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Maindet C, Burnod A, Minello C, George B, Allano G, Lemaire A. Strategies of complementary and integrative therapies in cancer-related pain-attaining exhaustive cancer pain management. Support Care Cancer 2019; 27:3119-3132. [PMID: 31076901 DOI: 10.1007/s00520-019-04829-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/23/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Complementary integrative therapies (CITs) correspond to growing demand in patients with cancer-related pain. This demand needs to be considered alongside pharmaceutical and/or interventional therapies. CITs can be used to cover certain specific pain-related characteristics. The objective of this review is to present the options for CITs that could be used within dynamic, multidisciplinary, and personalized management, leading to an integrative oncology approach. METHODS Critical reflection based on literature analysis and clinical practice. RESULTS Most CITs only showed trends in efficacy as cancer pain was mainly a secondary endpoint, or populations were restricted. Physical therapy has demonstrated efficacy in motion and pain, in some specific cancers (head and neck or breast cancers) or in treatments sequelae (lymphedema). In cancer survivors, higher levels of physical activity decrease pain intensity. Due to the multimorphism of cancer pain, certain mind-body therapies acting on anxiety, stress, depression, or mood disturbances (such as massage, acupuncture, healing touch, hypnosis, and music therapy) are efficient on cancer pain. Other mind-body therapies have shown trends in reducing the severity of cancer pain and improving other parameters, and they include education (with coping skills training), yoga, tai chi/qigong, guided imagery, virtual reality, and cognitive-behavioral therapy alone or combined. The outcome sustainability of most CITs is still questioned. CONCLUSIONS High-quality clinical trials should be conducted with CITs, as their efficacy on pain is mainly based on efficacy trends in pain severity, professional judgment, and patient preferences. Finally, the implementation of CITs requires an interdisciplinary team approach to offer optimal, personalized, cancer pain management.
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Affiliation(s)
- Caroline Maindet
- Pain management centre, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alexis Burnod
- Department of supportive care, Institut Curie, PSL Research University, Paris, France
| | - Christian Minello
- Anaesthesia-intensive care department, Cancer Centre Georges François Leclerc, Dijon, France
| | | | - Gilles Allano
- Pain management unit, Mutualist Clinic of la Porte-de-l'Orient, Lorient, France
| | - Antoine Lemaire
- Oncology and medical specialties department, Valenciennes General Hospital, Valenciennes, France.
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102
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Arch JJ, Stanton AL. Examining the "usual" in usual care: a critical review and recommendations for usual care conditions in psycho-oncology. Support Care Cancer 2019; 27:1591-1600. [PMID: 30788625 PMCID: PMC6534350 DOI: 10.1007/s00520-019-04677-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Within psycho-oncology clinical trials, usual care (UC) represents a common and important control condition. Yet recent shifts in oncology, coupled with insufficient description of such conditions, threaten to render UC increasingly difficult to define and interpret. This paper offers evidence of these shifts and recommendations for addressing them. METHODS The broader literature on usual care as a control condition in psychosocial/behavioral intervention trials was assessed, and usual care-controlled trials in psycho-oncology were selectively reviewed, toward to goal of conceptual synthesis. RESULTS We offer evidence that (1) UC control conditions are often insufficiently defined and assessed; and (2) the context of supportive care in oncology has shifted in a manner that contributes to this problem, with implications for interpreting and comparing findings across clinical trials. Three converging findings support these conclusions. First, the scientific literature increasingly documents the diversity in how "usual care" conditions are defined across psychosocial and behavioral trials, with important considerations for trial interpretation. Second, evidence suggests that the availability of psychosocial oncology care has increased over the past few decades. The increasing availability and variety of psychosocial care introduces potential confounds for UC conditions. Third, mental health care trends in the general population affect the supportive interventions available to oncology patients in UC conditions today versus in the past. CONCLUSIONS Shifts in psychosocial oncology and broader mental health care underscore the importance of carefully defining and assessing UC in psycho-oncology trials. Recommendations are offered for improving the design, evaluation, and interpretation of UC conditions, toward the ultimate goal of improving the quality of the evidence in psycho-oncology.
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Affiliation(s)
- Joanna J. Arch
- Department of Psychology and Neuroscience, University of
Colorado Boulder, 345 UCB Muenzinger, Boulder, CO 80309-0345;
; phone: 303-492-4634
- Division of Cancer Prevention and Control, University of
Colorado Cancer Center, Aurora, CO, 80045, USA
| | - Annette L. Stanton
- Department of Psychology, University of California Los
Angeles, Los Angeles, CA, 90095, USA;
- Department of Psychiatry and Biobehavioral Sciences,
University of California Los Angeles, Los Angeles, CA, 90095, USA
- Jonsson Comprehensive Cancer Center, University of
California Los Angeles, Los Angeles, CA, 90095, USA
- Cousins Center for Psychoneuroimmunology, UCLA Semel
Institute for Neuroscience, Los Angeles, CA, 90095, USA
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103
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Kalichman L, Menahem I, Treger I. Myofascial component of cancer pain review. J Bodyw Mov Ther 2019; 23:311-315. [PMID: 31103113 DOI: 10.1016/j.jbmt.2019.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pain is a common complaint of cancer patients, experienced by 38%-85% of patients. Some studies have shown a high incidence of myofascial pain syndrome (MPS) in cancer patients. AIMS 1) To estimate the prevalence of MPS in cancer patients; 2) to examine the efficacy of current treatment options for MPS in cancer patients. METHODS Narrative review. PubMed, CINAHL, PEDro, and Google Scholar databases were searched from inception until November 2017, for the keywords: cancer; cancer pain; breast cancer; mastectomy; lumpectomy; myofascial pain; trigger points. Trials of any methodological quality were included. All published material with an emphasis on randomized control trials was analyzed. RESULTS MPS is prevalent in cancer patients who suffer from pain, with a prevalence of between 11.9% and 44.8% in those diagnosed either with neck or head or breast cancer. Clinical studies showed conflicting results. Four interventional studies found that specific treatment for MPS may reduce the prevalence of active myofascial trigger points and therefore decrease pain level, sensitivity, and improve range of motion (in shoulder) in cancer patients. Two recent randomized control trials showed that pressure release of trigger points provides no additional beneficial effects to a standard physical therapy program for upper limb pain and function after breast cancer surgery. CONCLUSIONS We recommend including the evaluation of myofascial pain in routine clinical examination of cancer patients suffering from pain. Future studies are needed to investigate the long- and short-term effect of MPS treatments in cancer patients.
