Ethical considerations in the relief of cancer pain.
End of life care
Medical ethics
Opioid misuse
Pain
Palliative sedation
Journal
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
ISSN: 1433-7339
Titre abrégé: Support Care Cancer
Pays: Germany
ID NLM: 9302957
Informations de publication
Date de publication:
23 Jun 2023
23 Jun 2023
Historique:
received:
18
01
2023
accepted:
07
06
2023
medline:
26
6
2023
pubmed:
23
6
2023
entrez:
23
6
2023
Statut:
epublish
Résumé
The management of pain for patients with cancer and cancer survivors is a critical clinical task that involves a multitude of ethical issues at almost every phase of the cancer experience. This review is divided into three sections: In the first, we address rights and duties in the relief of pain from the perspective of patients, clinicians, health care institutions and organizations, and public policy. This section includes a detailed description of issues and duties in relation to opioid misuse and addiction. In the second section, we discuss the ethical consideration of therapeutic planning. The final section addresses ethical considerations in the management of pain at the end of life including a detailed discussion regarding ethical issues relating to the use of palliative sedation as a clinical intervention of last resort.
Identifiants
pubmed: 37351702
doi: 10.1007/s00520-023-07868-3
pii: 10.1007/s00520-023-07868-3
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
414Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
International Pain Summit of the International Association for the Study of Pain (2011) Declaration of Montreal: declaration that access to pain management is a fundamental human right. J Pain Palliat Care Pharmacother 25(1):29–31
Lohman D, Schleifer R, Amon JJ (2010) Access to pain treatment as a human right. BMC Med 8:8
pmcid: 2823656
Brennan F, Lohman D, Gwyther L (2019) Access to pain management as a human right. Am J Public Health 109(1):61–65
pmcid: 6301399
Goudas LC, Bloch R, Gialeli-Goudas M, Lau J, Carr DB (2005) The epidemiology of cancer pain. Cancer Invest 23(2):182–190
van den Beuken-van EM, de Rijke J, Kessels A, Schouten H, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18:1437–1449
Marcus DA (2011) Epidemiology of cancer pain. Curr Pain Headache Rep 15(4):231–234
Solano JP, Gomes B, Higginson IJ (2006) A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 31(1):58–69
Ostgathe C, Alt-Epping B, Golla H, Gaertner J, Lindena G, Radbruch L et al (2011) Non-cancer patients in specialized palliative care in Germany: what are the problems? Palliat Med 25(2):148–152
Chang VT, Janjan N, Jain S, Chau C (2006) Update in cancer pain syndromes. J Palliat Med 9(6):1414–1434
Caraceni A, Portenoy RK (1999) An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain. Pain. 82(3):263–274
Chapman S (2011) Chronic pain syndromes in cancer survivors. Nurs Stand 25(21):35–41
Stull DM, Hollis LS, Gregory RE, Sheidler VR, Grossman SA (1996) Pain in a comprehensive cancer center: more frequently due to treatment than underlying tumor (meeting abstract). Proc Annu Meet Am Soc Clin Oncol 15:1717
Jain PN, Chatterjee A (2010) Development of acute pain service in an Indian cancer hospital. J Pain Palliat Care Pharmacother 24(2):129–135
Sanford NN, Sher DJ, Butler SS, Xu X, Ahn C, Aizer AA et al (2019) Prevalence of chronic pain among cancer survivors in the United States, 2010-2017. Cancer 125(23):4310–4318
Gallaway MS, Townsend JS, Shelby D, Puckett MC (2020) Peer reviewed: pain among cancer survivors. Prev Chronic Dis 17
Brennan F, Carr DB, Cousins M (2007) Pain management: a fundamental human right. Anesth Analg 105(1):205–221
Cousins MJ, Brennan F, Carr DB (2004) Pain relief: a universal human right. Pain. 112(1-2):1–4
Alford DP, Zisblatt L, Ng P, Hayes SM, Peloquin S, Hardesty I et al (2016) SCOPE of pain: an evaluation of an opioid risk evaluation and mitigation strategy continuing education program. Pain Med 17(1):52–63
