European Pain in Cancer (EPIC) Global Results Presentation

July 2007
European Pain in Cancer (EPIC)
Global Results Presentation
EPIC Steering Group Presentation
© 2007
Research International. No part of these materials may
be used, reproduced or adapted without the prior written
consent of the copyright owner. All rights reserved

European Pain in Cancer (EPIC) survey
Objectives
1. Investigate the impact of pain on cancer patients
2. Establish the prevalence of pain for patients across all
cancer stages in Europe
3. Understand current treatment practices and levels of
satisfaction, and identify the gaps in the existing provision of
effective pain management for cancer patients across Europe
4. Explore the impact of pain on sufferers’ quality of life

EPIC: Countries involved
 1st phase – patients are
being screened in order to
obtain the prevalence of
cancer related pain in
cancer patients
 Patients are being
recruited from a wide
geographical area
 In each region, as many
potential routes for
recruitment as possible are
being undertaken
 Specialist pain units will
not be approached to
avoid bias in the data
collected
Finland
Switzerland
Israel
Romania
Italy
France
Norway
Sweden
Denmark
Czech Republic
UK
Ireland

 Respondents were recruited through a multi-modal approach
to ensure as representative a spread of data as possible.
Within each country, recruitment was carried out to provide a
broad cross section of that country’s population.
 The main methods of recruitment are the following:
1. Primary and secondary care physicians
2. Patient groups and associations
3. Advertising in national media
4. Panels of consumers
 No recruitment through Pain Specialists or Palliative Care
units in order to avoid bias with regard to the levels of pain
experienced by respondents
Recruitment Methodologies (1)

Recruitment Methodologies (2)
Primary and
secondary care
physicians
Patient groups
and associations
Advertising in
national media
Panels of
consumers
UK   
France   
Italy 
Switzerland  
Romania 
Czech Rep.  
Israel 
Finland   
Denmark   
Norway   
Sweden    
Ireland  

Sampling and methodology plan
Pilot Screening Phase
400 cancer patients (3 countries)
200 cancer patients (8 countries)
50 cancer patients (1 country)
 All patients screened to ensure
they experience pain (rated 5 or
more on a 0 to 10 scale)
 Inclusion of mix of solid tumour
types (including lymphomas/
blood-borne cancers)
 No stages of cancer were
excluded from this survey
Main Interview Stage
50 telephone interviews carried
out with patients who have
passed the screening phase
Phase 1 Phase 2
400 cancer
patients
200 cancer
patients
50 cancer
patients

In this report
Phase 1
target
Phase 2
target
Phase 1
results in
this report
Phase 2
results in
this report
UK 400 50 400 50
France 400 50 400 50
Italy 400 50 402 50
Switzerland 200 50 200 50
Romania 200 50 200 50
Czech Rep. 200 50 200 53
Israel 200 50 205 50
Finland 200 50 200 50
Denmark 200 50 200 50
Norway 200 50 200 50
Sweden 200 50 207 52
Ireland 100 50 50 15

In this report
All who complete screener and
experience pain more than once a
week
UK 311
France 379
Italy 299
Switzerland 195
Romania 155
Czech Rep. 163
Israel 167
Finland 178
Denmark 159
Norway 177
Sweden 199
Ireland 28

Percentage of patients reporting pain in cancer by country
71%
54%
52%
62%
52%
71%
88%
66%
61%
20%
75%
65%
56%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Czech Republic (n=282)
Denmark (n=373)
Finland (n=383)
France (n=642)
Ireland (n=96)
Israel (n=287)
Italy (n=457)
Norway (n=302)
Romania (n=327)
Sweden (n=1051)
Switzerland (n=267)
UK (n=617)
Global (n=5084)

European Pain in Cancer (EPIC)
Survey Results

Total number of patients contacted
5084
Total number of patients
screening IN
Total number of patients
screening OUT
2864 2220
Patients eligible for 2nd stage
quant*
2410
Patients agreeing to 2nd stage
quant
1226
56% 44%
Phase 1:
Screener
survey
Phase 2:
In-depth
interview
* All who completed screener and currently
experience pain more than once a week

