Introduction Young Adult cancer patients, aged 18–39 years, represent a unique demographic. Evidence from a limited body of international research indicates that these patients tend to experience a high symptom burden, particularly pain, during their final month of life1. In Australia, there is limited knowledge regarding their end-of-life symptoms and management strategies.

Objective This study aimed to identify the prevalence, severity, mechanisms and the specialist palliative management of pain in young adult patients who received end-of-life care and died at the Chris O’Brien Lifehouse, an Australian comprehensive cancer hospital.

Methods

A retrospective design analysed the case notes of 72 eligible patients, aged 18–39 years at diagnosis, who died in the hospital between January 2017 and May 2024. Quantitative analysis was performed on the collected data.

Results All patients had solid organ metastatic disease with the most common types being sarcoma (33%), lung (15%), and gynaecological cancer (10%). All patients received specialist palliative care input. The median length of hospitalisation to time of death was 17 days (SD 18.6 range 0–122). All patients experienced pain and received opioids. 87% of patient scored their pain on admission as moderate-severe on the Edmonton Symptom Assessment Scale (ESAS). The mean Oral Morphine Equivalent Dose (oMEDD) was 275 mg (SD 403.7, range 20- 2250) with 30 patients (41%) receiving more than 300 mg of OMEDD. 25 (35%) patients received methadone, 15 (20%) patients received infusion ketamine, 6 (8%) patients received infusion lignocaine and 7 (9%) patients underwent interventional pain procedure. 64 patients (89%) received benzodiazepine for agitation and/or anxiety. 4 patients (5%) had severe refractory pain requiring palliative sedation with levomepromazine and/or phenobarbitone.

Discussion and Conclusion Our findings showed that complex pain is highly prevalent in young adult cancer patients at the end of life requiring opioids, adjuncts and interventional pain strategies for management. This may be explained by age specific tumour types and predilection for bone and pelvic pain syndromes. Our data offer important information to the limited existing information in this area. In comparison standard palliative care cohort, our data showed that a large proportion of young adult patients require high doses of opioids for analgesia defined as OMEDD of more 300 mg2. Despite this pain remained poorly controlled in some patients requiring benzodiazepine or palliative sedation at the end of life, suggestive of total pain phenomenon, similarly reflected in several case reports1. When required, these patients require high doses of sedatives. Future research is needed to identify tailored treatment regimens for young adults with cancer-related pain, focusing on psychological symptom profile encompassing total pain.

References

1. Abdelaal, et al . Palliative care for adolescents and young adults with advanced illness: a scoping review. Palliative Medicine 2023;37(1):88–107.

2. Bercovitch, et al. High dose morphine use in the hospice setting. Cancer 2000;86(5):735–903.