 62.9% (112) patients satisfied with the treatment for BTP. In the multivariate analysis, SF-12 physical component scores (p = .017) and patient’s satisfaction with BTP treatment was better in follow-up visits (p = .031).

Conclusions: All clinical parameters compared between first visit for the treatment of BTP and follow-up visits were improved, so the quality of care was also considered improved. Elderly women and non-oncologic patients were observed to be the population with worse symptom control.

Keywords:

• Quality of life
• elderly
• breakthrough pain
• satisfaction

Transparency

Declaration of funding

The Andalusian Foundation for the Treatment of Pain was the sponsor of the study and received financial support from Kyowa Kirin Pharmaceutical SLU.

Author contributions: M.J.R. and L.M.T. participated in the design, inclusion of patients and drafting of the paper. R.d.l.T., J.L.O., J.M.T., D.B., A.J.J. and A.S.-Y. critically revised the paper for intellectual content. B.S. designed the study, completed the quality control and the statistical analysis of the study and drafted the paper. All authors approved the version to be published and agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

A.J.J. and A.S.-Y. have disclosed that they belong to the Medical Department of Kyowa Kirin Farmacéutica SLU. B.S. has disclosed that she was hired by the Andalusian Foundation for the Treatment of Pain to conduct the design, monitoring, statistical analysis, and management of the publications of the study. M.J.R., R.d.l.T., J.L.O., J.M.T., D.B. and L.M.T. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The participation of the following researchers in the study is appreciated: SAND study group: M.J. Rodríguez, L.M. Torres, A. Ballesteros, A. Bustos, J. Caballero, E. Collazo, R. De Alba, J. Gallego, R. Gálvez, A. García, J.M. González, F. Heredia, A. Martínez, F. Neira, A. Ontanilla, M. Robles, C. Rodríguez, M.J. Sánchez del Águila, J. Santiago and I. Velázquez.