pmcid: 4718419
Anghelescu DL, Ehrentraut JH, Faughnan LG (2013) Opioid misuse and abuse: risk assessment and management in patients with cancer pain. J Natl Compr Canc Netw 11(8):1023–1031
Alford DP, Lazure P, Murray S, Hardesty I, Krause JR, White JL (2019) National trends in prescription opioid risk mitigation practices: implications for prescriber education. Pain Med 20(5):907–915
Phillips DM (2000) JCAHO pain management standards are unveiled. JAMA. 284(4):428–429
Post LF, Blustein J, Gordon E, Dubler NN (1996) Pain: ethics, culture, and informed consent to relief. J Law Med Ethics 24(4):348–359
Starrels JL, Becker WC, Weiner MG, Li X, Heo M, Turner BJ (2011) Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain. J Gen Intern Med 26(9):958–964
pmcid: 3157518
Grant KJ, Baca CT (2010) Methadone deaths in pain and addiction populations. J Gen Intern Med 25(9):898 author reply 9
pmcid: 2917651
Manchikanti KN, Manchikanti L, Damron KS, Pampati V, Fellows B (2008) Increasing deaths from opioid analgesics in the United States: an evaluation in an interventional pain management practice. J Opioid Manag 4(5):271–283
Bennett MI, Eisenberg E, Ahmedzai SH, Bhaskar A, O’Brien T, Mercadante S et al (2019) Standards for the management of cancer-related pain across Europe—a position paper from the EFIC Task Force on Cancer Pain. Eur J Pain 23(4):660–668
pmcid: 7027571
Rich BA, Dubois M (2011) Pain, ethics, and public policy. Pain Med 12(9):1295–1296
Volkow ND, Blanco C (2021) The changing opioid crisis: development, challenges and opportunities. Mol Psychiatry 26(1):218–233
Volkow ND, Collins FS (2017) The role of science in addressing the opioid crisis. N Engl J Med 377(4):391–394
Vadivelu N, Kai AM, Kodumudi V, Sramcik J, Kaye AD (2018) The opioid crisis: a comprehensive overview. Curr Pain Headache Rep 22(3):1–6
The International Narcotics Control Board. Report 2021. Vienna: International Narcotics Control Board (UN) 2022.
Cleary J, Powell RA, Munene G, Mwangi-Powell FN, Luyirika E, Kiyange F et al (2013) Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 24:xi14–xi23
Cleary J, Radbruch L, Torode J, Cherny NI (2013) Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Asia: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 24:xi24–xi32
Cleary J, Simha N, Panieri A, Scholten W, Radbruch L, Torode J et al (2013) Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in India: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 24:xi33–xi40
Cleary J, De Lima L, Eisenchlas J, Radbruch L, Torode J, Cherny NI (2013) Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Latin America and the Caribbean: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 24:xi41–xi50
Cleary J, DeLima L, Eisenchlas J, Scholten W, Radbruch L, Torode J et al (2013) Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 24(Supplement 11):14–23
Cherny NI, Cleary J, Scholten W, Radbruch L, Torode J (2013) The Global Opioid Policy Initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the Middle East: introduction and methodology. Ann Oncol 24(Supplement 11):xi7–xi13
Cleary J, DeLima L, Eisenchlas J, Scholten W, Radbruch L, Torode J et al (2013) Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Caribbean and Latin America: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 24(Supplement 11):41–50
Knaul FM, Bhadelia A, Rodriguez NM, Arreola-Ornelas H, Zimmermann C (2018) The Lancet Commission on Palliative Care and Pain Relief—findings, recommendations, and future directions. Lancet Glob Health 6:S5–S6
De Lima L, Radbruch L (2018) The International Association for hospice and palliative care: advancing hospice and palliative care worldwide. J Pain Symptom Manage 55(2):S96–S103
