201
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Stress Axis in the Cancer Patient: Clinical Aspects and Management. ENDOCRINES 2021. [DOI: 10.3390/endocrines2040044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypothalamus–pituitary–adrenal (HPA) axis alterations are common in cancer patients, mainly due to the different antitumoral therapies, which lead to several acute and late endocrine side effects. This review summarizes the most recent evidence regarding HPA derangement, both in patients with active neoplasms and in cancer survivors, with particular attention to the impact of the different antitumoral treatments, focusing on the major clinical aspects. While acute hormone failure usually results from injury caused directly by tumor burden or surgical interventions, short- and long-term effects are generally due to chemotherapy, radiotherapy and, as more recently shown, to different types of targeted- and immuno-therapy. Adrenal insufficiency (AI) is mostly caused by pituitary or hypothalamic injury rather than a direct damage of the adrenal gland. Moreover, other treatments commonly employed as supportive therapy or in the context of palliative care (i.e., glucocorticoids, opioids) can lead to HPA dysfunction. Epidemiology and pathophysiology of stress axis alterations in cancer patients still require clarification. Since AI may represent a life-threatening condition, monitoring adrenal function in cancer patients is mandatory, especially in subjects who experience fatigue or during stress conditions, in order to promptly start replacement treatment when needed.
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Ren JL, Rojo RD, Perez JVD, Yeung SCJ, Hanna EY, Reyes-Gibby CC. Variations in pain prevalence, severity, and analgesic use by duration of survivorship: a cross-sectional study of 505 post-treatment head and neck cancer survivors. BMC Cancer 2021; 21:1304. [PMID: 34872526 PMCID: PMC8650364 DOI: 10.1186/s12885-021-09024-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/10/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Studies suggest a high prevalence of pain in head and neck cancer (HNC) patients at diagnosis, during and after treatment; however, these studies had small sample sizes and did not comprehensively assess factors known to influence pain. We surveyed a large cohort of HNC survivors to determine variations in the prevalence of pain, its treatment and management by duration of survivorship, and assessed a comprehensive list of risk factors. METHODS A cross sectional survey of post-treatment survivors of HNC during routine follow-up clinic visits. RESULTS A total of 505 HNC survivors with a median follow up of 3 years from cancer diagnosis were included in the study. Overall, 45% (n = 224) reported pain and 14.5, 22 and 7% reported use of prescribed pain medication, over-the-counter pain medication and alternative pain therapies, respectively. Prevalence of severe pain was 7.3% and did not vary significantly by years of survivorship (< 1 year = 5.7%; 1 to < 3 years = 7.1%; 3 to < 8 years = 7.6%; 8 years or more =9.7%; P = 0.392). However, use of prescribed pain medication significantly varied by years of survivorship (< 1 year = 45.7%; 1 to < 3 years = 24.6%; 3 to < 8 years = 18.9; 8 years or more = 18.3%; p < 0.001). Of note, a significant proportion of survivors reported moderate to severe pain (moderate to severe = 55.7% versus none to mild = 44.3%) despite step 3 analgesic use (p < 0.001). Multivariable regression shows that recurrent disease (OR 6.77, 95% CI [1.44, 31.80]), history of chemotherapy (OR 6.00, 95% CI [2.10, 17.14]), and depression (Mild-moderate OR 5.30, 95% CI [2.20, 12.78]; Major OR 8.00, 95% CI [2.67, 23.96]) were significant risk factors for severe pain. CONCLUSIONS We identified a high prevalence of pain among HNC survivors and determined that analgesic use varied by the duration of survivorship. Therefore, routine surveillance for pain must be consistent throughout the course of survivorship.
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Affiliation(s)
- Jenny L. Ren
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- Baylor College of Medicine, Houston, TX 77030 USA
| | - Raniv D. Rojo
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- College of Medicine, University of the Philippines Manila, 1000 Manila, Philippines
| | - Joy Vanessa D. Perez
- College of Medicine, University of the Philippines Manila, 1000 Manila, Philippines
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Cielito C. Reyes-Gibby
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
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203
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Zengul AG, Zengul FD, Ozaydin B, Oner N, Fiveash JB. Identifying research themes and trends in the top 20 cancer journals through textual analysis. J Cancer Policy 2021; 30:100313. [DOI: 10.1016/j.jcpo.2021.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
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204
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Bennett MI, Allsop MJ, Allen P, Allmark C, Bewick BM, Black K, Blenkinsopp A, Brown J, Closs SJ, Edwards Z, Flemming K, Fletcher M, Foy R, Godfrey M, Hackett J, Hall G, Hartley S, Howdon D, Hughes N, Hulme C, Jones R, Meads D, Mulvey MR, O’Dwyer J, Pavitt SH, Rainey P, Robinson D, Taylor S, Wray A, Wright-Hughes A, Ziegler L. Pain self-management interventions for community-based patients with advanced cancer: a research programme including the IMPACCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Each year in England and Wales, 150,000 people die from cancer, of whom 110,000 will suffer from cancer pain. Research highlights that cancer pain remains common, severe and undertreated, and may lead to hospital admissions.
Objective
To develop and evaluate pain self-management interventions for community-based patients with advanced cancer.
Design
A programme of mixed-methods intervention development work leading to a pragmatic multicentre randomised controlled trial of a multicomponent intervention for pain management compared with usual care, including an assessment of cost-effectiveness.
Participants
Patients, including those with metastatic solid cancer (histological, cytological or radiological evidence) and/or those receiving anti-cancer therapy with palliative intent, and health professionals involved in the delivery of community-based palliative care.
Setting
For the randomised controlled trial, patients were recruited from oncology outpatient clinics and were randomly allocated to intervention or control and followed up at home.
Interventions
The Supported Self-Management intervention comprised an educational component called Tackling Cancer Pain, and an eHealth component for routine pain assessment and monitoring called PainCheck.
Main outcome measures
The primary outcome was pain severity (measured using the Brief Pain Inventory). The secondary outcomes included pain interference (measured using the Brief Pain Inventory), participants’ pain knowledge and experience, and cost-effectiveness. We estimated costs and health-related quality-of-life outcomes using decision modelling and a separate within-trial economic analysis. We calculated incremental cost-effectiveness ratios per quality-adjusted life-year for the trial period.