Total number of patients screening OUT
2220
44%
137 respondents (3%) screened out because suffering from skin cancer
1350 respondents (27%) screened out because do not suffer pain at all
426 respondents (12%) screened out because they do not currently
experience pain or did not experience pain in the last month
105 respondents (3%) screened out because they experience pain
approximately once a month, less often than once a month, only when active
192 respondents (6%) screened out because their level of pain is
between 0-4
10 respondents screened out because linked to a pharmaceutical
company or a market research firm or were involved in pain med studies
S1
S4
S5
S7
S8
S11/1
2
n=4947 left in
n=3597 left in
n=3171 left in
n=3066 left in
n=2874 left in
n=2864 left in

Phase 1 Screener Survey
Results

Cancer staging – half of patients are unable to state the
stage of their cancer
Don't know, 50%
Stage 3, 12%
Stage 4, 11%
Stage 1, 9%
Stage 2, 12%
Stage 5, 5%
Metastasis, 1%
Half of patients do
not know at what
stage their cancer
is at
Base: all who has specified cancer (n=4947)
S2. And could you tell me what stage your cancer is at?
n=4947

Symptoms leading to diagnosis
31%
27%
11%
9%
7%
5%
5%
4%
3%
2%
2%
2%
2%
2%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
5%
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Base: all who has specified cancer (n=4947)
S3. What symptoms lead you to see the doctor prior to your diagnosis of cancer?
Pain is the key symptom leading to cancer diagnosis followed by a lump and
chronic fatigue
n=4947

Existence of pain due to cancer
Base: all screened – (individual base sizes shown on chart)
S4. Have you suffered any pain due to your cancer?
More than two thirds of cancer patients report pain which they
attribute to their cancer
27
7
8
10
13
14
14
18
18
23
23
25
38
34
47
73
93
92
90
87
86
86
82
82
77
77
75
62
66
53
T o tal (n=4947)
P ancreatic (n=142)
B o ne/ muscle (n=173)
B rain tumo ur (n=135)
N o n-H o dgkins (n=61)
Lung cancer (n=417)
H ead / N eck cancer (n=213)
B o wel / C o lo recto ral (n=504)
T esticular (n=150)
B lo o d bo rne (n=90)
Gynae cancer (n=411)
Lympho mas (n=102)
B reast cancer (n=1427)
Leukemia (n=125)
P ro state (n=624)
No pain Pain
n=4947
More than 50% of patients with
the following types of cancer
currently suffer from pain:
 Lung
 Pancreatic
 Brain Tumour
 Bone/Muscle
 Blood Borne
 Non-Hodgkins
 Head/Neck
 Leukaemia
From S5 - Patients
currently suffering
from pain

Existence of pain due to cancer – country breakdown
Base: all screened – (individual base sizes shown on chart)
S4. Have you suffered any pain due to your cancer?
More than two thirds of cancer patients report pain which they
attribute to their cancer
27
5
9
12
15
17
21
21
23
24
36
39
57
73
95
91
88
85
83
79
79
77
76
64
61
43
T o tal (n=4947)
Italy (n=457)
Switzerland (n=267)
Israel (n=269)
C zech R epublic (n=282)
N o rway (n=298)
D enmark (n=337)
R o mania (n=327)
UK (n=608)
F rance (n=642)
F inland (n=353)
Ireland (n=94)
Sweden (n=1013)
No pain Pain
n=4947

Recent experience of pain related to cancer
Base: all who suffered from pain (n=3597)
S5. Do you currently experience pain or have you experienced pain in the last month that is attributable to your cancer?
88% of cancer patients have
experienced pain within the
last month
Yes -
currently,
51%
Yes - in last
month, 37%
No, 12%
(n=1323)
(n=425)
(n=1848)
n=3597
Base: all who currently experience pain or have experienced pain in the last month (n=3171)
S6.How long have you suffered from pain that is directly caused by your cancer? S7. How often do you experience pain?
I experience pain… % (n)
At all times 16% (522)
Several times a day 19% (598)
Daily 22% (698)
Several times a week 23% (744)
Once a week 8% (256)
Several times a month 8% (248)
Approximately once a
month
1% (44)
Less than once a month 1% (18)
Only when active 1% (27)
Almost a third of cancer patients have been
experiencing pain for more than 12 months
More than half of patients experience pain at least
once a day
2562 patients
(81% answering
at this point)
are in pain at
least several
times a week

