Cancer is a growing problem. In the Netherlands, the twenty years prevalence of cancer
is rising during the years. In 1990, 223 540 persons were living with cancer (twenty years
prevalence). In 2002, the twenty years prevalence was 386 361 persons, and in 2010
540 371 persons. The prevalence of cancer increased with 3% – 3.5% per year since 1990.
This increase was mainly provoked by an increase in the national population, especially
elderly.
In cancer patients, pain is one of the most frequent and feared symptoms. Pain can
interfere with all aspects of daily life and pain relief is an important component of patients’
quality of life. The prevalence of cancer-related pain remained stable over the
years, although the knowledge on pain treatment did improve. For cancer patients with
all disease stages, the studies before 1990 showed that the prevalence of cancer-related
pain varied between 41% - 72%4-5, of whom 35% scored their pain as moderate to severe
(pain intensity score ≥ 5). The studies between 1990 and 2005 showed a prevalence
between 28% - 87%, of whom between 23% - 65% scored their pain as moderate to
severe, and studies after 2005 reported a prevalence of 52% - 72%, of whom between
20% - 56% scored their pain as moderate to severe. The prevalence of pain in cancer
patients is related to the stage of cancer. The review of Van den Beuken et al. showed
that the prevalence of cancer-related pain was 33% (95% Confi dence Interval (CI)
21-46%) in cancer patients after curative treatment (n=726); 59% (95% CI 44-73%) in
patients during anti-cancer treatment (n=1408); and 64% (95% CI 58-69%) in patients
with advanced disease (n=9763).
Cancer-related pain can be caused by (a) the direct growth and penetration by the
tumor and/ or metastases (70%) (e.g. bone metastases, compression or infi ltration of
nerves); (b) diagnostic procedures; (c) antitumor treatment, such as chemotherapy, surgery
or radiotherapy (20%); (d) and comorbidity or associated factors (10%) (e.g. constipation,
infections, muscular spasms). Cancer-related pain can be distinguished into
nociceptive pain and neuropathic pain. Nociceptive pain is caused by tissue damage.
This pain is often the result of bone metastases or infi ltration in soft tissues or viscera.
Neuropathic pain can be defi ned as pain resulting from damage to the peripheral or
central nervous system. Damage to the nervous system may be caused by compression
or invasive growth by a tumor, by chemotherapy or after surgical interventions. About
65%-68% of cancer-related pain is nociceptive and 8-9% is neuropathic. In 23-27% of
cases both types of pain can be found.
The aim of pain management is to reduce the pain intensity to a tolerable level with
acceptable side-eff ects. Cancer-related pain management consists of a combination
of anti-tumor treatment (i.e. therapy directed at the cause of the pain) and pharmacotherapy.http://repub.eur.nl/res/pub/31414/120215_Oldenmenger%2C%20Wilhelmina%20Hendrika.pdf
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