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Symptom led research


Pain is one of the most common and distressing symptoms in cancer patients. At the advanced and terminal stage, the prevalence of pain can be as high as 90%. Pharmacologic treatment is the main approach to control cancer pain.

The WHO has developed a three-step “analgesic ladder” for cancer pain relief. Although this “ladder” is effective in relieving pain for approximately 90% of patients with cancer and over 75% of terminally ill cancer patients, nearly 50% of cancer pain is undertreated.

The barriers to effective pain management are multimodal, and may come from healthcare professionals, patients, families and health care systems depending on settings. GPs are the second largest group of health professionals involved in the management of cancer pain.

GPs not only independently prescribe for patients; they also often function as part of teams to ensure continuity of services including active management of repeat prescriptions initiated by other health practitioners.

With the increased survival of cancer patients, we would see an increased role of GPs in managing cancer pain at end of life care.  It is important to have empirical data in helping to guide and inform practice. However, few studies have been conducted on the prescription variability for analgesics in UK primary care setting.

With the support from MRC and NIHR COMPASS Collaborative, we developed this UK pioneer project aiming to understand the prescribing practice of analgesics, factors associated with prescription variations, and the associations with the utilization of healthcare services.

The project is co-led by Dr Wei Gao and Professor Irene J Higginson. It is the first time that the GP routine practice data (General Practice Research Database, GPRD) has been used to understand palliative care and end of life care issues. We have extracted the clinical and socio-demographic information, as well as over 10 million prescribing records, of nearly 30,000 cancer patients for this study.

We have published our results on prescribing patterns for all three level analgesics and for opioid analgesics. We found an overall increasing trend in analgesic prescribing, and identified old age as a risk factor for under-prescription of painkillers. The next step we will focus on understanding multiple opioid prescribing, and the health service utilisation patterns. 

Published journal articles:

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