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Affiliation(s)
- Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Itay Menahem
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Iuly Treger
- Rehabilitation Department, Soroka Medical Center, Beer Sheva, Israel
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104
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Bennett MI, Eisenberg E, Ahmedzai SH, Bhaskar A, O'Brien T, Mercadante S, Krčevski Škvarč N, Vissers K, Wirz S, Wells C, Morlion B. Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain. Eur J Pain 2019; 23:660-668. [PMID: 30480345 PMCID: PMC7027571 DOI: 10.1002/ejp.1346] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/26/2018] [Accepted: 11/23/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Evidence from meta-analyses suggests that pain remains poorly controlled for a large proportion of patients; barriers to good management include poor assessment of pain, inadequate support for patient self-management and late or inadequate access to strong opioid analgesia in those with advanced disease. METHODS The European Pain Federation (EFIC) established a Task Force in 2017 which convened a European group of experts, drawn from a diverse range of relevant clinical disciplines, to prepare a position paper on appropriate standards for the management of cancer-related pain. The expert panel reviewed the available literature and made recommendations using the GRADE system to combine quality of evidence with strength of recommendation. The panel took into account the desirable and undesirable effects of the management recommendation, including the cost and inconvenience of each when deciding the recommendation. RESULTS AND CONCLUSIONS The 10 standards presented are aimed to improve cancer pain management and reduce variation in practice across Europe. The Task Force believes that adoption of these standards by all 37 countries will promote the quality of care of patients with cancer-related pain and reduce unnecessary suffering. SIGNIFICANCE Pain affects up to 40% of cancer survivors and affects at least 66% of patients with advanced progressive disease, many of whom experience poor pain control. These 10 standards are aimed to improve cancer pain management, promote the quality of care of patients and reduce variation across Europe.
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Affiliation(s)
- Michael I Bennett
- St Gemma's Academic Unit of Palliative Care, University of Leeds, Leeds, UK
| | - Elon Eisenberg
- Pain Research Unit, Institute of Pain Medicine, Rambam Health Care Campus and Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Arun Bhaskar
- Imperial College Healthcare NHS Trust, London, UK
| | - Tony O'Brien
- Marymount University Hospital & Hospice, Curraheen, Ireland.,Cork University Hospital, Wilton, Ireland.,College of Medicine & Health, University College Cork, Cork, Ireland
| | | | - Nevenka Krčevski Škvarč
- Faculty of Medicine, University of Maribor, Institute for Palliative Medicine and Care, Slovenia
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Stefan Wirz
- Centre for Pain Medicine, Department of Anesthesiology, Intensive Medicine, Pain/Palliative Medicine, GFO-Hospitals Bonn and University of Bonn
| | | | - Bart Morlion
- The Leuven Center for Algology and Pain Management, University Hospitals Leuven, KU Leuven, Belgium
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105
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Dalal S, Bruera E. Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era. Am Soc Clin Oncol Educ Book 2019; 39:24-35. [PMID: 31099619 DOI: 10.1200/edbk_100020] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Use of opioids for the treatment of pain is necessary for the majority of patients with advanced cancer, however its use has become challenging in the face of the opioid epidemic and the emerging evidence that patients with cancer are also at risk for nonmedical opioid use. This article proposes an assessment and treatment plan that incorporates universal screening with monitoring for all patients with cancer who are considered for opioid treatment to assess their risk for opioid misuse and harm. Timely identification with appropriate management, including referral of at-risk patients, will allow oncology professionals to optimize the risk-to-benefit and support the safe use of opioids for patients with cancer.
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Affiliation(s)
- Shalini Dalal
- 1 From the Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- 1 From the Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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106
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Cluxton C. The Challenge of Cancer Pain Assessment. THE ULSTER MEDICAL JOURNAL 2019; 88:43-46. [PMID: 30675079 PMCID: PMC6342038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Christopher Cluxton
- ,Correspondence to: Christopher Cluxton, 4th-year QUB medical student, E-mail:
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107
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Nairn RC, Merluzzi TV. Enhancing coping skills for persons with cancer utilizing mastery enhancement: a pilot randomized clinical trial. J Behav Med 2018; 42:423-439. [PMID: 30552531 DOI: 10.1007/s10865-018-0004-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
The purpose of this project was to develop a short-term, theory-based intervention for patients with self-reported limited self-efficacy to perform coping behaviors. Cancer patients with low coping self-efficacy were randomly assigned to a treatment (N = 66) or control condition (N = 68). The treatment, Mastery Enhancement Therapy, was based on self-regulation and self-efficacy theories. Measures of coping self-efficacy, functional status, depression, quality of life, and adjustment were administered at baseline, after session two, after the final (fourth) session, and at 3 months post-treatment. Control participants completed the measures at about the same time intervals. Treatment participants reported highly significant immediate post-treatment improvement in self-efficacy for coping compared to controls, although controls improved by 3 months post-treatment. However, treatment participants with lower levels of functional status benefited more than controls on depression and adjustment at follow-up. Mastery Enhancement Therapy is a time-limited treatment that increases coping efficacy and subsequently adjustment during active medical treatment, and appears to warrant a large-scale RCT with patients with below average coping self-efficacy and moderate to high symptoms.
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108
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Valenta S, Spirig R, Miaskowski C, Zaugg K, Spichiger E. Testing a pain self-management intervention by exploring reduction of analgesics' side effects in cancer outpatients and the involvement of family caregivers: a study protocol (PEINCA-FAM). BMC Nurs 2018; 17:54. [PMID: 30559603 PMCID: PMC6292053 DOI: 10.1186/s12912-018-0323-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/19/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pain is one of cancer patients’ most frequent and distressing symptoms; however, analgesics’ side effects often increase symptom burden. Further, with the home rapidly becoming the primary cancer care setting, family caregivers (FCs) commonly play central roles in patients’ pain self-management, but with little or no preparation. One US-tested intervention, the PRO-SELF© Plus Pain Control Program (PCP), designed to support cancer outpatients and their FCs in pain self-management, is currently being tested in the Swiss multi-centre PEINCA study. The current PEINCA-FAM study is a sub-study of PEINCA. The aims of PEINCA-FAM are: a) to test the efficacy of the adapted German PRO-SELF © Plus PCP to reduce side effects of analgesics; b) to enhance patients’/FCs’ knowledge regarding cancer pain; and c) to explore FCs’ involvement in patients’ pain self-management. Methods This mixed methods project combines a multi-centre randomized controlled clinical trial with qualitative data collection techniques and includes 210 patients recruited from three oncology outpatient clinics. FCs involved in patients’ pain self-management are also invited to participate. After baseline evaluation, eligible participants are randomized to a 6-week intervention group and a control group. Both groups complete a daily pain and symptom diary. Intervention group patients/FCs receive the weekly psychoeducational PRO-SELF© Plus PCP interventions; control group patients receive usual care. After completing the six-week study procedures, a subsample of 7–10 patients/FCs per group and hospital (N = 42–60) will be interviewed regarding their pain management experiences. Data collection will take place from April 2016 until December 2018. An intent-to-treat analysis and generalized linear mixed models will be applied. Qualitative data will be analysed by using interpretive description. Quantitative and qualitative results will be combined within a mixed method matrix. Discussion In clinical practice, specially trained oncology nurses in outpatient clinics could apply the intervention to reduce side effects and to enhance patients’/FCs’ self-efficacy and pain management knowledge. Trial registration The PEINCA study is registered in the Clinical Trials.gov site (code: NCT02713919, 08 March 2016).
