Prediction and management of pain in patients with advanced cancer

In a prospective controlled study, patients with incurable cancer and an estimated prognosis of three months to one year were allocated to two patient groups for evaluation of supportive interventions. One group, called "intensive," received home visits by a nurse practitioner acting as an extension of a multidisciplinary team; the other, termed "nonintensive," did not receive such visits. Both patient groups were periodically evaluated in their homes by an observer and by self-ratings, to measure changes in quality of life as their disease progressed. Several methodologic problems were identified, which have implications for future research. Pain problems later in the course of cancer seem to be predictable in those patients with higher scores on the Cornell Medical Index M-R scales (greater emotional disturbance) and on the Rotter Locus of Control (I-E) scale (expectation of more external control of self). The study also found that the home visiting nurse practitioners, specially trained in pain treatment, improved pain control in the "intensive" group of patients over the last 90 days of life, when pain was an increasingly major problem. Such nurses can significantly improve the quality of life for patients dying outside of institutions.