Results
Work package 1 – We found barriers to and variation in the co-ordination of advanced cancer care by oncology and primary care professionals. We identified that the median time between referral to palliative care services and death for 42,758 patients in the UK was 48 days. We identified key components for self-management and developed and tested our Tackling Cancer Pain resource for acceptability. Work package 2 – Patients with advanced cancer and their health professionals recognised the benefits of an electronic system to monitor pain, but had reservations about how such a system might work in practice. We developed and tested a prototype PainCheck system. Work package 3 – We found that strong opioids were prescribed for 48% of patients in the last year of life at a median of 9 weeks before death. We delivered Medicines Use Reviews to patients, in which many medicines-related problems were identified. Work package 4 – A total of 161 oncology outpatients were randomised in our clinical trial, receiving either supported self-management (n = 80) or usual care (n = 81); their median survival from randomisation was 53 weeks. Primary and sensitivity analyses found no significant treatment differences for the primary outcome or for other secondary outcomes of pain severity or health-related quality of life. The literature-based decision modelling indicated that information and feedback interventions similar to the supported self-management intervention could be cost-effective. This model was not used to extrapolate the outcomes of the trial over a longer time horizon because the statistical analysis of the trial data found no difference between the trial arms in terms of the primary outcome measure (pain severity). The within-trial economic evaluation base-case analysis found that supported self-management reduced costs by £587 and yielded marginally higher quality-adjusted life-years (0.0018) than usual care. However, the difference in quality-adjusted life-years between the two trial arms was negligible and this was not in line with the decision model that had been developed. Our process evaluation found low fidelity of the interventions delivered by clinical professionals.
Limitations
In the randomised controlled trial, the low fidelity of the interventions and the challenge of the study design, which forced the usual-care arm to have earlier access to palliative care services, might explain the lack of observed benefit. Overall, 71% of participants returned outcome data at 6 or 12 weeks and so we used administrative data to estimate costs. Our decision model did not include the negative trial results from our randomised controlled trial and, therefore, may overestimate the likelihood of cost-effectiveness.
Conclusions
Our programme of research has revealed new insights into how patients with advanced cancer manage their pain and the challenges faced by health professionals in identifying those who need more help. Our clinical trial failed to show an added benefit of our interventions to enhance existing community palliative care support, although both the decision model and the economic evaluation of the trial indicated that supported self-management could result in lower health-care costs.
Future work
There is a need for further research to (1) understand and facilitate triggers that prompt earlier integration of palliative care and pain management within oncology services; (2) determine the optimal timing of technologies for self-management; and (3) examine prescriber and patient behaviour to achieve the earlier initiation and use of strong opioid treatment.
Trial registration
Current Controlled Trials ISRCTN18281271.
Funding
This project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Bridgette M Bewick
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - S José Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Zoe Edwards
- School of Pharmacy, University of Bradford, Bradford, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Division of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Geoff Hall
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Jones
- Yorkshire Centre for Health Informatics, 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
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John O’Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | | | | | - Sally Taylor
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Angela Wray
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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205
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[The management of multimorphic cancer pain, from diagnosis to treatment]. Bull Cancer 2021; 109:537-547. [PMID: 34848047 DOI: 10.1016/j.bulcan.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 11/27/2022]
Abstract
Cancer pain remains a major public health issue. Despite progress in pain medicine thanks to the interest shown in early and timely supportive care, more than half the patients managed for cancer are in pain. One of the key factors in high quality multidisciplinary management throughout the care pathway is to assess more than just pain: it is necessary to assess the patient as a whole. Understanding the complexity of cancer pain - or the various types of pain - through the innovative multimorphic cancer pain model, effectively opens up new perspectives for a targeted, personalised, and multimodal approach. The subsequent treatment strategies, whether drug-based with opioids, or interventional, are codified by guidelines based on scientific evidence for the healthcare professionals and, ultimately, patients.
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206
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Sine H, Achbani A, Filali K. The Effect of Hypnosis on the Intensity of Pain and Anxiety in Cancer Patients: A Systematic Review of Controlled Experimental Trials. Cancer Invest 2021; 40:235-253. [PMID: 34698595 DOI: 10.1080/07357907.2021.1998520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pain is a common symptom in cancer patients. Hypnosis is considered one of the most recognized non-pharmacological techniques in pain management. In oncology, this technique can be used as a complementary treatment to reduce the level of pain and anxiety. The objective of this study is to systematically review and evaluate controlled clinical trials (CCTs) examining the effect of hypnosis on the intensity of pain, and anxiety in cancer patients. METHODS A systematic review was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA). The Cochrane systematic review database, the abstract databases, Scopus, PubMed, Google Scholar, and Cochrane Library have been systematically reviewed from 2005 to 2018. RESULTS Eleven CCT with a total of 1182 participants met the inclusion criteria and were included in this review. The participants were mainly women (n = 968). Their average age alternates between 48 and 58 years. Perceived pain was measured primarily by visual analog scale (VAS)/numerical pain rating scale (NPRS), which showed that anxiety was measured by Hospital Anxiety and Depression scale (HADS). Hypnosis-related anxiety and pain decreased significantly with respect to usual treatment. CONCLUSIONS Evidence suggests promising results of hypnosis on the management of pain, and anxiety levels in the vast majority of cancer patients. Therefore, because of the exploratory design and high risk of bias, the effectiveness of hypnosis or hypnotherapy in reducing pain and anxiety levels remains unclear. There is a need for more rigorous randomized controlled trials (RCTs).
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Affiliation(s)
- Hayat Sine
- Clinical Epidemiology and Medico-Surgical Sciences, Faculty of Medicine and Pharmacy, Mohammed V-Rabat University, Rabat, Morocco
| | - Abderrahmane Achbani
- Department of Biology, Faculty of Sciences, Laboratory of Cell Biology and Molecular Genetics, University Ibn Zohr, Agadir, Morocco.,Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco
| | - Karim Filali
- Clinical Epidemiology and Medico-Surgical Sciences, Faculty of Medicine and Pharmacy, Mohammed V-Rabat University, Rabat, Morocco
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207
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Jo HG, Lee D. East Asian herbal medicine for cancer pain: A protocol for systematic review and meta-analysis with using association rule analysis to identify core herb pattern. Medicine (Baltimore) 2021; 100:e27699. [PMID: 34766572 PMCID: PMC10545247 DOI: 10.1097/md.0000000000027699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cancer pain is an important factor in cancer management that affects a patient's quality of life and survival-related outcomes. The aim of this review is to systematically evaluate the efficacy and safety of oral administration East Asian herbal medicine (EAHM) for primary cancer pain, and to explore core herb patterns based on collected data. METHODS A comprehensive literature search will be conducted in 10 electronic databases including PubMed, Cochrane Library, Cumulative Index to Nursing & Allied Health Literature, EMBASE, Korean Studies Information Service System, Research Information Service System Oriental Medicine Advanced Searching Integrated System, Korea Citation Index, Chinese National Knowledge Infrastructure Database (CNKI), CiNii for randomized controlled trials from their inception until August 19, 2021. Statistical analysis will be performed in the software R version 4.1.1. and R studio program using the default settings of the 'meta' package. When heterogeneity in studies is detected, the cause will be identified through meta regression and subgroup analysis. Methodological quality will be assessed independently using the revised tool for risk of bias in randomized trials (Rob 2.0). RESULTS This study will provide more comprehensive and specific evidence of EAHM for cancer pain management. CONCLUSIONS Based on the results of this review, it is expected that the efficacy and safety of East Asian herbal medicine for cancer pain may be confirmed. In addition, it will be possible to derivation of a core herb pattern related to this research topic through additional association rule mining analysis.