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Affiliation(s)
- Sabine Valenta
- 1Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.,2Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Rebecca Spirig
- 1Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.,3Department of Nursing Science, University of Witten/ Herdecke, Witten, Germany
| | - Christine Miaskowski
- 4School of Nursing, University of California San Francisco (UCSF), San Francisco, USA
| | - Kathrin Zaugg
- 5Department of Radiation Oncology, Stadtspital Triemli, Zurich, Switzerland.,6Department of Radiation Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Elisabeth Spichiger
- 1Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.,7Head Office of Nursing and Allied Health Professionals, Inselspital, University Hospital Bern, Bern, Switzerland
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109
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Nipple-Sparing Mastectomy Incisions for Cancer Extirpation Prospective Cohort Trial: Perfusion, Complications, and Patient Outcomes. Plast Reconstr Surg 2018; 142:13-26. [PMID: 29878989 DOI: 10.1097/prs.0000000000004498] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nipple-sparing mastectomy offers several advantages for women seeking postmastectomy breast reconstruction, but compromised skin and nipple perfusion may lead to skin and nipple necrosis. It is unclear whether the incisional approach contributes to these complications; therefore, the purpose of this study was to compare the impact of incision type on outcomes in patients undergoing nipple-sparing mastectomy. METHODS This is a prospective cohort study of patients undergoing nipple-sparing mastectomy with prosthetic breast reconstruction through an inframammary fold versus a lateral radial incision. Skin and nipple perfusion as represented by fluorescence intensity, mammometric parameters, patient-reported outcomes, and clinical outcomes were analyzed and compared for the two cohorts, and multivariable logistic regression models were performed to evaluate the effects of covariates on outcomes. RESULTS Seventy-nine patients were studied: 55 in the inframammary fold cohort and 24 in the lateral radial cohort. The inframammary fold group had significantly less fluorescence intensity to the inferior (21.9 percent versus 36.9 percent; p = 0.001) and lateral portions of breast skin (23.1 percent versus 40.7 percent; p = 0.003) after reconstruction. Decreased fluorescence intensity was associated with smoking, decreased mean arterial pressure, and greater specimen weight. Postreconstruction breast volumes were increased over preoperative volumes in the inframammary fold group (38.3 percent) versus the lateral radial (31.2 percent) group; however, patients with a lateral radial incision had a greater increase in satisfaction with their breasts and psychosocial well-being. CONCLUSIONS There are significant differences in patient-reported outcomes and final breast volumes based on the incisional approach to nipple-sparing mastectomy. These data can be used to guide providers and counsel patients considering nipple-sparing mastectomy with prosthetic reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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110
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Abstract
Medical progress, the improvement of general living conditions, and an increase in life expectancy have led to an increase in the general prevalence of oncologic disease. More importantly, more and more patients survive cancer or live with the disease for long periods of time. While the battle for survivorship is continuously being fought, improving patients' quality of life has come to the fore. Psychosocial issues may modulate the course of the disease, but mainly have a deep impact on patients' physical and mental wellbeing. Psycho-oncology has risen as a relatively new interdisciplinary field with the aim of addressing these issues and providing support for patients confronting numerous challenges throughout the different stages of the disease. In this article, we provide an overview of the current knowledge of body-mind interactions in cancer and an outline of the broad spectrum of psycho-oncologic care, with a special focus on the treatment of pain, fatigue, sexual issues, and fear of progression.
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111
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112
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Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, Ripamonti CI. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29:iv166-iv191. [PMID: 30052758 DOI: 10.1093/annonc/mdy152] [Citation(s) in RCA: 416] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- M Fallon
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh, UK
| | - R Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome
| | - F Aielli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, Hertfordshire, UK
| | - R Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - M Sharma
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - C I Ripamonti
- Department of Onco-Haematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
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113
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Qi S, Lai H, Zhang Y, Dong Q, Zhu X. Chinese herbal medicine for opioid induced constipation in cancer patients: Protocol for a systematic review. Medicine (Baltimore) 2018; 97:e12594. [PMID: 30278572 PMCID: PMC6181624 DOI: 10.1097/md.0000000000012594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Opioid induced constipation (OIC) is a symptom that is commonly encountered in cancer pain management. Chinese herbal medicine (CHM) has been widely used to improve OIC in China. Many clinical trials indicate that CHM could improve OIC. In this systematic review, we aim to evaluate the effectiveness and safety of CHM for OIC in cancer patients. METHODS We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of CHM for OIC in cancer patients: CENTRAL, EMBASE, MEDILINE, CINAHL and China National Knowledge Infrastructure. Each database will be searched from inception to June 2018. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses. RESULTS This proposed study will evaluate the effectiveness and safety of CHM for OIC. The outcomes will include change in bowel movements, quality of life and adverse events. CONCLUSIONS This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of CHM for OIC in cancer patients. DISSEMINATION AND ETHICS The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.
