Real world cancer pain incidence and treatment in daily hospital

Background: Approximately 34-67 percent of cancer patients experience an episode of uncontrolled pain during the course of their disease, depending on the stage.

Aims: to provide real world data for pain prevalence, diagnosis and treatment recommendations on integrative model of medical oncology and palliative care for patients with cancer diagnostic in a day hospital, we made also a short review of the pain treatment summary published in Academia Edu.

Patients and method: Consultation register and electronic records of 166 Patients (Pts) were studied from April 2023 to March 2025. Pts with pain syndrome were selected. The pain was objectified by the visual pain scale. To elucidate the causes of the pain investigations were carried out: bone scintigraphy, CT scan, PET-CT. The analgesic treatments was  represented by week and strong morphine, radiotherapy, bisphosphonates, non-morphine drug combination. We try to understand and we also tried to assess the preference for treatment of the patients and why they refuse opioid treatment.

Result: During the mentioned period, 166 oncological patients (74 women and 92 men) were treated in the oncology day hospitalization service. There were 1,500 consultations, 40 of which were only for pain. The neoplastic locations were: gynecological, malignant melanoma, breast, gastric, bronchopulmonary, colorectal, liver, pancreatic, bladder, kidney. 70 Pts presented pain syndrome. The causes of the pain were represented by bone metastases, compressive tumors, post-surgical status.

Drug treatment: Tramadol or tramadol with paracetamol (Doreta) 47 Pts of which 3 switched to a major opioid (Oxycodonum, Morphine sulfate), 5 Pts were treated with Oxycodonum as the first intention.

Other drugs therapy administrated with morphine agents or in nonmorphynic combination  were: Midazolam plus am nonsteroidal anti-inflammatory drug, Alprazolam, Lorazepam, Metilprednisolon, bisphosphonates .

Refusal of opioid treatment was encountered in 7 patients who argued that they were afraid of depressing their breathing or that therapy with morphine derivatives was the last stage before death.

 In 3 patients we have rotated morphine, 20 Pts received palliative radiotherapy, 10 Pts were treated with bisphosphonates. 2 Pts required neurosurgery consultation for an antalgic intervention. 5 Pts had important adverse reactions to morphine. In the Academia edu. we don’t find this particular aspects presented in our study.

Conclusions: The prevalence of pain was similar to that described in the literature. In most cases, the pain could be managed in the day hospital. Weak and strong morphines represented the main pain therapy but many patients ask to have nonmorphine combination drugs.Treatment with bisphosphonates was useful. Radiotheray was frequent indicated ,surgical interventions were rarely indicated. Mood and education of patients have determinate the patients preference for treatment.

Dr. Alexandru Calin Grigorescu, from the Clinical Hospital for Nephrology “Dr. Carol Davila” in Bucharest, Romania, became a specialist in medical oncology in 1991 and was awarded a grant in thoracic oncology in France in 1993. In 2003, he obtained his competence in palliative care and successfully passed the habilitation exam, qualifying him to supervise doctoral research. He received the prestigious ESMO grant in palliative care in 2018 and was awarded the Researcher Degree I (Research Professor) in 2014 at Bucharest UMF “Carol Davila,” confirmed by the Ministry of Health. Dr. Grigorescu serves as a reviewer for Elsevier and is the Editor-in-Chief of the national Romanian journal of oncology, Oncolog Hematolog. In recognition of his significant contributions to the field, he was honored as a member of the Romanian Academy of Medical Sciences in 2022.