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Affiliation(s)
- Hee-Geun Jo
- Chung-Yeon Central Institute, 64, Sangmujungang-ro, Seo-gu, Gwangju, Republic of Korea
| | - Donghun Lee
- Department of Herbal Pharmacology, College of Korean Medicine, Gachon University, 1342 Seongnamdae-ro, Sujeong-gu, Seongnam, Republic of Korea
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208
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Gupta S, Sutradhar R, Li Q, Coburn N. The effectiveness of a provincial symptom assessment program in reaching adolescents and young adults with cancer: A population-based cohort study. Cancer Med 2021; 10:9030-9039. [PMID: 34738747 PMCID: PMC8683532 DOI: 10.1002/cam4.4401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Symptom control is prioritized by cancer patients and may improve overall survival. Ontario, Canada thus offers all cancer patients screening using the Edmonton Symptom Assessment System (ESAS) at outpatient cancer‐related visits. We determined whether this initiative reached adolescents and young adults (AYA) and factors associated with screening in this population. Methods We linked all Ontario AYA diagnosed with cancer 2010–2018 aged 15–29 years to population‐based databases identifying outpatient visits and ESAS screening. For each 2‐week period in the year post‐diagnosis, AYA with cancer‐related visits were categorized as “unscreened” (no ESAS score) versus “screened” (≥1 ESAS score). Demographic and disease‐related covariates were examined. Results Among 5435 AYA, 4204 (77.4%) had ≥1 ESAS screen. Within any 2‐week period, only 30%–44% of AYA attending cancer‐related visits were screened. Patients with hematologic malignancies were least likely to be screened [odds ratio (OR) vs. breast cancer 0.77, 95% confidence interval (95% CI) 0.67–0.88; p < 0.001]. AYA in remote Northern or rural areas had equivalent or higher rates of ESAS screening compared to those in high‐income urban areas. However, AYA living in the lowest income urban neighborhoods were less likely to be screened (OR 0.86, 95% CI 0.77–0.97; p = 0.01). Conclusions Within a population‐wide symptom assessment program, while AYA living in rural and remote areas had high rates of screening, than those in low‐income urban areas were substantially less likely to be screened. Though patients with hematologic cancers suffer from particularly high symptom burdens, they were also less likely to be screened. Interventions targeting AYA are required to increase uptake.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Qing Li
- Cancer Research Program, ICES, Toronto, Canada
| | - Natalie Coburn
- Cancer Research Program, ICES, Toronto, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
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209
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Akezaki Y, Nakata E, Kikuuchi M, Sugihara S, Katayama Y, Katayama H, Hamada M, Ozaki T. Factors Affecting the Quality of Life of Patients with Painful Spinal Bone Metastases. Healthcare (Basel) 2021; 9:healthcare9111499. [PMID: 34828545 PMCID: PMC8625781 DOI: 10.3390/healthcare9111499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 11/21/2022] Open
Abstract
This study examined changes in the quality of life (QOL), as well as the factors affecting QOL, among patients with painful spinal bone metastases without paralysis for 1 month after radiotherapy. Methods: This study included 79 participants (40 male and 39 female; median age, 65 (42–88) years) who had undergone radiotherapy for painful spinal bone metastases without paralysis. Patients’ age, sex, activities of daily living (Barthel index), pain, spinal instability (spinal instability neoplastic score [SINS]), and QOL (EORTC QLQ-C30) were investigated. Results: Having an unstable SINS score was a positive factor for global health status (p < 0.05). The improvement in activities of daily living and response to pain were positive factors for physical function (p < 0.05). A positive effect on emotional function was confirmed among female patients (p < 0.05). Conclusion: Engaging in rehabilitation along with radiotherapy leads to improvements in QOL for patients with spinal bone metastases.
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Affiliation(s)
- Yoshiteru Akezaki
- Division of Physical Therapy, Kochi Professional University of Rehabilitation, Kochi 781-1102, Japan;
| | - Eiji Nakata
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (H.K.); (T.O.)
- Correspondence:
| | - Masato Kikuuchi
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ehime 791-0280, Japan; (M.K.); (S.S.)
| | - Shinsuke Sugihara
- Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ehime 791-0280, Japan; (M.K.); (S.S.)
| | - Yoshimi Katayama
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama 700-8558, Japan; (Y.K.); (M.H.)
| | - Haruki Katayama
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (H.K.); (T.O.)
| | - Masanori Hamada
- Department of Rehabilitation Medicine, Okayama University Hospital, Okayama 700-8558, Japan; (Y.K.); (M.H.)
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (H.K.); (T.O.)
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210
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Diller ML, Master VA. Integrative surgical oncology: A model of acute integrative oncology. Cancer 2021; 127:3929-3938. [PMID: 34407223 DOI: 10.1002/cncr.33688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/09/2022]
Abstract
Integrative oncology has emerged as a recognized medical subspecialty because of growing interest in the use of integrative medicine in modern cancer care on behalf of both patients and providers. Acutherapy and mind-body techniques, such as meditation and yoga, have been shown to aid in symptom control and improve quality of life in oncologic patient populations, and the Society of Integrative Oncology and American Society of Clinical Oncology have recently endorsed a set of guidelines for the implementation of these techniques specifically in patients with breast cancer. Although the current guidelines focus largely on the management of chronic symptoms, there exists evidence to support the use of these techniques in acute symptom management as well. With surgical resection representing the backbone of many cancer treatment regimens, symptoms that arise during the perioperative period are prime examples of the acute symptomatology common among patients with cancer. Here, the authors provide a detailed literature review of the current evidence supporting the use of integrative techniques during the perioperative period and demonstrate their applicability for acute symptom management within oncologic and surgical populations. In doing so, the authors introduce a new paradigm of surgical practice they call integrative surgical oncology and integrative surgery.