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Affiliation(s)
- Shuo Qi
- Dongzhimen Hospital Affiliate to Beijing University of Chinese Medicine, Beijing, China
- The Chinese Medicine Center, Collaboration Between Beijing University of Chinese Medicine and Western Sydney University
| | - Hezheng Lai
- School of Health and Science, Western Sydney University, Campbelltown, New South Wales
- The Chinese Medicine Center, Collaboration Between Beijing University of Chinese Medicine and Western Sydney University
| | - Yayue Zhang
- Dongzhimen Hospital Affiliate to Beijing University of Chinese Medicine, Beijing, China
| | - Qing Dong
- Dongzhimen Hospital Affiliate to Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoshu Zhu
- School of Health and Science, Western Sydney University, Campbelltown, New South Wales
- The Chinese Medicine Center, Collaboration Between Beijing University of Chinese Medicine and Western Sydney University
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114
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Jazzar U, Yong S, Klaassen Z, Huo J, Hughes BD, Esparza E, Mehta HB, Kim SP, Tyler DS, Freedland SJ, Kamat AM, Wolf DV, Williams SB. Impact of psychiatric illness on decreased survival in elderly patients with bladder cancer in the United States. Cancer 2018; 124:3127-3135. [PMID: 29660813 PMCID: PMC6097900 DOI: 10.1002/cncr.31404] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Treatments for muscle-invasive bladder cancer are multimodal, complex, and often carry significant risks of physical and psychological morbidity. The objectives of this study were to define the incidence and types of psychiatric illnesses diagnosed after treatment and to determine their impact on survival outcomes. METHODS In total, 3709 patients who were diagnosed with clinical stage T2 through T4a bladder cancer from January 1, 2002, to December 31, 2011, from the Surveillance, Epidemiology, and End Results-Medicare were analyzed. Multivariable analysis and Cox proportional-hazards models were used to determine the predictors associated with psychiatric diagnosis and impact on survival outcomes. RESULTS Of 3709 patients, 1870 (50.4%) were diagnosed with posttreatment psychiatric disorders. Patients who underwent radical cystectomy were identified as being at significantly greater risk of having a posttreatment psychiatric illness compared with those who received radiotherapy and/or chemotherapy (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07-1.31; P = .001). In adjusted analyses, diagnosis of a psychiatric disorder resulted in significantly worse overall survival (HR, 2.80; 95% CI, 2.47-3.17; P < .001) and cancer-specific survival (HR, 2.39; 95% CI, 2.05-2.78; P < .001). CONCLUSIONS One-half of patients with muscle-invasive bladder cancer who underwent treatment were diagnosed with a psychiatric disorder, which resulted in worse survival outcomes compared with patients who did not have a posttreatment psychiatric diagnosis. This information can be used to inform interventions to educate patients with muscle-invasive bladder cancer regarding the impact of different treatments on mental health. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Usama Jazzar
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Shan Yong
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, The University of Florida, Gainesville, FL
| | - Byron D. Hughes
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Edgar Esparza
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Hemalkumar B. Mehta
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Simon P. Kim
- Urology Institute, Center for Health Care Quality and Outcomes, University Hospitals Case Western Medical Center, Case Western Reserve University, Cleveland, OH
- Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT
| | - Douglas S. Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - Ashish M. Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dwight V. Wolf
- Department of Psychiatry, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Stephen B. Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
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115
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Bail JR, Traeger L, Pirl WF, Bakitas MA. Psychological Symptoms in Advanced Cancer. Semin Oncol Nurs 2018; 34:241-251. [DOI: 10.1016/j.soncn.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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116
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Tait RC, Zoberi K, Ferguson M, Levenhagen K, Luebbert RA, Rowland K, Salsich GB, Herndon C. Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment. THE JOURNAL OF PAIN 2018; 19:1367-1383. [PMID: 29966772 DOI: 10.1016/j.jpain.2018.06.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 05/18/2018] [Accepted: 06/12/2018] [Indexed: 12/31/2022]
Abstract
Persistent Post-Mastectomy Pain (PPMP) is a common condition that can follow surgeries for breast cancer, the most common cancer in women. Because of the frequency of PPMP and its potential severity, it has received increasing research attention. This manuscript reviews the recent research literature, beginning with a brief history and then relevant medical, surgical, demographic, and psychosocial risk factors. Subsequently, social, psychological, and functional sequelae that have been linked to PPMPS are considered, as is research on current pharmacological, psychological, and rehabilitative approaches to treatment. The review concludes with a discussion of directions for future research and treatment that might reduce the incidence and impact of PPMP on breast cancer survivors. PERSPECTIVE: This article describes current research literature involving mechanisms, risks, and treatments related to persistent post-mastectomy pain. Implications of research findings also are discussed for pre- and post-surgical approaches to pain management, current treatments, and promising research directions.
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Affiliation(s)
| | - Kim Zoberi
- Saint Louis University School of Medicine
| | | | | | | | - Kevin Rowland
- Southern Illinois University Edwardsville School of Dentistry
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Psychological Treatment. Hematol Oncol Clin North Am 2018; 32:483-491. [DOI: 10.1016/j.hoc.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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118
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Mayahara M, Wilbur J, Fogg L, Breitenstein SM. Behavioral Pain Intervention for Hospice and Palliative Care Patients: An Integrative Review. Am J Hosp Palliat Care 2018; 35:1245-1255. [PMID: 29772922 DOI: 10.1177/1049909118775421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite the advances in pain management, achieving optimal pain control in hospice and palliative care is challenging. Patient/caregiver's lack of pain management knowledge, poor pain reporting, and poor adherence to pain management regimens are all associated with inadequate pain control. The purpose of this integrated review is to examine behavioral interventions designed for patients and caregivers to improve pain control in hospice and palliative care settings. Ten studies were identified through a database search. Seven of the 10 studies found significant improvement in at least 1 pain marker. Of the 7 studies that looked at changes in pain knowledge, 5 had significant improvements in at least 1 knowledge subscale. The 2 studies that looked at adherence to pain management found significant improvements. One limitation of the reviewed studies was that the delivery of them would not be efficient across all health-care settings, and, as a consequence, more technologically sophisticated delivery methods are needed. Therefore, while it is clear from the review that effective pain management interventions have been developed for hospice and palliative care patients, it is also clear that future research needs to focus on providing these same interventions through a more technologically sophisticated delivery method.
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Eaton LH, Brant JM, McLeod K, Yeh C. Nonpharmacologic Pain Interventions: A Review of Evidence-Based Practices for Reducing Chronic Cancer Pain
. Clin J Oncol Nurs 2018; 21:54-70. [PMID: 28524909 DOI: 10.1188/17.cjon.s3.54-70] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain is a common issue for patients with cancer and can be challenging to manage effectively. Healthcare professionals need to be knowledgeable about evidence-based nonpharmacologic interventions.
. OBJECTIVES This systematic review critically appraises the strength and quality of the empirical evidence for nonpharmacologic interventions in reducing chronic cancer pain.
. METHODS Intervention studies were critically appraised and summarized by an Oncology Nursing Society Putting Evidence Into Practice team of RNs, advanced practice nurses, and nurse scientists. A level of evidence and a practice recommendation was assigned to each intervention.
. FINDINGS Based on evidence, recommended interventions to reduce chronic cancer pain are celiac plexus block for pain related to pancreatic and abdominal cancers and radiation therapy for bone pain. Although psychoeducational interventions are considered likely to be effective, the effective components of these interventions and their dose and duration need to be determined through additional research.
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When a policy decision meets practice realities: The case of cancer survivorship care and rehabilitation needs assessment. Eur J Oncol Nurs 2018; 33:70-77. [DOI: 10.1016/j.ejon.2018.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/13/2017] [Accepted: 01/25/2018] [Indexed: 11/22/2022]
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Allsop MJ, Wright-Hughes A, Black K, Hartley S, Fletcher M, Ziegler LE, Bewick BM, Meads D, Hughes ND, Closs SJ, Hulme C, Taylor S, Flemming K, Hackett J, O'Dwyer JL, Brown JM, Bennett MI. Improving the management of pain from advanced cancer in the community: study protocol for a pragmatic multicentre randomised controlled trial. BMJ Open 2018; 8:e021965. [PMID: 29572400 PMCID: PMC5879575 DOI: 10.1136/bmjopen-2018-021965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION For patients with advanced cancer, research shows that pain is frequent, burdensome and undertreated. Evidence-based approaches to support cancer pain management have been developed but have not been implemented within the context of the UK National Health Service. This protocol is for a pragmatic multicentre randomised controlled trial (RCT) to assess feasibility, acceptability, effectiveness and cost-effectiveness for a multicomponent intervention for pain management in patients with advanced cancer. METHODS AND ANALYSIS This trial will assess the feasibility of implementation and uptake of evidence-based interventions, developed and piloted as part of the Improving the Management of Pain from Advanced Cancer in the Community Programme grant, into routine clinical practice and determine whether there are potential differences with respect to patient-rated pain, patient pain knowledge and experience, healthcare use, quality of life and cost-effectiveness. 160 patients will receive either the intervention (usual care plus supported self-management) delivered within the oncology clinic and palliative care services by locally assigned community palliative care nurses, consisting of a self-management educational intervention and eHealth intervention for routine pain assessment and monitoring; or usual care. The primary outcomes are to assess implementation and uptake of the interventions, and differences in terms of pain severity. Secondary outcomes include pain interference, participant pain knowledge and experience, and cost-effectiveness. Outcome assessment will be blinded and patient-reported outcome measures collected via post at 6 and 12 weeks following randomisation. ETHICS AND DISSEMINATION This RCT has the potential to significantly influence National Health Service delivery to community-based patients with pain from advanced cancer. We aim to provide definitive evidence of whether two simple interventions delivered by community palliative care nurse in palliative care that support-self-management are clinically effective and cost-effective additions to standard community palliative care. TRIAL REGISTRATION NUMBER ISRCTN18281271; Pre-results.
