Adequate Pain Control Unlikely to Decrease Survival in Mesothelioma Patients

Giving advanced mesothelioma patients and others with advanced cancer enough medication to keep their pain in check will not hasten their death, despite misconceptions to the contrary.

That conclusion comes from an Egyptian study published in the Annals of Palliative Medicine. The study included 123 patients with advanced cancer, including some with pleural mesothelioma. Patients were divided into three categories based on how much opioid medications their doctors had prescribed to control pain at the end of life.

One group of cancer patients got little or no pain medication on a daily basis, a second got an intermediate dose of 120 to 300 milligrams per day, and a third received more than 300 milligrams. Most of the pleural mesothelioma patients were in the highest dose category.

Although there is a common misconception that high doses of opioid pain medication at the end of life can lead to an earlier death, the study found no evidence of that. In fact, the average time to death for patients in the palliative medicine unit was significantly lower among patients who had the least pain medication. This group had a median survival of just 45 days, whereas the 24 patients (many of whom had mesothelioma) in the high dose group lived for a median of 153 days.

“The results suggest that the dose of opioids has no detrimental impact on the survival of patients with advanced cancer in an Egyptian palliative care setting,” write the authors. They go on to say that further research is needed to “overcome barriers to cancer pain control.”

The control of cancer pain at the end of life is a particularly critical topic for mesothelioma patients and their families and the Egyptian study is not the first to show a survival benefit in people whose pain is kept in check. Inadequate pain control and loss of pulmonary function can significantly impact quality of life in mesothelioma patients at the end of life.

A study published in the Journal of Thoracic Oncology earlier this year suggested that radiation can also help to alleviate pain and reduce pressure on the lungs and chest in late-stage mesothelioma patients.

Sources:

Alsirafy, SA at al, “The use of opioids at the end-of-life and the survival of Egyptian palliative care patients with advanced cancer”, October 2014, Annals of Palliative Medicine, pp. 173-177.

MacLeod, N, et al, “Is radiotherapy useful for treating pain in mesothelioma? A phase II trial”, February 4, 2015, Journal of Thoracic Oncology, Epub ahead of print.