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Affiliation(s)
- Maggie L Diller
- Department of Surgery, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Viraj A Master
- Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Urology, Emory University, Atlanta, Georgia
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211
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[Applicability of QUIKS in conservatively treated tumor inpatients]. Schmerz 2021; 36:342-349. [PMID: 34705120 PMCID: PMC9512755 DOI: 10.1007/s00482-021-00599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022]
Abstract
Hintergrund „Qualitätsverbesserung im konservativen Schmerzmanagement“ (QUIKS), das Modul für nichtoperative Patienten welches an das „QUIPS“-Projekt angelehnt ist, wurde an einer Kohorte Tumorpatienten auf Anwendbarkeit getestet. Material und Methoden Prospektiv wurden stationär konservativ behandelte Patienten am Universitätsklinikum Würzburg (UKW) anhand des Ergebnisfragebogens QUIKS zur Qualität der Schmerztherapie befragt (AZ 129/17, Ethikkommission am UKW). Informationen zur Therapie und Demografie wurden dem klinikinternen Dokumentationssystem entnommen. Ergebnisse Im Erfassungszeitraum konnten 100 Tumorpatienten aus verschiedenen Kliniken eingeschlossen werden. 74 % der Patienten benötigten Unterstützung bei der Beantwortung des Fragebogens. Funktionelle Einschränkungen oder schmerztherapiebedingte Nebenwirkungen lagen bei 77 % der Patienten vor, im Durchschnitt lagen Schmerzen von 6 auf der numerischen Rating-Skala vor. Die am häufigsten benannten Schmerzentitäten waren Rücken- und Kopfschmerzen. 18 % der Patienten erhielten eine Schmerztherapie mit Opioiden, 26 % mit Nichtopioiden, eine Anpassung der Schmerztherapie erfolgte in 5 % mit Opioiden und in 44 % mit Nichtopioiden, ein Einbezug schmerzmedizinischer Spezialisten erfolgte in 9 %. Fazit Die Anwendung des Fragebogens wurde von den Patienten gut akzeptiert, war jedoch mit einem großen Maß an Unterstützung beim Ausfüllen verbunden. Es zeigte sich ein hohes Schmerzniveau während des Krankenhausaufenthalts. Eine Anpassung der Schmerztherapie oder ein Einbezug schmerzmedizinischer Spezialisten erfolgte selten. Die Interpretation bzgl. Aussagen zur Qualität des Schmerzmanagements könnte eingeschränkt sein, da andere (vorbestehende) Schmerzentitäten, wie nichttumorassoziierter Schmerz oder chronischer Tumorschmerz, nicht eindeutig abgrenzbar sind. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00482-021-00599-6) enthält die QUIKS-Prozessparameter und den QUIKS-Ergebnisfragebogen.
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212
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Mohamed Bayoumi MM, Khonji LMA, Gabr WFM. Are nurses utilizing the non-pharmacological pain management techniques in surgical wards? PLoS One 2021; 16:e0258668. [PMID: 34673781 PMCID: PMC8530299 DOI: 10.1371/journal.pone.0258668] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/03/2021] [Indexed: 12/05/2022] Open
Abstract
The non-pharmacological pain management therapies have a valuable effect in managing moderate to mild pain intensity, especially if demonstrated in the pre-operative phase. The study aimed to explore the nurses’ practice toward using non-pharmacological pain management techniques in surgical wards. In a cross-sectional research design, a convenient sample of 47 nurses in the surgical wards in Egyptian hospital (Third Level) participated in the study. Data gathered using modified Non-pharmacological Methods Questionnaire. Results of the study indicated that nurse’s perception regarding applying the cognitive-behavioral methods as a distraction and Positive reinforcement techniques were more common (68.1%,53.2%), whereas most of them used emotional support (93.6%) and preferred to demonstrate physical methods. Meanwhile, nurses addressed the barriers to apply nonpharmacological pain management as lack of time, patient unwillingness, and patients’ health beliefs. Nevertheless, nurses reported the non-pharmacological pain management is less expensive and has fewer side effects than medication and can demonstrated post-discharge. Nurses play a key role in applying effective and different non-pharmacological therapies in surgical wards. Thus, nurses should be encouraged to demonstrate the non-pharmacological pain management therapies with patients undergoing surgical procedures.
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Affiliation(s)
- Magda Mohamed Mohamed Bayoumi
- Department of Medical Surgical Nursing, Faculty of Nursing, Beni-Suef University, Beni Suef, Egypt
- Nursing Department, College of Health and Sport Sciences, University of Bahrain, Zallaq, Bahrain
- * E-mail:
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213
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Bruno G, De Logu F, Souza Monteiro de Araujo D, Subbiani A, Lunardi F, Rettori S, Nassini R, Favre C, Calvani M. β2-and β3-Adrenergic Receptors Contribute to Cancer-Evoked Pain in a Mouse Model of Osteosarcoma via Modulation of Neural Macrophages. Front Pharmacol 2021; 12:697912. [PMID: 34646131 PMCID: PMC8502859 DOI: 10.3389/fphar.2021.697912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
The mechanisms involved in the development and maintenance of cancer pain remain largely unidentified. Recently, it has been reported that β-adrenergic receptors (β-ARs), mainly β2-and β3-ARs, contribute to tumor proliferation and progression and may favor cancer-associated pain and neuroinflammation. However, the mechanism underlying β-ARs in cancer pain is still unknown. Here, we investigated the role of β1-, β2-and β3-ARs in a mouse model of cancer pain generated by the para-tibial injection of K7M2 osteosarcoma cells. Results showed a rapid tumor growth in the soft tissue associated with the development of mechanical allodynia in the hind paw ipsilateral to the injected site. In addition to reduce tumor growth, both propranolol and SR59230A, β1-/β2-and β3-AR antagonists, respectively, attenuated mechanical allodynia, the number of macrophages and an oxidative stress by-product accumulated in the ipsilateral tibial nerve. The selective β1-AR antagonist atenolol was able to slightly reduce the tumor growth but showed no effect in reducing the development of mechanical allodynia. Results suggest that the development of the mechanical allodynia in K7M2 osteosarcoma-bearing mice is mediated by oxidative stress associated with the recruitment of neural macrophages, and that antagonism of β2-and β3-ARs contribute not solely to the reduction of tumor growth, but also in cancer pain. Thus, the targeting of the β2-and β3-ARs signaling may be a promising therapeutic strategy against both tumor progression and the development of cancer-evoke pain in osteosarcoma.