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Affiliation(s)
- Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alexandra Wright-Hughes
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Kath Black
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lucy E Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bridgette M Bewick
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - S José Closs
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sally Taylor
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, Heslington, UK
| | - Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John L O'Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Julia M Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Yennurajalingam S, Kang DH, Hwu WJ, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients With Advanced Cancer: A Preliminary Study. J Pain Symptom Manage 2018; 55:198-206. [PMID: 28870799 DOI: 10.1016/j.jpainsymman.2017.08.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Cranial electrotherapy stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACPs). OBJECTIVES The aim of the study was to determine the feasibility and preliminary efficacy of a four-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted. METHODS In this one group open label pre- and post-intervention study with a four-week CES intervention, ACPs with one or more of four moderate intensity (≥3/10) Edmonton Symptom Assessment Scale (ESAS) symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0%-100%), satisfaction rates (0-10), and safety were assessed. ESAS, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index, Brief Pain Inventory, and salivary levels (cortisol, alpha amylase, C-reactive protein, and interleukin-1β, and interleukin-6) were assessed from baseline to Week 4. RESULTS Thirty-three of 36 patients (92%) completed the CES. Median (interquartile range) adherence CES use and satisfaction scores were 93% (89-100) and 10% (9-10), respectively, and the adherence criteria was met in the study. CES use was safe (no Grade 3 or higher adverse events). HADS anxiety (P < 0.001), HADS depression (P = 0.024), ESAS anxiety (P = 0.001), ESAS depression (P = 0.025), Brief Pain Inventory pain (P = 0.013), Pittsburgh Sleep Quality Index daytime dysfunction (P = 0.002), and medication use (P = 0.006) scores improved after four-week CES treatment. CONCLUSION In this preliminary study, we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Duck-Hee Kang
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nikhil S Padhye
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Charles Masino
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyedeh S Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhanni Lu
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Peterson SE, Selvaggi KJ, Scullion BF, Blinderman CD. Pain Management and Antiemetic Therapy in Hematologic Disorders. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00091-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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124
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Spichiger E, Valenta S. [Not Available]. PRAXIS 2018; 107:71-76. [PMID: 29338627 DOI: 10.1024/1661-8157/a002873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Krebsbedingte Schmerzen sind häufig, für Betroffene sehr belastend und oft ungenügend behandelt. Krebs ist zur chronischen Krankheit geworden; viele Patienten sind gefordert zu Hause selber oder mit Unterstützung von Angehörigen mit Therapien und Auswirkungen der Erkrankung zurechtzukommen. Dazu gehört auch das Schmerz-Selbstmanagement. Dieses ist komplex und verlangt spezifisches Wissen und Können, um eine Schmerztherapie im Alltag erfolgreich umzusetzen. Oft gelingt dies nicht, weil patientenbezogene Barrieren wie Bedenken gegenüber Opiaten eine gute Schmerzkontrolle verhindern. Mit getesteten Interventionen konnten teilweise moderate Schmerzreduktionen erreicht werden. Wegen unterschiedlichen methodischen Ansätzen und Interventionen bleibt offen, wie eine Unterstützung von Patienten und pflegenden Angehörigen am wirksamsten erfolgt. Es empfiehlt sich, Patienten zu informieren, dabei bekannte Barrieren anzugehen, Können zu vermitteln und pflegende Angehörige einzubeziehen.
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Affiliation(s)
- Elisabeth Spichiger
- 1 Pflegewissenschaft, Departement Public Health, Medizinische Fakultät, Universität Basel
- 2 Inselspital Universitätsspital Bern
| | - Sabine Valenta
- 1 Pflegewissenschaft, Departement Public Health, Medizinische Fakultät, Universität Basel
- 3 Klinik für Hämatologie, Universitätsspital Basel
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Miyashita M. Editorial Special Issue: Pain Management. Asia Pac J Oncol Nurs 2018; 5:245-247. [PMID: 29963585 PMCID: PMC5996587 DOI: 10.4103/apjon.apjon_22_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
To cope with cancer and its treatment-related side effects and toxicities, people are increasingly using complementary and alternative medicine (CAM). Consequently, integrative oncology, which combines conventional therapies and evidence-based CAM practices, is an emerging discipline in cancer care. The use of yoga as a CAM is proving to be beneficial and increasingly gaining popularity. An electronic database search (PubMed), through December 15, 2016, revealed 138 relevant clinical trials (single-armed, nonrandomized, and randomized controlled trials) on the use of yoga in cancer patients. A total of 10,660 cancer patients from 20 countries were recruited in these studies. Regardless of some methodological deficiencies, most of the studies reported that yoga improved the physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing a strong support for yoga's integration into conventional cancer care. This review article presents the published clinical research on the prevalence of yoga's use in cancer patients so that oncologists, researchers, and the patients are aware of the evidence supporting the use of this relatively safe modality in cancer care.
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Affiliation(s)
- Ram P Agarwal
- Department of Medicine, Division of Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adi Maroko-Afek
- Department of Medicine, Division of Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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SEOM clinical guideline for treatment of cancer pain (2017). Clin Transl Oncol 2017; 20:97-107. [PMID: 29127593 PMCID: PMC5785609 DOI: 10.1007/s12094-017-1791-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/23/2022]
Abstract
Pain is a highly prevalent symptom in patients with cancer. Despite therapeutic advances and well-accepted treatment guidelines, a percentage of patients with pain are under-treated.
Currently, it has been recognized that several barriers in pain management still exist and, in addition, there are new challenges surrounding complex subtypes of pain, such as breakthrough and neuropathic pain, requiring further reviews and recommendations. This is an update of the guide our society previously published and represents the continued commitment of SEOM to move forward and improve supportive care of cancer patients.
