Impact of dementia in cancer discovery anf pain

doi:10.1111/j.1479-8301.2010.00344.x

PSYCHOGERIATRICS 2011; 11: 6–13

ORIGINAL ARTICLE

Impact of dementia on cancer discovery and pain
Shuji IRITANI,1,2 Mizuho TOHGI,2 Hiroaki MIYATA3 and Gen OHI2

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1 Department of Psychiatry, Graduate School of Medicine, Nagoya University, Aichi, 2Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, and 3Department ofHealthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Japan

Abstract
Background: Dementia is clinically noted to influence both reporting and experience of cancer pains. However, no systemic evaluation of this aspect has been reported. The aim of the present study was to retrospectively evaluate how dementia modified the cancer discovery process, frequency of cancerpain reports and analgesic-narcotic use at a large psychiatric hospital. Methods: We reviewed all the records of cancer patients with and without dementia treated at the surgical ward of Matsuzawa Hospital from 1993 to 2004. Psychiatric diseases other than dementia, brain metastasis and alcoholism, as well as leukaemia and skin cancer, were excluded. Patients’ communicativeness as to pain wasascertained from nursing records. Results: A total of 134 cancer patients with and without dementia (50 demented and 84 non-demented) were included. Demented patients were accidentally discovered to have cancer (48%) or by an unexpected unfolding of clinical signs (44%), whereas most non-demented patients (63%) voluntarily sought medical evaluation (P = 0.000). Overall, 76% of non-demented patients hadcancer pains (stages I and II, 64%; stages III and IV, 84%), whereas just 22% of demented patients had cancer pains (stages I and II, 16%; stages III and IV, 26%; P = 0.000). Non-demented patients showed stage-dependent requirements for both non-narcotic analgesics (stages I and II, 64%; stages III and IV, 84%) and narcotics (stages I and II, 0%; stages III and IV, 41%). Demented patients requiredmuch less analgesics (stages I and II, 11%; stages III and IV, 13%), with only one stage IV patient requiring narcotics (P = 0.000). Conclusion: Dementia greatly modifies the cancer discovery process, reduces prevalence of cancer pain and analgesic requirement.

Correspondence: Dr Shuji Iritani MD PhD, Department of Psychiatry, Graduate School of Medicine, Nagoya University, 65 Tsurumai,Showa-ku, Nagoya, Aichi 466-8550, Japan. Email: iritani@med. nagoya-u.ac.jp Received 21 September 2010; accepted 16 November 2010.

Key words: analgesics, cancer, dementia, pain.

INTRODUCTION
The impact of dementia on pain and its management has been reported mainly in the context of underreporting, underdetection and undertreatment.1–4 Regarding the phenomena of reduced pain complaints andsubsequent low requirement of analgesics, the question arose whether an alteration in pain experience in the demented individuals was reflected or whether this was a result of a decline in the patients’ ability to communicate about their pain.5 It was suggested that dementia influenced both the experience and reporting of pain in elderly 6

individuals.6–8 Parmelee et al. reported that in the elderly withmild to moderate cognitive impairment, their pain complaints are as valid as those of the non-demented elderly.6 More specifically, as to pain experience, Alzheimer’s disease (AD) patients appeared to perceive less pain intensity and pain affect than non-demented elderly, despite the fact that both groups had equal sensitivity regarding pain stimuli and pain thresholds.9,10 Scherder et al.repeated pain assessments on AD patients daily for 4 weeks, and 2 months later for 5 days and confirmed the foregoing finding.11
© 2011 The Authors Psychogeriatrics © 2011 Japanese Psychogeriatric Society

Dementia and cancer pain

If demented individuals tend to tolerate intensified pain and experience less pain affect, they are anticipated to have an increased risk of not noticing the forewarning...