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Affiliation(s)
- Gennaro Bruno
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy.,Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Francesco De Logu
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy
| | | | - Angela Subbiani
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy.,Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Federica Lunardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sofia Rettori
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy
| | - Romina Nassini
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy
| | - Claudio Favre
- Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Maura Calvani
- Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
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214
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Yennurajalingam S, Astolfi A, Indio V, Beccaro M, Schipani A, Yu R, Shete S, Reyes-Gibby C, Lu Z, Williams JL, Yeun SC, Anderson AE, Biasco G, Bruera E. Genetic Factors Associated With Pain Severity, Daily Opioid Dose Requirement, and Pain Response Among Advanced Cancer Patients Receiving Supportive Care. J Pain Symptom Manage 2021; 62:785-795. [PMID: 33848569 DOI: 10.1016/j.jpainsymman.2021.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current understanding of genetic factors associated with pain severity, and improvement of pain with opioids in advanced cancer patients (AC) is inadequate for delivery of personalized pain therapy (PPT). Therefore, the aim of this study was to determine the genetic factors associated with pain severity, daily opioid dose, and pain response in AC patients receiving supportive care. METHODS In this prospective study, AC patients were eligible if they had cancer pain ≥4/10 on Edmonton Symptom Assessment Scale (ESAS) - Pain Item and needed opioid rotation for pain control by specialist at the outpatient supportive care center. Association of genetic factors with pain phenotype was assessed using logistic regression models and SKATO (Gene-block) analysis. RESULTS About 174/178 (98%) patient samples were analyzed. After adjustment for demographic and clinical variables, pain severity was negatively associated with intron variant alleles in OPRM1 rs9322446, P = 0.02; rs2270459, P = 0.038; rs62052210, P = 0.038. Opioid daily dose was positively associated NFKBIA rs2233419, P = 0.008; rs2233417, P = 0.007; rs3138054, P = 0.008; rs1050851, P = 0.015; ORPM1 rs9479759, P = 0.046; rs2003185, P = 0.047; rs636433, P = 0.044; COMT (rs9306234, P = 0.014; rs165728, P = 0.014; rs2020917, P = 0.036; rs165728, P = 0.034); ARRB2 (rs1045280, P = 0.045); and pain response to opioids was negatively associated OPRM1 rs1319339, P = 0.024; rs34427887, P = 0.048; and COMT rs4646316, P = 0.03; rs35478083, P = 0.028, respectively. SKATO analysis showed association between pain severity and CXCL8 (P = 0.0056), and STAT6 (P = 0.0297) genes respectively, and pain response with IL-6 (P = 0.00499). CONCLUSIONS This study identified that SNPs of OPRM1, COMT, NFKBIA, CXCL8, IL-6, STAT6, and ARRB2 genes were associated with pain severity, opioid daily dose, and pain response in AC receiving supportive care. Additional studies are needed to validate our findings for PPT.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative care, Rehabilitation Medicine, and Integrative Medicine UT MD Anderson Cancer Center (S.Y., C.R.-G., Z.L., J.L.W., S.-C.Y., A.E.A., E.B.), Houston, Texas.
| | - Annalisa Astolfi
- "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, University of Bologna (A.A., V.I., A.S., G.B.), Bologna, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara (A.A.), Ferrara, Italy
| | - Valentina Indio
- "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, University of Bologna (A.A., V.I., A.S., G.B.), Bologna, Italy
| | - Monica Beccaro
- Academy of the Sciences of Palliative Medicine (ASMEPA) (M.B., G.B.), Bentivoglio-Bologna, Italy
| | - Angela Schipani
- "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, University of Bologna (A.A., V.I., A.S., G.B.), Bologna, Italy
| | - Robert Yu
- Department of Biostatistics, UT MD Anderson Cancer Center (R.Y., S.S.), Houston, Texas
| | - Sanjay Shete
- Department of Biostatistics, UT MD Anderson Cancer Center (R.Y., S.S.), Houston, Texas
| | - Cielito Reyes-Gibby
- Department of Palliative care, Rehabilitation Medicine, and Integrative Medicine UT MD Anderson Cancer Center (S.Y., C.R.-G., Z.L., J.L.W., S.-C.Y., A.E.A., E.B.), Houston, Texas
| | - Zhanni Lu
- Department of Palliative care, Rehabilitation Medicine, and Integrative Medicine UT MD Anderson Cancer Center (S.Y., C.R.-G., Z.L., J.L.W., S.-C.Y., A.E.A., E.B.), Houston, Texas
| | - Janet L Williams
- Department of Palliative care, Rehabilitation Medicine, and Integrative Medicine UT MD Anderson Cancer Center (S.Y., C.R.-G., Z.L., J.L.W., S.-C.Y., A.E.A., E.B.), Houston, Texas
| | - Sai-Ching Yeun
- Department of Palliative care, Rehabilitation Medicine, and Integrative Medicine UT MD Anderson Cancer Center (S.Y., C.R.-G., Z.L., J.L.W., S.-C.Y., A.E.A., E.B.), Houston, Texas
| | - Aimee E Anderson
- Department of Palliative care, Rehabilitation Medicine, and Integrative Medicine UT MD Anderson Cancer Center (S.Y., C.R.-G., Z.L., J.L.W., S.-C.Y., A.E.A., E.B.), Houston, Texas
| | - Guido Biasco
- "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, University of Bologna (A.A., V.I., A.S., G.B.), Bologna, Italy; Academy of the Sciences of Palliative Medicine (ASMEPA) (M.B., G.B.), Bentivoglio-Bologna, Italy
| | - Eduardo Bruera
- Department of Palliative care, Rehabilitation Medicine, and Integrative Medicine UT MD Anderson Cancer Center (S.Y., C.R.-G., Z.L., J.L.W., S.-C.Y., A.E.A., E.B.), Houston, Texas
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215
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Jairam V, Yang DX, Pasha S, Soulos PR, Gross CP, Yu JB, Park HS. Temporal Trends in Opioid Prescribing Patterns Among Oncologists in the Medicare Population. J Natl Cancer Inst 2021; 113:274-281. [PMID: 32785685 DOI: 10.1093/jnci/djaa110] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/05/2020] [Accepted: 06/11/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In the wake of the US opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries among oncologists and nononcologists. METHODS We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset for all physicians between January 1, 2013, and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid and gabapentinoid prescribing rate, defined as the annual number of drug claims (original prescriptions and refills) per beneficiary, among oncologists and nononcologists on a national and state level. RESULTS From 2013 to 2017, the national opioid-prescribing rate declined by 20.7% (P < .001) among oncologists and 22.8% (P < .001) among non oncologists. During this time frame, prescribing of gabapentin increased by 5.9% (P < .001) and 23.1% (P < .001) among oncologists and nononcologists, respectively. Among palliative care providers, opioid prescribe increased by 15.3% (P < .001). During the 5-year period, 43 states experienced a decrease (P < .05) in opioid prescribing among oncologists, and in 5 states, opioid prescribing decreased more among oncologists than nononcologists (P < .05). CONCLUSIONS Between 2013 and 2017, the opioid-prescribing rate statistically significantly decreased nationwide among oncologists and nononcologists, respectively. Given similar declines in opioid prescribing among oncologists and nononcologists, there is concern that opioid-prescribing guidelines intended for the noncancer population are being applied inappropriately to patients with cancer and cancer survivors.