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129
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Ciucă A, Băban A. Psychological factors and psychosocial interventions for cancer related pain. ACTA ACUST UNITED AC 2017; 55:63-68. [PMID: 28186958 DOI: 10.1515/rjim-2017-0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Indexed: 11/15/2022]
Abstract
The present paper is aimed at briefly presenting psychological factors involved in cancer related pain and what psychosocial interventions are efficient in reducing it. Cancer related pain is a complex experience and the most integrative and recommended approach is the biopsychosocial model. It has been proved that chronic pain is more strongly related to psychological factors than to treatment or illness related factors. Psychological factors influencing pain experience can be intuitively grouped starting with awareness of pain (i.e., attentional factor), then with evaluation of pain (i.e., cognitive factors) which is leading to feelings (i.e., emotional factors), and behaviours (i.e., coping strategies) regarding pain. Psychosocial interventions (i.e., skill based and education based interventions) have strong evidence that is effective in reducing cancer related pain.
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130
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Markozannes G, Aretouli E, Rintou E, Dragioti E, Damigos D, Ntzani E, Evangelou E, Tsilidis KK. An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction. BMC Psychol 2017; 5:31. [PMID: 28859685 PMCID: PMC5580223 DOI: 10.1186/s40359-017-0200-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/24/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychological interventions are widely implemented for pain management and treatment, but their reported effectiveness shows considerable variation and there is elevated likelihood for bias. METHODS We summarized the strength of evidence and extent of potential biases in the published literature of psychological interventions for pain treatment using a range of criteria, including the statistical significance of the random effects summary estimate and of the largest study of each meta-analysis, number of participants, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance bias. RESULTS Thirty-eight publications were identified, investigating 150 associations between several psychological interventions and 29 different types of pain. Of the 141 associations based on only randomized controlled trials, none presented strong or highly suggestive evidence by satisfying all the aforementioned criteria. The effect of psychological interventions on reducing cancer pain severity, pain in patients with arthritis, osteoarthritis, rheumatoid arthritis, breast cancer, fibromyalgia, irritable bowel syndrome, self-reported needle-related pain in children/adolescents or with chronic musculoskeletal pain, chronic non-headache pain and chronic pain in general were supported by suggestive evidence. CONCLUSIONS The present findings reveal the lack of strong supporting empirical evidence for the effectiveness of psychological treatments for pain management and highlight the need to further evaluate the established approach of psychological interventions to ameliorate pain.
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Affiliation(s)
- Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.
| | - Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Evangelia Rintou
- Department of Psychiatry, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Elena Dragioti
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Dimitrios Damigos
- Department of Psychiatry, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, 02903, USA
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
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Odonkor CA, Kim G, Erdek M. Global cancer pain management: a systematic review comparing trials in Africa, Europe and North America. Pain Manag 2017; 7:299-310. [PMID: 28699421 DOI: 10.2217/pmt-2016-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM Despite the rise in cancer survivorship, few reviews have examined the quality of studies of cancer pain management and practices around the globe. With a void in trials spanning multiple geographical settings, this review evaluates the quality of cancer trials across three continents. MATERIALS & METHODS A literature review and search of established databases was conducted to identify eligible studies. The Cochrane method, the Jadad Score and a cancer pain-specific ad hoc tool were used to evaluate quality of studies. RESULTS Eighteen studies representing a total of 4693 individuals were included in the review. Study quality correlated positively with study sample size and palliative care index. Trials in all three continents were prone to use opioids for pain management, whereas trials in Europe and North America utilized other adjuvant therapies such as antidepressants and steroids. CONCLUSION This review underscores the need for better multidimensional quality assessment tools for cancer pain trials.
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Affiliation(s)
- Charles A Odonkor
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Gabriel Kim
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC 20059, USA
| | - Michael Erdek
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Gorin SS, Haggstrom D, Han PKJ, Fairfield KM, Krebs P, Clauser SB. Cancer Care Coordination: a Systematic Review and Meta-Analysis of Over 30 Years of Empirical Studies. Ann Behav Med 2017; 51:532-546. [DOI: 10.1007/s12160-017-9876-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yamato TP, Maher C, Koes B, Moseley A. The PEDro scale had acceptably high convergent validity, construct validity, and interrater reliability in evaluating methodological quality of pharmaceutical trials. J Clin Epidemiol 2017; 86:176-181. [DOI: 10.1016/j.jclinepi.2017.03.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/09/2016] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
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Johannsen M, Sørensen J, O'Connor M, Jensen A, Zachariae R. Mindfulness-based cognitive therapy (MBCT) is cost-effective compared to a wait-list control for persistent pain in women treated for primary breast cancer-Results from a randomized controlled trial. Psychooncology 2017; 26:2208-2214. [DOI: 10.1002/pon.4450] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/27/2017] [Accepted: 04/27/2017] [Indexed: 11/09/2022]
Affiliation(s)
- M. Johannsen
- Unit for Psychooncology and Health Psychology, Dept. of Oncology; Aarhus University Hospital and Dept of Psychology; Aarhus University; Aarhus Denmark
- Centre for Integrated Registry-Based Research (CIRRAU); Aarhus University; Aarhus Denmark
| | - J. Sørensen
- Centre for Health Economics Research, Dept of Public Health; University of Southern Denmark; Odense C Denmark
- Health Outcome Research Centre; Royal College of Surgeons in Ireland; Dublin 2 Ireland
| | - M. O'Connor
- Unit for Psychooncology and Health Psychology, Dept. of Oncology; Aarhus University Hospital and Dept of Psychology; Aarhus University; Aarhus Denmark
| | - A.B. Jensen
- Dept. of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - R. Zachariae
- Unit for Psychooncology and Health Psychology, Dept. of Oncology; Aarhus University Hospital and Dept of Psychology; Aarhus University; Aarhus Denmark
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Feldstain A, MacDonald N, Bhargava R, Chasen M. Reported distress in patients living with advanced cancer: changes pre-post interdisciplinary palliative rehabilitation. Support Care Cancer 2017; 25:3191-3197. [DOI: 10.1007/s00520-017-3728-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
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Disease burden and pain in obese cancer patients with chemotherapy-induced peripheral neuropathy. Support Care Cancer 2017; 25:1873-1879. [PMID: 28124735 DOI: 10.1007/s00520-017-3571-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/09/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) and obesity are prevalent in cancer survivors and decrease quality of life; however, the impact of the co-occurrence of these conditions has garnered little attention. This study investigated differences between obese and non-obese cancer survivors with CIPN and predictors of symptom burden and pain. METHODS Patients with CIPN were administered the MD Anderson Symptom Inventory and a modified version of pain descriptors from the McGill Pain Inventory. Independent t tests assessed group differences between obese and non-obese survivors, and linear regression analyses explored predictors of patient outcomes. RESULTS Results indicated a significant difference in symptom severity scores for obese (M = 32.89, SD = 25.53) versus non-obese (M = 19.35, SD = 16.08) patients (t(37.86) = -2.49, p = .02). Significant differences were also found for a total number of pain descriptors endorsed by obese (M = 4.21, SD = 3.45) versus non-obese (M = 2.42, SD = 2.69) participants (t(74) = -2.53, p = .01). Obesity was a significant predictor of symptom severity and total pain descriptors endorsed. Other significant predictors included age and months since treatment. CONCLUSIONS Cancer survivors with CIPN and co-occurring obesity may be more at risk for decreased quality of life through increased symptom severity and pain compared to non-obese survivors. This paper identified risk factors, including obesity, age, and months since treatment, that can be clinically identified for monitoring distress in CIPN patients. Future research should focus on the longitudinal relationship between obesity and CIPN, and robust interventions to address the multifaceted issues faced by cancer survivors.
