Tackle cancer pain to cut out-of-hours visits, GPs told

Helping more patients with cancer to self-manage pain symptoms could reduce demands on GP out-of-hours services, research suggests.

A third of out-of-hours call-outs for cancer patients are for pain symptoms (Photo: Paul Starr)
A third of out-of-hours call-outs for cancer patients are for pain symptoms (Photo: Paul Starr)

A study published in the British Journal of General Practice found pain was the most common reason for cancer patients calling out-of-hours services, accounting for nearly a third of cases.

Researchers said routine anticipatory cancer care should prioritise patient education about how to self-manage pain symptoms during daytime consultations, which is a more appropriate setting for such advice than an out-of-hours visit.

This should tackle patients’ fears about addiction and the side-effects of opiate analgesics, as well as patient reluctance to ‘mask’ pain if they feel it is a useful indicator of disease activity, they said.

Further research could determine whether this would reduce reliance on out-of-hours services, they said.

Studies have shown pain is the most frequent reason for cancer patients attending emergency departments, but little is known about the reasons for these patients contacting GP out-of-hours services.

Patient education 'a priority'

A team from the University of Aberdeen led by Dr Rosalind Adam, a GPSI in chronic pain, examined the records of 950 patients with cancer who contacted the Grampian out-of-hours service between 2010 and 2011.

A fifth of patients were admitted to a hospital or hospice as a result of their assessment by the out-of-hours practitioner.

Pain was present in 31% of patients, followed by nausea or vomiting in 12% and agitation in 6%.

Over a quarter of patients reporting pain were treated with injections for pain relief, despite many already being on strong oral opiates.

In addition, one in seven patients with pain were managed with education and reassurance.

Researchers suggested that planned, daytime anticipatory care may be a better place for patients to be given this self-management advice.

They said: ‘Patient education about pain self management with attention to any barriers that may exist to the use of opioid analgesics should be a priority in routine anticipatory cancer care.

‘Future research is required to explore whether improved patient education and targeted anticipatory care could result in less reliance on unscheduled primary care and to characterise and quantify the potentially mutual benefits of such interventions for patients and practitioners.’

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