Osman H, Shrestha S, Temin S, Ali ZV, Corvera RA, Ddungu HD et al (2018) Palliative care in the global setting: ASCO resource-stratified practice guideline. J Glob Oncol 4:1–24
Donkor A, Luckett T, Aranda S, Phillips J (2018) Barriers and facilitators to implementation of cancer treatment and palliative care strategies in low-and middle-income countries: systematic review. Int J Public Health 63(9):1047–1057
Caraceni A, Shkodra M (2019) Cancer pain assessment and classification. Cancers (Basel) 11(4):510
Kumar G, Markert RJ, Patel R (2011) Assessment of hospice patients’ goals of care at the end of life. Am J Hosp Palliat Care 28(1):31–34
Haberle TH, Shinkunas LA, Erekson ZD, Kaldjian LC (2011) Goals of care among hospitalized patients: a validation study. Am J Hosp Palliat Care 28(5):335–341
Kaldjian LC, Curtis AE, Shinkunas LA, Cannon KT (2008) Goals of care toward the end of life: a structured literature review. Am J Hosp Palliat Care 25(6):501–511
Duggleby W, Berry P (2005) Transitions and shifting goals of care for palliative patients and their families. Clin J Oncol Nurs 9(4):425–428
Cherny N, Portenoy R (2021) Core concepts in palliative care. In: Cherny N, Currow D, Fallon M, Portenoy R, Kaasa S (eds) Oxfortd Textbook of Palliative Medicine, 6th edn. Oxford University Press, London, pp 44–54
Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20(8):1420–1433
Fisch MJ, Lee JW, Weiss M, Wagner LI, Chang VT, Cella D et al (2012) Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol 30(16):1980–1988
pmcid: 3383175
Wu HS, Natavio T, Davis JE, Yarandi HN (2013) Pain in outpatients treated for breast cancer: prevalence, pharmacological treatment, and impact on quality of life. Cancer Nurs 36(3):229–235
Moskovitz BL, Benson CJ, Patel AA, Chow W, Mody SH, McCarberg BH et al (2011) Analgesic treatment for moderate-to-severe acute pain in the United States: patients’ perspectives in the Physicians Partnering Against Pain (P3) survey. J Opioid Manag 7(4):277–286
Foley KM (2011) How well is cancer pain treated? Palliat Med 25(5):398–401
Cohen MZ, Musgrave CF, Munsell MF, Mendoza TR, Gips M (2005) The cancer pain experience of Israeli and American patients 65 years and older. J Pain Symptom Manage 30(3):254–263
Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ (1993) Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group. Ann Intern Med 119(2):121–126
Darawad M, Alnajar MK, Abdalrahim MS, El-Aqoul AM (2019) Cancer pain management at oncology units: comparing knowledge, attitudes and perceived barriers between physicians and nurses. J Cancer Educ 34(2):366–374
Koyyalagunta D, Burton AW, Toro MP, Driver L, Novy DM (2011) Opioid abuse in cancer pain: report of two cases and presentation of an algorithm of multidisciplinary care. Pain Physician 14(4):E361–E371
Starr TD, Rogak LJ, Passik SD (2010) Substance abuse in cancer pain. Curr Pain Headache Rep 14(4):268–275
Jairam V, Yang DX, Verma V, James BY, Park HS (2020) National patterns in prescription opioid use and misuse among cancer survivors in the United States. JAMA Netw Open 3(8):e2013605
pmcid: 7431994
Højsted J, Sjøgren P (2007) Addiction to opioids in chronic pain patients: a literature review. Eur J Pain 11(5):490–518
Kwon JH, Hui D, Bruera E (2015) A pilot study to define chemical coping in cancer patients using the Delphi method. J Palliat Med 18(8):703–706
pmcid: 4522949
Castaneda AM, Lee CS, Kim YC, Lee D, Moon JY (2018) Addressing opioid-related chemical coping in long-term opioid therapy for chronic noncancer pain: a multicenter, observational, cross-sectional study. J Clin Med 7(10):354
pmcid: 6210168
Strang J, Volkow ND, Degenhardt L, Hickman M, Johnson K, Koob GF et al (2020) Opioid use disorder. Nat Rev Dis Primers 6(1):1–28
Schuckit MA (2016) Treatment of opioid-use disorders. N Engl J Med 375(4):357–368
Gorfinkel L, Voon P, Wood E, Klimas J (2018) Diagnosing opioid addiction in people with chronic pain. BMJ:k3949