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139
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Bennett M, Paice JA, Wallace M. Pain and Opioids in Cancer Care: Benefits, Risks, and Alternatives. Am Soc Clin Oncol Educ Book 2017; 37:705-713. [PMID: 28561731 DOI: 10.1200/edbk_180469] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pain remains common in the setting of malignancy, occurring as a consequence of cancer and its treatment. Several high-quality studies confirm that more than 50% of all patients with cancer experience moderate to severe pain. The prevalence of pain in cancer survivors is estimated to be 40%, while close to two-thirds of those with advanced disease live with pain. Progress has occurred in the management of cancer pain, yet undertreatment persists. Additionally, new challenges are threatening these advances. These challenges are numerous and include educational deficits, time restraints, and limited access to all types of care. New challenges to access are occurring as a result of interventions designed to combat the prescription drug abuse epidemic, with fewer clinicians willing to prescribe opioids, pharmacies reluctant to stock the medications, and payers placing strict limits on reimbursement. A related challenge is our evolving understanding of the risks of long-term adverse effects associated with opioids. And reflective of the opioid abuse epidemic affecting the general population, the potential for misuse or abuse exists in those with cancer. Guidelines have been developed to support oncologists when prescribing the long-term use of opioids for cancer survivors. The challenges surrounding the use of opioids, and the need for safe and effective alternative analgesics, are leading to intense interest in the potential benefits of cannabis for cancer-related pain. Oncologists are faced with questions regarding the types of cannabis available, differences between routes of administration, data concerning safety and efficacy, and legal and regulatory dynamics.
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Affiliation(s)
- Mike Bennett
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Judith A Paice
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Mark Wallace
- From the Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom; Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University; Chicago, IL; Department of Anesthesiology, University of California, San Diego, San Diego, CA
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140
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Satija A, Bhatnagar S. Complementary Therapies for Symptom Management in Cancer Patients. Indian J Palliat Care 2017; 23:468-479. [PMID: 29123357 PMCID: PMC5661353 DOI: 10.4103/ijpc.ijpc_100_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Cancer patients are often poly-symptomatic which distressingly affects their quality of lives (QOLs). Alhough, conventional management provides adequate symptom control, yet is coupled with some limitations. Complementary therapies (CTs) have shown beneficial effects in cancer patients for symptomatic relief. The aim of this article is to provide evidence-based review of commonly used CTs for symptom management in cancer care. Hypnosis has promising evidence to be used for managing symptoms such as pain, chemotherapy-induced nausea/vomiting, distress, fatigue, and hot flashes. Guided imagery increases comfort and can be used as a psycho-supportive therapy. Meditation substantially improves psychological function, mental health, and QOL. Cognitive behavioral therapies effectively reduce pain, distress, fatigue, anxiety, and depression; and improve subjective sleep outcomes along with mood and QOL. Yoga has short term beneficial effects for anxiety, depression, fatigue, perceived stress, QOL, and well-being. T'ai Chi and qigong are beneficial adjunctive therapies for supportive cancer care, but their role in reducing cancer pain is not well proven. Acupuncture is effective for reducing treatment related side-effects, pain and fatigue. Other therapies such as massage techniques, energy therapies, and spiritual interventions have also demonstrated positive role in managing cancer-related symptoms and improve overall well-being. However, the clinical effectiveness of these therapies for symptom management in cancer patients cannot be concluded due to poor strength of evidence. Nonetheless, these are relatively free from risks and hence can be given along with conventional treatments. Only by tailoring these therapies as per patient's beliefs and preferences, optimal patient-centered holistic care can be provided.
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Affiliation(s)
- Aanchal Satija
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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141
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Kühne F, Meinders C, Mohr H, Hafenbrack K, Kieseritzky K, Rosenberger C, Härter M, Schulz-Kindermann F, Klinger R, Nestoriuc AY. Schmerzpsychologische Interventionen bei onkologischen Patienten. Schmerz 2016; 30:496-509. [DOI: 10.1007/s00482-016-0169-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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142
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Bower JE. Mindfulness Interventions for Cancer Survivors: Moving Beyond Wait-List Control Groups. J Clin Oncol 2016; 34:3366-8. [PMID: 27551114 DOI: 10.1200/jco.2016.68.2468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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143
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Hill RC, Dempster M, Donnelly M, McCorry NK. Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions. Palliat Med 2016; 30:825-33. [PMID: 26944534 DOI: 10.1177/0269216316637237] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Staff in palliative care settings perform emotionally demanding roles which may lead to psychological distress including stress and burnout. Therefore, interventions have been designed to address these occupational risks. AIM To investigate quantitative studies exploring the effectiveness of psychosocial interventions that attempt to improve psychological wellbeing of palliative care staff. DESIGN A systematic review was conducted according to methodological guidance from UK Centre for Reviews and Dissemination. DATA SOURCES A search strategy was developed based on the initial scans of palliative care studies. Potentially eligible research articles were identified by searching the following databases: CINAHL, MEDLINE (Ovid), PsycINFO and Web of Science. Two reviewers independently screened studies against pre-set eligibility criteria. To assess quality, both researchers separately assessed the remaining studies using the Quality Assessment Tool for Quantitative Studies. RESULTS A total of 1786 potentially eligible articles were identified - nine remained following screening and quality assessment. Study types included two randomised controlled trials, two non-randomised controlled trial designs, four one-group pre-post evaluations and one process evaluation. Studies took place in the United States and Canada (5), Europe (3) and Hong Kong (1). Interventions comprised a mixture of relaxation, education, support and cognitive training and targeted stress, fatigue, burnout, depression and satisfaction. The randomised controlled trial evaluations did not improve psychological wellbeing of palliative care staff. Only two of the quasi-experimental studies appeared to show improved staff wellbeing although these studies were methodologically weak. CONCLUSION There is an urgent need to address the lack of intervention development work and high-quality research in this area.
