Current status of pain control for older cancer patients in comparison to younger patients in outpatient and inpatient settings: a report from one prefectural cancer care hospital

Background： While the number of older cancer patients increases as the society ages, the current status of the pain control is not well characterized among older patients. To improve the quality of care, it is necessary to understand the current status. Objectives： The aim of this study was to describe the pain control for older cancer patients in comparison to younger counterparts and characterize it. Methods： During four months in 2013, Aomori Prefectural Central Hospital started asking all hospitalized cancer patients about their pain every day using a standardized pain questionnaire. In addition, a questionnaire adopted to the outpatient setting was distributed to the patients who visited outpatient department of the hospital. The information about pain, quality of life (QOL) and the medical histories were included in the data analyses. Their responses were compared between outpatients versus inpatients and older ( ≥65 years) versus younger (＜65 years) patients. Results： The response rate was 57.0％. Pain management was less adequate among outpatients than among inpatients, with pain relief rate of 28.9％ for the former and 52.6％ for the latter (P＜0.001). Among outpatients, the pain relief rate for the older patients was particularly low (older：24.7％ vs younger：35.8％, P＜0.01). Conclusion： Pain management for older patients in the outpatient settings needs a particular attention for improvement. Resources should be allocated to enable better detection and relief of pain among outpatients.

Usage of Anticancer Drugs in Japan and US / 薬剤疫学

Objective and Data Sources : To clarify where the crux of the problems lies in general usage of anticancer drugs in Japan, we examined the tracking reports on leading products in cancer market during 1994-1996. The results obtained were compared with 1995-6's actual purchase in National Cancer Center (NCC), Japan, and those in 1996 from the M. D. Anderson Cancer Center (MDACC), USA.<BR>Results : In Japan, oral agent of fluoropyrimidine such as UFT, doxifluridine (Furtulon), or 5-FU tablet, immunopotentiator such as Picibanil or Krestin, and anticancer hormonal agents accounted for approximately 70% of the market. As a result, the cytocidal anticancer injections which should be the leading agents for cancer chemotherapy are in the minority. In contrast, the actual purchase of NCC revealed that approximately 85% was for the cytotoxic injections and it was nearly the same with MDACC. In spite of this, the actual purchase for granulocyte colony stimulating factors (G-CSF) and antiemetics such as granisetron was so much larger in MDACC (30% of the total) that in NCC (7% of the total).<BR>Conclusion : The special circumstances in Japanese market reflects the poor development of medical oncology in this country where the truth-telling is uncommon, and less toxic chemotherapy is chosen without considering how much actually effective. Although, on the other hand, the similarity in NCC and MDACC indicates the expertness of cancer treatment, so big expense for G-CSF and antiemetics in USA makes us consider the importance of the rationalization for their usage in toxic chemotherapy in Japan.