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Affiliation(s)
- Vikram Jairam
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel X Yang
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Saamir Pasha
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA
| | - James B Yu
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA
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216
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Danon N, Al-Gobari M, Burnand B, Rodondi PY. Are mind-body therapies effective for relieving cancer-related pain in adults? A systematic review and meta-analysis. Psychooncology 2021; 31:345-371. [PMID: 34545984 PMCID: PMC9291932 DOI: 10.1002/pon.5821] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate or severe pain. METHODS We searched for all randomized or quasi-randomized controlled trials that included adults (≥18 years) with cancer-related pain who were treated with mind-body therapies (mindfulness, hypnosis, yoga, guided imagery, and progressive muscle relaxation) in MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index, Web of Science, trials registers, and reference lists. The primary outcome was pain intensity. We calculated the standardized mean differences and 95% confidence intervals (CIs) and assessed the risk of bias. RESULTS We identified 40 primary studies involving a total of 3569 participants. The meta-analysis included 24 studies (2404 participants) and showed a significant effect of -0.39 (95% CI -0.62 to -0.16) with considerable heterogeneity (I2 = 86.3%, p < 0.001). After we excluded four "outlier" studies in sensitivity analyses, the effect size remained significant but weaker. There was a high risk of bias in all studies, for example, performance bias due to lack of participant blinding. Patients in multiple settings were included but many studies were of low quality. CONCLUSIONS Mind-body therapies may be effective in improving cancer pain, but the quality of the evidence is low. There is a need for further high-quality clinical trials.
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Affiliation(s)
- Nadia Danon
- Pain Center and Center for Integrative and Complementary Medicine, Department of Anesthesiology, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary Care and Public Health (Unisanté) and Cochrane Switzerland, University of Lausanne, Lausanne, Switzerland
| | - Muaamar Al-Gobari
- Center for Primary Care and Public Health (Unisanté) and Cochrane Switzerland, University of Lausanne, Lausanne, Switzerland.,Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Bernard Burnand
- Center for Primary Care and Public Health (Unisanté) and Cochrane Switzerland, University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Rodondi
- Center for Primary Care and Public Health (Unisanté) and Cochrane Switzerland, University of Lausanne, Lausanne, Switzerland.,Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
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217
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Dupoiron D. Cancer Pain Management-A European Perspective. Cancer Treat Res 2021; 182:39-55. [PMID: 34542875 DOI: 10.1007/978-3-030-81526-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cancer pain management is a major challenge in both Europe and the United States. Recent studies show that the incidence of cancer pain remains high and even increases at an advanced stage of the disease.
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Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest, Rue Boquel, 49055, Angers, France.
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218
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Alodhayani A, Almutairi KM, Vinluan JM, Alsadhan N, Almigbal TH, Alonazi WB, Batais MA. Gender Difference in Pain Management Among Adult Cancer Patients in Saudi Arabia: A Cross-Sectional Assessment. Front Psychol 2021; 12:628223. [PMID: 34512429 PMCID: PMC8427662 DOI: 10.3389/fpsyg.2021.628223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To compare gender differences in pain management among adult cancer patients in Saudi Arabia and to explore the predictors associated with attitudinal barriers of cancer patients to pain management. Methods A descriptive cross-sectional study was conducted among 325 cancer patients from tertiary hospitals in Saudi Arabia. Result Of the total participants, 67.4% were women (N = 219) and 32.6% were men (N = 106). The overall mean scores of the attitudinal barriers questionnaire were 49.51 ± 13.73 in men and 54.80 ± 22.53 in women. The analysis shows significant differences in scores in subscales of tolerance (men = 7.48 ± 2.37), (women = 8.41 ± 3.01) (p = 0.003) and fear of distraction in the course of treatment (men = 6.55 ± 1.34), and (women = 7.15 ± 2.63) (p = 0.008). Female patients reported a more moderate to severe level of pain than men (worst pain in last week of 7.07 ± 1.50, worst pain in last week of 5.84 ± 2.65, respectively). Splitting by gender, the significant predictor for physiology effect domains in male cancer patients includes age, marital status, employment status, monthly income, cancer type, and presence of comorbid disease (p < 0.050). Age was a significant predictor of the domains of fatalism, communication, and harmful effects (p < 0.050) among female cancer patients. Conclusion The present study revealed significant differences between men and women with attitudinal barriers to cancer pain management. Managing pain requires the involvement of all methods in a comprehensive manner, thus unalleviated pain influences the patient's psychological or cognitive aspect.
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Affiliation(s)
- Abdulaziz Alodhayani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M Almutairi
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Jason M Vinluan
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Norah Alsadhan
- Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Turky H Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wadi B Alonazi
- College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Ali Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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219
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Wang JJ, Rubin SJ, Devaiah AK, Faden DL, Salama AR, Edwards HA. Long-Term Opioid Use in Post-Surgical Management of Patients With Head and Neck Cancer. Ann Otol Rhinol Laryngol 2021; 131:844-850. [PMID: 34521247 DOI: 10.1177/00034894211045771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aims to identify clinical and socioeconomic factors associated with long-term, post-surgical opioid use in the head and neck cancer population. METHODS A single center retrospective study was conducted including patients diagnosed with head and neck cancer between January 1, 2014 and July 1, 2019 who underwent primary surgical management. The primary outcome measure was continued opioid use 6 months after treatment completion. Both demographic and cancer-related variables were recorded to determine what factors were associated with prolonged opioid use. Univariate analysis was performed using chi-squared test for categorical variables and 2-sample t-test for continuous variables. Multivariate analysis was performed using logistic regression. RESULTS A total of 359 patients received primary surgical management. Forty-five patients (12.53%) continued to take opioids 6 months after treatment completion. Using univariate analysis, patients less than 65 years of age (P = .0126), adjuvant chemoradiation (n = 25, P < .001), and overall length of hospital stay (8.60 ± 8.58 days, P = .0274) were significantly associated with long term opioid use. Multivariate logistic regression showed that adjuvant chemoradiation (OR = 3.446, 95% CI [1.742, 6.820], P = .0004) and overall length of hospital stay (OR = 0.949, 95% CI [0.903, 0.997], P = .0373) to be significantly associated with opioid use 6 months after head and neck cancer treatment. CONCLUSION Long-term postoperative opioid use in head and neck cancer patients is significantly associated with adjuvant chemoradiation, and patients with longer length of hospital stay. Therefore, future research should focus on interventions to better manage opioid use during the acute treatment period to decrease long-term use.