All patients consider themselves to be in some level of pain
Base: all who currently experience pain once a month (n=3066)
S8. Thinking about the last time you experienced pain, please give me a number from 0 to 10 indicating the intensity of your pain where a “0” means
“no pain at all” and a “10” means “the worst pain imaginable”. ?
0%
0%
1%
2%
3%
29%
21%
20%
14%
7%
4%
0% 5% 10% 15% 20% 25% 30% 35%
0
1
2
3
4
5
6
7
8
9
10
94% report that they experience moderate to severe pain (rated 5 -
10 on the pain scale)
4% regard their pain as ‘the worst pain imaginable’
Of those patients who scored 0- 4 on the
pain scale, none stated 0 as their score.
This shows that they all consider
themselves to be in some level of pain,
even if it is only low
(n=109)
(n=213)
(n=418)
(n=610)
(n=632)
(n=892)
(n=80)
(n=66)
(n=23)
(n=5)
(n=0)
CROSS REFERENCE: 21% of patients
suffering from moderate to
severe pain, experience it
daily
n=3066

Level of pain per country
Mean Level of pain
6.11
6.94
6.52
6.72
6.1
6.96
6.27
5.82
6.67
5.59
6.5
6.36
4 5 6 7 8
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Swiss
UK
 Sweden and
Norway are the
countries with
the lowest level
of pain
 Israel is the
country where
the intensity of
pain is the
highest with 63%
of respondents
within the 7-10
range
Global mean score: 6.38
n=3066

Pain scores
75%
60%
65%
73%
86%
65%
80%
81%
66%
50%
63%
75%
20%
39%
33%
24%
14%
34%
17%
14%
30%
19%
27%
23%
0% 20% 40% 60% 80% 100%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Swiss
UK
Scores in the
bracket 5-7
Scores in the
bracket 8-10
n=3066

Almost a quarter of patients who experience moderate to
severe pain (rated 5 or more) are not receiving treatment for
their pain
Base: all who score 5 -10 on pain scale (n=2874)
S10. Are you currently receiving any treatment for your pain?
I am
receiving
treatment
for my pain,
77%
I am not
receiving
treatment
for my pain,
23%
Patients who
rate 5 or
more in
terms of pain
experience
CROSS REFERENCE: 19% of patients
who suffer daily from moderate to
severe pain, DO NOT receive
treatment
n=2874

Phase 2 In-Depth Interview
Survey Results

Those completing the main survey are more likely to have
breast and bowel/colorectal cancer and have a higher level
of pain experienced than average
All who completed 2nd stage (n=573)
The sample is comprised of 35% men and 65% women
9% are aged between 18-40, 30% aged between 50-59, and 17% over the
age of 70
Patients are more likely to be suffering from breast and bowel/colorectal
cancer (27% and 12% respectively)
All suffer from pain, most report that they are experiencing pain at the
present time (75%). 51% have suffered from pain for more than 12 months
On the 0-10 pain scale, average reported pain levels were 6.95 (vs overall
mean of 6.38)
Pain frequency is most likely to occur on a daily basis (72%) with 142
respondents (25%) stating they are constantly in pain.
82% are receiving treatment for their pain
Demographics
Cancer Pain

Few patients have been referred to a pain clinic
yes,
24%
no,
73%
Don't know
3%
Base: All respondents (n=573)
Q15. Have you ever been referred to see a pain management specialist or to a pain clinic about your cancer pain?
89% of those referred have received some form of treatment for
their pain. Of those not referred, 81% had also received treatment
% ever been referred to see a pain
management specialist or a pain clinic COUNTRY COMPARISON
 The countries with the highest
number of patients being
referred to a pain clinic are Italy
and Israel with 52% and 40%
respectively
 UK, Ireland and France are all
near to the average
 Romania has the least amount
being referred with only 6% of
patients
n=573

HCP with main responsibility for management of cancer pain
are the Oncologist and the GP
HCP with main responsibility for management of cancer pain for all
patients contacted (Q12)
Medical Oncologist, 42%
General/Family Practitioner, 19%
Medical Doctor, 9%
Radiation Oncologist, 1%
Palliative care physician, 2%
Haematologist, 4%
General Surgeon, 4%
Physiotherapist, 1%
Other, 5%
None, 3%
Pain Specialist, 3%
OB/GYN, 2%
Neurologist, 2%
Nurse/Specialist Nurse, 1%
Anaesthetist, 1%
n=573

