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Cancer Patients Hold Fast to Belief That Opioids Mean Death

Docs need to educate that drugs such as morphine are more than just a last resort

WEDNESDAY, Dec. 12 (HealthDay News) -- Many cancer patients endure unnecessary suffering when they resist treatment with morphine and other opioid painkillers because they believe the use of these drugs signifies imminent death, a new British study suggests.

"If we are to employ the range of available opioids in order to successfully manage pain caused by cancer, we must ensure that morphine does not remain inextricably linked with death. If this connection stays in place, then morphine will continue to be viewed as a comfort measure for the dying rather than a means of pain control for the living," study author Dr. Colette Reid, a consultant in palliative medicine at the Gloucester Royal Hospital, said in a prepared statement.

Publishing online Dec. 11 in the Annals of Oncology, Reid and her team interviewed 18 people, aged 55 to 82, with metastatic cancer who took part in a cancer pain management trial. A central theme of morphine as a last resort for dying patients emerged from the interviews.

"We found that patients with cancer who were offered morphine for pain relief interpreted this as a signal that their health professional thought they were dying, because opioids were interventions used only as a 'last resort.' Because participants themselves were not ready to die, they rejected morphine and other opioids as analgesics, despite the pain experienced as a consequence," the study authors wrote.

"Participants' descriptions of the role of professionals indicated that patients value professionals' confidence in opioids. Some patients may therefore become more frightened when offered a choice, since this indicates a lack of confidence in the opioid as an analgesic."

Reid noted that World Health Organization guidelines for the management of cancer pain state that severity of pain, not patient prognosis, should be the basis for making painkiller treatment decisions.

"So patients at all stages of cancer could have morphine if their pain is sufficient. In reality, the patients most likely to experience pain, and likely also to have the most severe pain, are those with metastatic disease, i.e., their cancer cannot be cured. These patients may yet have many months to live, but their quality of life is adversely affected by pain, since unrelieved pain leads to social isolation, loss of role and depressed mood," Reid said.

More information

The U.S. National Cancer Institute has more about cancer pain control.

-- Robert Preidt

SOURCE: European Society for Medical Oncology, news release, Dec. 11, 2007

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