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Affiliation(s)
- Judy J Wang
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Samuel J Rubin
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Anand K Devaiah
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Daniel L Faden
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Andrew R Salama
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA, USA
| | - Heather A Edwards
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
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220
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Rosiglitazone Alleviates Mechanical Allodynia of Rats with Bone Cancer Pain through the Activation of PPAR- γ to Inhibit the NF- κB/NLRP3 Inflammatory Axis in Spinal Cord Neurons. PPAR Res 2021; 2021:6086265. [PMID: 34484316 PMCID: PMC8413064 DOI: 10.1155/2021/6086265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/28/2021] [Indexed: 02/08/2023] Open
Abstract
Bone cancer pain (BCP) is a serious clinical problem that affects the quality of life of cancer patients. However, the current treatment methods for this condition are still unsatisfactory. This study investigated whether intrathecal injection of rosiglitazone modulates the noxious behaviors associated with BCP, and the possible mechanisms related to this effect were explored. We found that rosiglitazone treatment relieved bone cancer-induced mechanical hyperalgesia in a dose-dependent manner, promoted the expression of peroxisome proliferator-activated receptor-γ (PPAR-γ) in spinal cord neurons, and inhibited the activation of the nuclear factor-kappa B (NF-κB)/nod-like receptor protein 3 (NLRP3) inflammatory axis induced by BCP. However, concurrent administration of the PPAR-γ antagonist GW9662 reversed these effects. The results show that rosiglitazone inhibits the NF-κB/NLRP3 inflammation axis by activating PPAR-γ in spinal neurons, thereby alleviating BCP. Therefore, the PPAR-γ/NF-κB/NLRP3 signaling pathway may be a potential target for the treatment of BCP in the future.
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221
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Practice, Knowledge, and Attitude of Health Care Providers regarding Cancer Pain Management: A National Survey. Pain Res Manag 2021; 2021:1247202. [PMID: 34471442 PMCID: PMC8405340 DOI: 10.1155/2021/1247202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022]
Abstract
Background A lack of knowledge and inadequate practices of health care providers (HCPs) are the main obstacles to effective cancer pain management (CPM). The main objective of the study was to evaluate the CPM knowledge, CPM practice, and attitudes towards pharmacists' participation and advanced methods in CPM of physicians, nurses, and pharmacists in China. Methods An open online survey was adopted using social media software (WeChat) as the platform to conduct a nationwide survey of HCPs involved in CPM in public medical institutions at all levels in China from March to June 2019. Results A total of 1279 physicians, 2267 nurses, and 1466 pharmacists participated in the survey. Among the three types of professionals, nurses had the highest level of practical ability (61.63 ± 28.99) and best attitudes towards pharmacists' participation and advanced methods in CPM (72.05 ± 33.71) and physicians had the best mastery of CPM-related knowledge (69.60 ± 28.45), while pharmacists performed the worst in these three aspects (50.04 ± 26.69, 61.49 ± 28.95, and 62.07 ± 36.46, respectively). Only 19.69% of the hospitals had a pharmacist to tumor patient ratio ≥1 : 50. Hierarchical analysis showed that passing a good pain management (GPM) ward program and participating in advanced training had positive impacts on the scores of all three parts in the three professions (ptrend <0.05). Conclusions HCPs' levels of practice, knowledge, and attitudes towards pharmacists and advanced methods of CPM were average in China; however, pharmacists had the worst performance, which demonstrates a need for further improvement. Furthermore, GPM ward programs and advanced trainings are helpful for improving CPM levels.
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222
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Takagi S, Yasu T, Kuroki A, Shirota M. Drug-Drug Interactions Associated with Introduction of Oxycodone for Management of Cancer-Related Pain in Hospitalized Patients. J Palliat Med 2021; 24:1272-1273. [PMID: 34469226 DOI: 10.1089/jpm.2021.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shigemi Takagi
- Department of Pharmacy, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takeo Yasu
- Department of Pharmacy, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.,Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Tokyo, Japan
| | - Akane Kuroki
- Department of Pharmacy, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Mikio Shirota
- Department of Pharmacy, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Bland KA, Harrison M, Zopf EM, Sousa MS, Currow DC, Ely M, Agar M, Butcher BE, Vaughan V, Dowd A, Martin P. Quality of Life and Symptom Burden Improve in Patients Attending a Multidisciplinary Clinical Service for Cancer Cachexia: A Retrospective Observational Review. J Pain Symptom Manage 2021; 62:e164-e176. [PMID: 33652095 DOI: 10.1016/j.jpainsymman.2021.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cancer cachexia negatively affects quality of life (QoL) and increases symptom burden. A multimodal treatment approach may optimize cachexia outcomes, including QoL. We evaluated QoL and symptoms over time among patients attending a multidisciplinary clinical service for cancer cachexia. METHODS Adults with cancer who attended the clinical service three times between 2017 and 2020 were included. Quality of life and symptoms were assessed using the European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL) and the Functional Assessment Anorexia/Cachexia Therapy (FAACT) questionnaires. Physical function was assessed using the 30s sit-to-stand test and handgrip strength. RESULTS Overall, 162 patients (age = 67.2 ± 12.0 years) were included. Mean six-month weight loss at baseline was 10.4% ± 9.4%. Mean body weight was stable between clinic visits (P = 0.904) and no change in sit-to-stand repetitions (P = 0.133) or handgrip strength (P = 0.734) occurred over time. Improvements in EORTC QLQ-C15-PAL overall QoL (Δ10.7 ± 2.5, P < 0.001), physical function (Δ8.0 ± 2.4, P = 0.003) and emotional function (Δ11.4 ± 2.9, P < 0.001) occurred by the second visit. EORTC QLQ-C15-PAL fatigue (Δ13.8 ± 2.9, P < 0.001), pain (Δ10.3 ± 3.3, P = 0.007), nausea/vomiting (Δ16.1 ± 3.0, P < 0.001) and appetite symptoms (Δ25.9 ± 3.8, P < 0.001) also improved by the second visit. FAACT total score (Δ14.6 ± 2.7, P < 0.001), anorexia-cachexia symptoms (Δ6.6 ± 1.1, P< 0.001), and physical (Δ3.7 ± 0.70, P < 0.001), emotional (Δ1.9 ± 0.60, P = 0.005) and functional wellbeing (Δ2.7 ± 0.71, P = 0.001) improved by the second visit. All improvements in EORTC QLQ-C15-PAL and FAACT outcomes were maintained at the third visit. CONCLUSION Significant improvements in QoL and symptoms were associated with attending a cancer cachexia clinical service. Our findings support using multidisciplinary, multimodal cancer cachexia treatment approaches to improve patient wellbeing.
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Affiliation(s)
- Kelcey A Bland
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne VIC, Australia
| | - Meg Harrison
- School of Medicine, Deakin University, Geelong, VIC, Australia; Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne VIC, Australia
| | - Mariana S Sousa
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David C Currow
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Matthew Ely
- Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Meera Agar
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Belinda E Butcher
- WriteSource Medical Pty Ltd., Lane Cove, NSW, Australia; School of Medical Sciences, University of New South Wales, UNSW, Sydney, Australia
| | - Vanessa Vaughan
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Anna Dowd
- Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Peter Martin
- School of Medicine, Deakin University, Geelong, VIC, Australia; Palliative Care, Barwon Health, Geelong, VIC, Australia.