33% of patients recall having had their pain assessed using
a pain scale
y e s
2 1%
no
6 8 %
DK/ Ca n' t
r e me mbe r
11%
Q18. How does your HCP assess how much pain you are in?
Prompted recall
Q19 Does the HCP use a pain
scale?
55%
26%
5%
2%
15%
7%
0% 10% 20% 30% 40% 50% 60%
I proactively tell him/her
HCP examines me
HCP asks me to move part of my body
HCP asks me to walk
HCP uses pain scale
HCP does nothing
However only 15% of patients mentioned use of a pain scale
spontaneously
Spontaneous recall
n=573

Country differences in pain scale usage – prompted and
spontaneous
0% 20% 40% 60% 80% 100%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Spontaneous Prompted
 Italy, Israel, France and
Switzerland are the
countries where most
respondents
acknowledged the use of a
pain scale unprompted,
with 44%, 28% and 20%
respectively
 Only when prompted,
countries such as UK,
Norway, Ireland, Finland
and Denmark highly
recalled using a pain scale
for measuring their pain
Q18. How does your HCP assess how much pain you are in?
Q19 Does the HCP use a pain scale?
n=573

Almost a quarter of patients report that their HCP never or
rarely asks them about their pain
56%
17%
4%
11%
12%
0% 10% 20% 30% 40% 50% 60%
At every consultation
At most but not all consultations
At less than half consultations
Only occasionally
Never
Q16. How often does the HCP who treats your cancer ask you about the pain you are experiencing? Please note, this is the physician who treats
your cancer and NOT your cancer pain. Does this happen…?
How often does your HCP ask you about your pain?
CROSS REFERENCE:
54% of respondents that
are asked about their
pain by their HCP at
every consultation,
also proactively tell
their doctor about their
pain
n=573

Country comparison
46%
42%
42%
29%
4%
83%
42%
46%
62%
80%
82%
32%
74%
54%
56%
9%
26%
15%
8%
30%
25%
52%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Never/occasionally At every consultation
 In Scandinavian
countries most
patients are rarely
asked about their
pain by their HCPs
 In Czech
Republic, Italy
and Ireland
most patients
are asked
about their
pain at every
consultation
Q16. How often does the HCP who treats your cancer ask you about the pain you are experiencing? Please note, this is the physician who treats
your cancer and NOT your cancer pain. Does this happen…?
n=573

HCP does not take into consideration their quality of life to a
great extent
32%
62%
78%
50%
58%
24%
64%
32%
48%
80%
34%
27%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Global % : 50%
Q24 To what extent does HCP take into consideration your quality of life?
n=573

HCP does not understand that pain is a problem
34%
9%
22%
8%
15%
8%
10%
17%
12%
2%
4%
0% 5% 10% 15% 20% 25% 30% 35% 40%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Global % : 13%
n=573
Q25 My doctor understands my pain is a problem

HCP would rather treat their cancer than their pain
54%
48%
50%
56%
37%
56%
34%
28%
33%
19%
20%
24%
0% 10% 20% 30% 40% 50% 60%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Global % : 38%
n=573
Q25 My doctor would rather treat my cancer than my pain

HCP does not have enough time to discuss pain
32%
44%
42%
34%
58%
32%
30%
28%
23%
20%
33%
7%
0% 10% 20% 30% 40% 50% 60% 70%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Global % : 33%
n=573
Q25 I do not have enough time to discuss my pain with my doctor

HCP does not know how to control their pain
62%
42%
13%
38%
37%
26%
15%
28%
13%
10%
14%
8%
0% 10% 20% 30% 40% 50% 60% 70%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Global % : 26%
n=573
Q25 I think my doctor does not know how to control my pain

HCP does not always ask them about their pain
62%
56%
50%
27%
30%
23%
26%
13%
8%
4%
12%
0% 10% 20% 30% 40% 50% 60% 70%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Global % : 27%
n=573
Q25 My doctor always asks me about my pain