Preux C, Bertin M, Tarot A, Authier N, Pinol N, Brugnon D et al (2022) Prevalence of opioid use disorder among patients with cancer-related pain: a systematic review. J Clin Med 11(6):1594
pmcid: 8954099
Savage SR, Joranson DE, Covington EC, Schnoll SH, Heit HA, Gilson AM (2003) Definitions related to the medical use of opioids: evolution towards universal agreement. J Pain Symptom Manage 26(1):655–667
Kosten TR, Baxter LE (2019) Effective management of opioid withdrawal symptoms: a gateway to opioid dependence treatment. Am J Addict 28(2):55–62
pmcid: 6590307
Covington EC, Argoff CE, Ballantyne JC, Cowan P, Gazelka HM, Hooten WM et al (2020) Ensuring patient protections when tapering opioids: consensus panel recommendations. In: Mayo Clinic Proceedings. Elsevier 95(10):2155–2171
Kwon JH, Tanco K, Hui D, Reddy A, Bruera E (2014) Chemical coping versus pseudoaddiction in patients with cancer pain. Palliat Support Care 12(5):413–417
Bell K, Salmon A (2009) Pain, physical dependence and pseudoaddiction: redefining addiction for ‘nice’ people? Int J Drug Policy 20(2):170–178
Cagle JG, McPherson ML, Frey JJ, Sacco P, Ware OD, Wiegand DL et al (2020) Estimates of medication diversion in hospice. JAMA. 323(6):566–568
pmcid: 7042838
Berde C, Nurko S (2008) Opioid side effects--mechanism-based therapy. N Engl J Med 358(22):2400–2402
Cherny N, Ripamonti C, Pereira J, Davis C, Fallon M, McQuay H et al (2001) Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 19(9):2542–2554
Centers for Disease Control and Prevention (CDC) (2012) Vital signs: risk for overdose from methadone used for pain relief - United States, 1999-2010. Morb Mortal Wkly Rep 61(26):493–497
Minogue B (2000) The two fundamental duties of the physician. Acad Med 75(5):431–442
Benzar E, Hansen L, Kneitel AW, Fromme EK (2011) Discharge planning for palliative care patients: a qualitative analysis. J Palliat Med 14(1):65–69
pmcid: 3021325
Mor V, Besdine RW (2011) Policy options to improve discharge planning and reduce rehospitalization. JAMA. 305(3):302–303
pmcid: 6666409
Anil N, Smallwood N, Dunn S (2022) Opioids in advanced lung malignancy: a clinical audit of opioid prescription, patient education and safeguarding. Intern Med J 52(10):1698–1706
Lacey J, Cherny N (2021) Management of the actively dying patient. In: Cherny N, Currow D, Fallon M, Portenoy R, Kaasa S (eds) Oxfortd Textbook of Palliative Medicine, 6th edn. Oxford University Press, London
Hagarty AM, Bush SH, Talarico R, Lapenskie J, Tanuseputro P (2020) Severe pain at the end of life: a population-level observational study. BMC Palliat Care 19(1):1–13
Clark K, Smith J, Lovell M, Currow DC (2012) Longitudinal pain reports in a palliative care population. J Palliat Med 15(12):1335–1341
Cherny NI, Radbruch L (2009) European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 23(7):581–593
Pauker SG, Kassirer JP (1980) The threshold approach to clinical decision-making. N Engl J Med 302(20):1109–1117
Blinderman CD (2012) Do surrogates have a right to refuse pain medications for incompetent patients? J Pain Symptom Manage 43(2):299–305
Miller FG, Fins JJ, Bacchetta MD (1996) Clinical pragmatism: John Dewey and clinical ethics. J Contemp Health Law Policy 13(1):27–51
Fins JJ, Bacchetta MD, Miller FG (1997) Clinical pragmatism: a method of moral problem solving. Kennedy Inst Ethics J 7:129–145
Gevers S (2003) Terminal sedation: a legal approach. Eur J Health Law 10(4):359–367
Devlin P (1985) Easing the passing. Bodley Head, London
Burt RA (1997) The Supreme Court speaks--not assisted suicide but a constitutional right to palliative care. N Engl J Med 337(17):1234–1236
Boyle J (2004) Medical ethics and double effect: the case of terminal sedation. Theor Med Bioeth 25(1):51–60
Quill TE, Dresser R, Brock DW (1997) The rule of double effect--a critique of its role in end-of-life decision making. N Engl J Med 337(24):1768–1771
