Management of Pain in Elderly Patients With Cancer

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Abstract
THE PREVALENCE OF cancer increases with age,1 and pain is one of cancer's most frequent and disturbing symptoms.2 Despite the widespread dissemination of the World Health Organization's (WHO's) 3-level ladder,3 and the demonstration that its appropriate use can relieve pain in more than 90% of cases,4,5 pain management remains poor. A high prevalence of unrelieved cancer pain has been documented in a variety of clinical settings, including general medical and surgical units,6 oncology wards,7 emergency departments,8 and pediatric wards.9 Even in oncology outpatient clinics, the management of pain falls well below accepted standards.10,11 Although there is no physiologic basis for a decrease in pain with increasing age, pain is believed to be less prevalent among the aged and is historically underreported and undertreated. While the WHO ladder approach is applicable to older patients with cancer,12 limited attention has been devoted to the management of pain in this age group.