Although most patients feel that their HCP shows consideration and
listens to them, not all patients receive this level of care
50%* say that their HCP
does not take into
consideration their
quality of life to a great
extent (Q24)
CROSS REFERENCE: 38% of these are patients
whose oncologist is the main person
responsible for managing their pain
33%* report that their
doctor does not have
enough time to
discuss pain with
them (Q25)
CROSS REFERENCE: 40% of these are
patients whose oncologist is the main
person responsible for managing their
pain
26%* report that their
doctor does not know
how to control their
pain (Q25)
CROSS REFERENCE: 31% of these are
patients whose oncologist is the main
person responsible for managing their
pain
13%* feel that their doctor
does not understand
that pain is a problem
(Q25)
CROSS REFERENCE: 25% of these are patients
whose oncologist is the main person
38%* report that their doctor would rather treat their
cancer rather than their pain (Q25)
CROSS REFERENCE: 39% of these are patients whose oncologist is the main person
27%* report that their doctor does not always ask
them about their pain (Q25)
CROSS REFERENCE: 26% of these are patients whose oncologist is the main person
*Total number of patients (573) randomly selected to participate in an in depth interview about cancer pain

Q35. Which prescription medicines are you currently taking for the specific pain we have been discussing?
Base: All using prescription meds (n=441)
46% of cancer patients using prescription medication are on
strong opioids
Italy, Switzerland and
Sweden are the
countries which make
greater use of strong
opioids, with 84%, 76%
and 63% respectively
37%
32%
15%
46%
0% 10% 20% 30% 40% 50%
Strong opioids
Weak opioids
Non opioids
Not stated
France, Romania and UK
are the countries which
make greater use of
weak opioids, with 70%,
62% and 54%
respectively
n=441

Use of strong opioids per country
40%
60%
42%
84%
76%
63%
25%
11%
34%
29%
33%
30%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Base: All using prescription meds (n=varies by country)
Q 35. Which prescription medicines are you currently taking for the specific
pain we have been discussing?
Global % : 46%

The initial rating of the effectiveness of prescription drugs in
controlling cancer pain is good – the vast majority of
respondents consider them to be effective
Overall, how effective do you think your current prescription pain
medicines are at controlling your cancer pain?
24%
60%
12%
2% 2%
0%
10%
20%
30%
40%
50%
60%
70%
Very
effective
Quite
effective
Quite
ineffective
Very
ineffective
DK/Not sure
Initially, when
respondents are
asked to rate the
effectiveness of
their prescription
medication, they
respond positively,
however when
prompted more
specifically later on
in the survey, more
negative aspects
arise
Q36. Overall, how effective do you think your current prescription pain medicines are at controlling your cancer pain?
n=441

However, when prompted, more than half of patients using prescribed
analgesia (64%) report that there are times when their medicines are
not adequate to control their pain
6%
1%
20%
32%
26%
13%
0%
5%
10%
15%
20%
25%
30%
35%
All the time Every
hour
A few
times a
day
A few
times a
week
A few
times a
month
Very rarely
Q 37. Are there ever times when your pain medicines are not adequate to control your pain?
Base: All those whose meds do not control pain (n=281)
Q 38. How often does this happen?
Perceived lack of efficacy of pain management when on medication
In these patients,
pain occurs
frequently:
CROSS REFERENCE: 57% of
patients who report
that there are times
their medicines are not
adequate to control
their pain, are in daily
pain
n=441

Times when medicines are not adequate to control pain
– across countries
41%
73%
81%
67%
47%
70%
63%
71%
49%
72%
68%
47%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Global % : 64%
Q 37. Are there ever times when your pain medicines are not adequate to control your pain?
n=441

The main reasons for changing
medication are:
 42% – Need stronger medication
 29% – Pain became worse
 23% - Medication did not work
 16% – Did not like side effects
 12% - Had a negative reaction to
medication
Changing medication
Q31 Switching Medication
58% of patients taking prescription
medication have had their
medication changed
More than half of respondents have had their medication
changed and/or are taking more than one medication
The main reasons for taking more than
one medication are:
 34% – Need stronger medication
 23% – Pain became worse
 16% - Effects of medication didn’t last
long enough
 10% – Current doctor’s
recommendation
Q33 Additional Medication
54% of patients taking prescription
medication have been prescribed more
than one medicine for the same pain
Out of the patients who perceived their medication to be quite ineffective ..
70% of them switched
medication
53% of them are taking
additional medication
n=441