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Affiliation(s)
- Rebecca C Hill
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Martin Dempster
- School of Psychology, Queen's University Belfast, Belfast, UK
| | | | - Noleen K McCorry
- School of Psychology, Queen's University Belfast, Belfast, UK Marie Curie Cancer Care, Belfast, UK
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Nooner A, Dwyer K, DeShea L, Yeo T. Using Relaxation and Guided Imagery to Address Pain, Fatigue, and Sleep Disturbances: A Pilot Study. Clin J Oncol Nurs 2016; 20:547-52. [DOI: 10.1188/16.cjon.547-552] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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145
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Oh PJ, Kim J. The Effects of Nonpharmacologic Interventions on Cognitive Function in Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2016; 43:E205-17. [DOI: 10.1188/16.onf.e205-e217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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146
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De Lima L, Pastrana T. Evaluation of the Effectiveness of Workshops on the Availability and Rational Use of Opioids in Latin America. J Palliat Med 2016; 19:964-71. [DOI: 10.1089/jpm.2016.0091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Liliana De Lima
- International Association for Hospice and Palliative Care (IAHPC), Houston, Texas
| | - Tania Pastrana
- Department for Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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147
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Hughes ND, Closs SJ, Flemming K, Bennett MI. Supporting self-management of pain by patients with advanced cancer: views of palliative care professionals. Support Care Cancer 2016; 24:5049-5057. [PMID: 27557834 DOI: 10.1007/s00520-016-3372-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study is to ascertain the views of specialist palliative care professionals on patient self-management of cancer pain in order to inform the development of a new educational intervention to support self-management. METHODS This is a qualitative research study using focus group interviews. RESULTS Participants viewed self-management of cancer pain as desirable and achievable but also as something that could be problematic. Challenges to self-management were perceived in patient attitudes and behaviours, professionals' own beliefs and actions and the wider social system. Practitioners showed awareness of potential tension between their espoused views (the desirability that patients manage pain autonomously) and their tacit views (the undesirability of patients managing pain in ways which conflict with professionals' knowledge and identity). CONCLUSIONS Practitioners espoused patient-centred professional practice which inclined them towards supporting self-management. They showed awareness of factors which might inhibit them from effectively incorporating education and support for self-management into routine practice.
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Affiliation(s)
- Nicholas D Hughes
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9UT, UK.
| | - S José Closs
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9UT, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, School of Medicine, University of Leeds, Leeds, UK
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Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, Constine LS, Cooper A, Glare P, Keefe F, Koyyalagunta L, Levy M, Miaskowski C, Otis-Green S, Sloan P, Bruera E. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34:3325-45. [PMID: 27458286 DOI: 10.1200/jco.2016.68.5206] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors. METHODS An ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation. RESULTS A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus. RECOMMENDATIONS Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored. Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function. Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment. Risks of adverse effects of opioids should be assessed. Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. Additional information is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki.
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Affiliation(s)
- Judith A Paice
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Russell Portenoy
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Christina Lacchetti
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Toby Campbell
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Andrea Cheville
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Marc Citron
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Louis S Constine
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Andrea Cooper
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Paul Glare
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Frank Keefe
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Lakshmi Koyyalagunta
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Michael Levy
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Christine Miaskowski
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Shirley Otis-Green
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Paul Sloan
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
| | - Eduardo Bruera
- Judith A. Paice, Northwestern University Feinberg School of Medicine, Chicago, IL; Russell Portenoy, MJHS Institute for Innovation in Palliative Care; Paul Glare, Memorial Sloan Kettering Cancer Center, New York; Marc Citron, ProHealth Care Assoc, Lake Success; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria, VA; Toby Campbell, University of Wisconsin, Madison, WI; Andrea Cheville, Mayo Clinic, Minnesota, MO; Andrea Cooper, Mercy Medical Center, Baltimore, MD; Frank Keefe, Duke University, Durham, NC; Lakshmi Koyyalagunta and Eduardo Bruera, MD Anderson Cancer Center, Houston, TX; Michael Levy, Fox Chase Cancer Center, Philadelphia, PA; Christine Miaskowski, University of California-San Francisco, San Francisco; Shirley Otis-Green, Coalition for Compassionate Care of California, Sacramento, CA; and Paul Sloan, University of Kentucky, Lexington, KY
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Pain buddy: A novel use of m-health in the management of children's cancer pain. Comput Biol Med 2016; 76:202-14. [PMID: 27479493 DOI: 10.1016/j.compbiomed.2016.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Over 12,000 children are diagnosed with cancer every year in the United States. In addition to symptoms associated with their disease, children undergoing chemotherapy frequently experience significant pain, which is unfortunately often undertreated. The field of m-Health offers an innovative avenue for pain assessment and intervention in the home setting. The current study describes the development and initial evaluation of a tablet-based program, Pain Buddy, aimed to enhance pain management and foster improved quality of life in children ages 8-18 years undergoing cancer treatment. METHODS An animated avatar-based tablet application was developed using state-of-the-art software. Key aspects of Pain Buddy include daily pain and symptom diaries completed by children, remote monitoring of symptoms by uploading patient's data through internet to a cloud server, cognitive and behavioral skills training, interactive three-dimensional avatars that guide children through the program, and an incentive system to motivate engagement. Twelve children between the ages of 8 and 18 participated in a pilot study of Pain Buddy. RESULTS Children were highly satisfied with the program. Pain and appetite disturbances were most frequently endorsed. Symptom trigger alerts to outside providers were largely related to clinically significant pain. Children infrequently used analgesics, and reported using some non-pharmacological pain management strategies. CONCLUSION Pain Buddy appears to be a promising tool to improve pain and symptom management in children undergoing cancer treatment. Results from the current study will inform future improvements to Pain Buddy, in preparation for a randomized controlled trial to assess the efficacy of this innovative treatment.
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On the reproducibility of meta-analyses: six practical recommendations. BMC Psychol 2016; 4:24. [PMID: 27241618 PMCID: PMC4886411 DOI: 10.1186/s40359-016-0126-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/15/2016] [Indexed: 12/12/2022] Open
Abstract
Background Meta-analyses play an important role in cumulative science by combining information across multiple studies and attempting to provide effect size estimates corrected for publication bias. Research on the reproducibility of meta-analyses reveals that errors are common, and the percentage of effect size calculations that cannot be reproduced is much higher than is desirable. Furthermore, the flexibility in inclusion criteria when performing a meta-analysis, combined with the many conflicting conclusions drawn by meta-analyses of the same set of studies performed by different researchers, has led some people to doubt whether meta-analyses can provide objective conclusions. Discussion The present article highlights the need to improve the reproducibility of meta-analyses to facilitate the identification of errors, allow researchers to examine the impact of subjective choices such as inclusion criteria, and update the meta-analysis after several years. Reproducibility can be improved by applying standardized reporting guidelines and sharing all meta-analytic data underlying the meta-analysis, including quotes from articles to specify how effect sizes were calculated. Pre-registration of the research protocol (which can be peer-reviewed using novel ‘registered report’ formats) can be used to distinguish a-priori analysis plans from data-driven choices, and reduce the amount of criticism after the results are known. Summary The recommendations put forward in this article aim to improve the reproducibility of meta-analyses. In addition, they have the benefit of “future-proofing” meta-analyses by allowing the shared data to be re-analyzed as new theoretical viewpoints emerge or as novel statistical techniques are developed. Adoption of these practices will lead to increased credibility of meta-analytic conclusions, and facilitate cumulative scientific knowledge.
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