Materstvedt LJ (2020) Distinction between euthanasia and palliative sedation is clear-cut. J Med Ethics 46(1):55–56
Levy MH, Cohen SD (2005) Sedation for the relief of refractory symptoms in the imminently dying: a fine intentional line. Semin Oncol 32(2):237–246
Hasselaar JG, Reuzel RP, van den Muijsenbergh ME, Koopmans RT, Leget CJ, Crul BJ et al (2008) Dealing with delicate issues in continuous deep sedation. Varying practices among Dutch medical specialists, general practitioners, and nursing home physicians. Arch Intern Med 168(5):537–543
Kuhse H, Singer P, Baume P, Clark M, Rickard M (1997) End-of-life decisions in Australian medical practice. Med J Aust 166(4):191–196
Stevens CA, Hassan R (1994) Management of death, dying and euthanasia: attitudes and practices of medical practitioners in South Australia. Arch Intern Med 154(5):575–584
Willems DL, Daniels ER, van der Wal G, van der Maas PJ, Emanuel EJ (2000) Attitudes and practices concerning the end of life: a comparison between physicians from the United States and from The Netherlands [In Process Citation]. Arch Intern Med 160(1):63–68
Meier DE, Emmons CA, Wallenstein S, Quill T, Morrison RS, Cassel CK (1998) A national survey of physician-assisted suicide and euthanasia in the United States [see comments]. N Engl J Med 338(17):1193–1201
Douglas CD, Kerridge IH, Rainbird KJ, McPhee JR, Hancock L, Spigelman AD (2001) The intention to hasten death: a survey of attitudes and practices of surgeons in Australia. Med J Aust 175(10):511–515
Rietjens JA, van der Heide A, Vrakking AM, Onwuteaka-Philipsen BD, van der Maas PJ, van der Wal G (2004) Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands. Ann Intern Med 141(3):178–185
Billings JA, Block SD (1996) Slow euthanasia. J Palliat Care 12(4):21–30
Fainsinger RL, De Moissac D, Mancini I, Oneschuk D (2000) Sedation for delirium and other symptoms in terminally ill patients in Edmonton. J Palliat Care 16(2):5–10
Murray SA, Boyd K, Byock I (2008) Continuous deep sedation in patients nearing death. BMJ. 336(7648):781–782
pmcid: 2292273
Higgins PC, Altilio T (2007) Palliative sedation: an essential place for clinical excellence. J Soc Work End Life Palliat Care 3(4):3–30
Reuzel RP, Hasselaar GJ, Vissers KC, van der Wilt GJ, Groenewoud JM, Crul BJ (2008) Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study. Palliat Med 22(5):641–646
Hasselaar JG, Reuzel RP, Verhagen SC, de Graeff A, Vissers KC, Crul BJ (2007) Improving prescription in palliative sedation: compliance with Dutch guidelines. Arch Intern Med 167(11):1166–1171
Rietjens JA, Hauser J, van der Heide A, Emanuel L (2007) Having a difficult time leaving: experiences and attitudes of nurses with palliative sedation. Palliat Med 21(7):643–649
Craig GM (1996) On withholding artificial hydration and nutrition from terminally ill sedated patients. The debate continues [published erratum appears in J Med Ethics 1996 Dec;22(6):361]. J Med Ethics 22(3):147–153
pmcid: 1376978
Craig GM (1994) On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? [see comments]. J Med Ethics 20(3):139–143 discussion 44-5
pmcid: 1376497
Craig G (1994) Is sedation without hydration or nourishment in terminal care lawful? Med Leg J 62(Pt 4):198–201
Orentlicher D (1997) The Supreme Court and physician-assisted suicide--rejecting assisted suicide but embracing euthanasia. N Engl J Med 337(17):1236–1239
Hahn MP (2012) Review of palliative sedation and its distinction from euthanasia and lethal injection. J Pain Palliat Care Pharmacother 26(1):30–39
Sulmasy DP, Ury WA, Ahronheim JC, Siegler M, Kass L, Lantos J et al (2000) Palliative treatment of last resort and assisted suicide. Ann Intern Med 133(7):562–563
Chiu T-Y, Hu W-Y, Chuang R-B, Chen C-Y (2002) Nutrition and hydration for terminal cancer patients in Taiwan. Support Care Cancer 10:630–636