63% of patients using prescription analgesia report that they
are affected by breakthrough pain
5%
14%
7%
21%
7%
18%
8%
10%
8%
0%
5%
10%
15%
20%
25%
A
t
a
l
l
t
i
m
e
s
S
e
v
e
r
a
l
t
i
m
e
s
a
d
a
y
O
n
c
e
a
d
a
y
S
e
v
e
r
a
l
t
i
m
e
s
a
w
e
e
k
A
p
p
r
o
x
o
n
c
e
a
w
e
e
k
S
e
v
e
r
a
l
t
i
m
e
s
a
m
o
n
t
h
A
p
p
r
o
x
o
n
c
e
a
m
o
n
t
h
L
e
s
s
t
h
a
n
o
n
c
e
a
m
o
n
t
h
O
n
l
y
o
n
a
c
t
i
v
i
t
y
Base: All who suffer from breakthrough pain (n=279)
Q42. How often do you suffer from breakthrough pain?
More than half of patients taking prescription medication suffer
from breakthrough pain at least once a week
n=279

Breakthrough pain across countries
44%
77%
62%
82%
67%
53%
50%
87%
60%
72%
50%
73%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Czech Republic
Denmark
Finland
France
Ireland
Israel
Italy
Norway
Romania
Sweden
Switzerland
UK
Q41 Do you ever suffer from breakthrough pain?
Global % : 63%
n=441

Only a third of patients experiencing breakthrough pain are
taking additional prescription medication to treat it
72% of respondents who experience breakthrough pain say that there are
times their medicines are not adequate to control their pain
However, 33% of patients experiencing breakthrough pain are being treated
with additional painkillers
ADDITIONAL PAINKILLERS TAKEN TO
TREAT BREAKTHROUGH PAIN ARE:
 35% Strong opioids
 25% Weak opioids
 29% Non opioids
Positive rating for additional
painkillers:
 35% say - Very effective
 49% say - Quite effective
 10% say - Quite ineffective
CROSS REFERENCE – Out of
patients who experience
breakthrough pain
 45% use Strong opioids
 40% use Weak opioids
 35% use Non opioids
n=279

Side effects due to current prescription medication
31%
30%
19%
12%
7%
7%
5%
4%
3%
19%
32%
0% 5% 10% 15% 20% 25% 30% 35%
Constipation
Nausea/Vomiting
Sedation
Psychological effects
Diarrhoea
Tremor
Itchy skin
Breathing difficulties
Urinary retention
Other
None
Q47. What side effects have you experienced due to the current prescription medication you are taking?
Q48. Did your HCP ever prescribe a laxative in conjunction with your painkiller(s)?
47% of respondents worry about the side effects of pain medication (Q54)
What side effect have you experienced due to the current
prescription medication you are taking?
Constipation is the
most common side
effect of prescription
medication –
however there are
47% of patients who
are not being
prescribed laxatives
in conjunction with
their medication and
5% state that they go
and purchase them
themselves
n=441

Non prescription medication
Base: all who receive treatment (n=506)
Q.49 Are you currently taking any over the counter (OTC)/non-prescription pain medicine?
Base: all currently taking OTC medicine (n=170)
Q.50 Which OTC medicines are you currently taking?
Base: all taking OTC medicine only (n=48)
Q.51 Overall, how effective are your current non-prescription pain medicines at controlling your cancer pain?
34% of patients who are receiving treatment for cancer related pain
are currently taking non-prescription medication
CROSS REFERENCE:
72% of these patients are also taking prescription medication
20%
15%
12%
0%
5%
10%
15%
20%
25%
Paracetamol Ibuprofen Aspirin
TOP 3 OTC MEDICATION CURRENTLY TAKEN Patients who are only
taking non prescription
medication are asked
to rate the
effectiveness of their
medication – 33% of
them rated their
medication as
“Quite ineffective”
n=506

Alternative methods
14%
13%
12%
11%
11%
9%
9%
8%
8%
7%
4%
4%
3%
2%
2%
1%
1%
1%
1%
19%
32%
0% 10% 20% 30% 40%
Massage
Vitamins
Heat (heating pad)
Exercise
Acupuncture
Physical therapy
Herbal supplements
Support groups
Change in diet
Relaxation therapy
Meditation
Ointments/creams
Therapy/counselling
Alcoholic drinks
Cold (ice packs)
Alcohol rubs
Nerve stimulation or TENS
Hypnosis
Imagery
Other
I don't use any other methods
Base: all who receive treatment (n=506)
Q.52 What, if any, other methods, remedies or treatments, apart from medications have you ever tried to relieve your pain we have
been discussing?
68% of cancer patients receiving treatment for their pain use
alternative methods – the most popular are massage and vitamins
n=506

16% of respondents are not being treated for their cancer
pain
12 %
9 %
9 %
7%
4 %
3 %
3 %
1%
1%
1%
1%
1%
16 %
12 %
13 %
15%
2 2 %
0% 5% 10% 15% 20% 25%
M a na ge / l i v e wi t h t he pa i n
Not ne e de d/ no l onge r ne c e ssa r y
S i de e f f e c t s
Doc t or ne v e r of f e r e d me di c a t i on
P a i n not ba d e nough
Onl y ha s i nt e r mi t t e nt pa i n
Di sl i k e s t a k i ng me di c a t i on
Doc t or doe s not be l i e v e me di c a t i on i s ne e de d
M e di c a t i on i s i ne f f e c t i v e
Not hi ng mor e c a n be done
Doe s not ha v e a doc t or f or pa i n
Ex e r c i se he l ps
Di sl i k e goi ng t o doc t or
P a i n i s gone
No me di c a l c ov e r a ge
Too busy
Ot he r
Base: All whose pain not being treated (n=67)
Q27. Why are you not currently being treated for your pain?
Almost a quarter of patients in phase 2 report that managing to live with the pain is
the main reason for them not being treated for their pain
20% of
respondents
have had a
surgical
procedure for
their cancer pain
n=67

For 13% of patients, the pain alone associated with the
cancer forced them to stop work
26% 26%
19%
13%
4%
11%
0%
5%
10%
15%
20%
25%
30%
Having
cancer
Pain &
Treatment
Combined
Cancer
treatment
Cancer pain Tiredness Other
reason
Base: All not currently employed who were before diagnosis (n=192)
Q.10 What was the primary reason for you stopping work?
The primary reasons for stopping work were reported to be pain
and cancer treatment combined, and having cancer itself. 44% of
patients who are currently not employed have stopped working
following their diagnosis
n=192

Top of mind, 49% of patients claim they have a good quality of life, however this does
not mean that their cancer and pain they experience has not had a significant impact
on their life
Cancer patients suffering pain hold a certain degree of independence,
however...
Expectations of pain
71% believe that pain is part of “having cancer”
But
51% believe their pain stops them from thinking or concentrating
53% would spend all their money on cancer treatment if they knew it
would work
Cancer patients suffering pain hold a certain degree of independence,
however...
44% believe that pain forces them to rely too much on other people
31% agree that they are in too much pain to care for themselves and
other people
n=573

My friends and family don’t really understand
“I am not alone in tackling my pain”
23% disagree
“My family does not understand
how pain affects my life”
29% agree
“I feel my pain affects my relationship
with my family”
41% agree
“I think people treat me differently (in a
negative way) because of my pain”
25% agree
66% feel that people don’t
understand how much pain they
are in
29% feel like they should not
discuss their pain
Although families and friends are very supportive and close to the
patients, they do not seem to comprehend the intensity of the pain
cancer patients are suffering
CROSS REFERENCE:
24% of these respondents
are never or only
occasionally asked about
their pain by their HCP
n=573

Almost half of patients believe their cancer prevents them
from leading a normal life
67% of patients find the pain associated with cancer distressing
66% of patients consider the impact of cancer on work and social life
distressing
More than half (61%) of patients find the impact of cancer treatment
distressing
69% of patients consider the impact of cancer on family/loved ones to be
distressing
Almost half (48%) of patients are distressed by the idea of death
Cancer pain
Impact of cancer on
work & social life
Impact of cancer
treatment
Impact of cancer on
family/loved ones
Fear of death
33% of patients feel that sometimes their pain is so bad that they feel like
they want to die
Feel they want to
die
37% of patients feel that their pain is intolerable
Pain is
intolerable
n=573
69% of respondents also report difficulty in performing activities in everyday
life (ADLs)
Difficulties in
everyday life

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