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Patel JN, Boselli D, Symanowski J, Wodarski S, Turner S, Slaughter C, Myers M, Edwards R, Susi B, Greiner R, Edelen C. Pilot study of multi-gene pharmacogenetic testing for pain management in oncology palliative medicine. Pharmacogenomics 2021; 22:737-748. [PMID: 34414777 DOI: 10.2217/pgs-2021-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: We evaluated the application and clinical impact of multi-gene pharmacogenetic testing in oncology palliative medicine. Patients & methods: In a single-arm pilot trial, cancer patients with uncontrolled pain were assessed in a palliative medicine clinic at baseline and received pharmacogenetic testing. Results were used as applicable up to the final visit (day 30). Pain scores, opioid prescribing, and use of pharmacogenetic test results were collected. Results: In 75 patients, the median baseline pain score was 7/10. Of 54 evaluable at the final visit, 28 required opioid modifications and 19 had actionable genotypes, mostly CYP2D6. Pain improvement (≥2-point reduction) was higher than historical data (56 vs 30%; p < 0.001). There were no differences in pain improvement between those with and without actionable genotypes (61 vs 53%). Conclusion: Multi-gene testing identified actionable genotypes and may improve cancer pain.
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Affiliation(s)
- Jai N Patel
- Department of Cancer Pharmacology & Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Danielle Boselli
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - James Symanowski
- Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Stephanie Wodarski
- Department of Clinical Trials, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - ShRhonda Turner
- Department of Clinical Trials, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Courtney Slaughter
- Department of Clinical Trials, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Melissa Myers
- Department of Supportive Oncology, Section of Palliative Medicine, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Rebecca Edwards
- Department of Supportive Oncology, Section of Palliative Medicine, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Beth Susi
- Department of Supportive Oncology, Section of Palliative Medicine, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Rebecca Greiner
- Department of Supportive Oncology, Section of Palliative Medicine, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Connie Edelen
- Community Hospice & Palliative Care, Jacksonville, FL 32257, USA
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Abstract
BACKGROUND This is an update of the original Cochrane Review first published in Issue 10, 2016. For people with advanced cancer, the prevalence of pain can be as high as 90%. Cancer pain is a distressing symptom that tends to worsen as the disease progresses. Evidence suggests that opioid pharmacotherapy is the most effective of these therapies. Hydromorphone appears to be an alternative opioid analgesic which may help relieve these symptoms. OBJECTIVES To determine the analgesic efficacy of hydromorphone in relieving cancer pain, as well as the incidence and severity of any adverse events. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and clinical trials registers in November 2020. We applied no language, document type or publication status limitations to the search. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared hydromorphone with placebo, an alternative opioid or another active control, for cancer pain in adults and children. Primary outcomes were participant-reported pain intensity and pain relief; secondary outcomes were specific adverse events, serious adverse events, quality of life, leaving the study early and death. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. We calculated risk ratio (RR) and 95% confidence intervals (CI) for binary outcomes on an intention-to-treat (ITT) basis. We estimated mean difference (MD) between groups and 95% CI for continuous data. We used a random-effects model and assessed risk of bias for all included studies. We assessed the evidence using GRADE and created three summary of findings tables. MAIN RESULTS With four new identified studies, the review includes a total of eight studies (1283 participants, with data for 1181 participants available for analysis), which compared hydromorphone with oxycodone (four studies), morphine (three studies) or fentanyl (one study). All studies included adults with cancer pain, mean age ranged around 53 to 59 years and the proportion of men ranged from 42% to 67.4%. We judged all the studies at high risk of bias overall because they had at least one domain with high risk of bias. We found no studies including children. We did not complete a meta-analysis for the primary outcome of pain intensity due to skewed data and different comparators investigated across the studies (oxycodone, morphine and fentanyl). Comparison 1: hydromorphone compared with placebo We identified no studies comparing hydromorphone with placebo. Comparison 2: hydromorphone compared with oxycodone Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured using a visual analogue scale (VAS)) in people treated with hydromorphone compared with those treated with oxycodone, but the evidence is very uncertain (3 RCTs, 381 participants, very low-certainty evidence). Participant-reported pain relief We found no studies reporting participant-reported pain relief. Specific adverse events We found no clear evidence of a difference in nausea (RR 1.13 95% CI 0.74 to 1.73; 3 RCTs, 622 participants), vomiting (RR 1.18, 95% CI 0.72 to 1.94; 3 RCTs, 622 participants), dizziness (RR 0.91, 95% CI 0.58 to 1.44; 2 RCTs, 441 participants) and constipation (RR 0.92, 95% CI 0.72 to 1.19; 622 participants) (all very low-certainty evidence) in people treated with hydromorphone compared with those treated with oxycodone, but the evidence is very uncertain. Quality of life We found no studies reporting quality of life. Comparison 3: hydromorphone compared with morphine Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured using the Brief Pain Inventory (BPI) or VAS)) in people treated with hydromorphone compared with those treated with morphine, but the evidence is very uncertain (2 RCTs, 433 participants; very low-certainty evidence). Participant-reported pain relief We found no clear evidence of a difference in the number of clinically improved participants, defined by 50% or greater pain relief rate, in the hydromorphone group compared with the morphine group, but the evidence is very uncertain (RR 0.99, 95% CI 0.84 to 1.18; 1 RCT, 233 participants; very low-certainty evidence). Specific adverse events At 24 days of treatment, morphine may reduce constipation compared with hydromorphone, but the evidence is very uncertain (RR 1.56, 95% CI 1.12 to 2.17; 1 RCT, 200 participants; very low-certainty evidence). We found no clear evidence of a difference in nausea (RR 0.94, 95% CI 0.66 to 1.30; 1 RCT, 200 participants), vomiting (RR 0.87, 95% CI 0.58 to 1.31; 1 RCT, 200 participants) and dizziness (RR 1.15, 95% CI 0.71 to 1.88; 1 RCT, 200 participants) (all very low-certainty evidence) in people treated with hydromorphone compared with those treated with morphine, but the evidence is very uncertain. Quality of life We found no studies reporting quality of life. Comparison 4: hydromorphone compared with fentanyl Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured by numerical rating scale (NRS)) at 60 minutes in people treated with hydromorphone compared with those treated with fentanyl, but the evidence is very uncertain (1 RCT, 82 participants; very low-certainty evidence). Participant-reported pain relief We found no studies reporting participant-reported pain relief. Specific adverse events We found no studies reporting specific adverse events. Quality of life We found no studies reporting quality of life. AUTHORS' CONCLUSIONS The evidence of the benefits and harms of hydromorphone compared with other analgesics is very uncertain. The studies reported some adverse events, such as nausea, vomiting, dizziness and constipation, but generally there was no clear evidence of a difference between hydromorphone and morphine, oxycodone or fentanyl for this outcome. There is insufficient evidence to support or refute the use of hydromorphone for cancer pain in comparison with other analgesics on the reported outcomes. Further research with larger sample sizes and more comprehensive outcome data collection is required.
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Affiliation(s)
- Yan Li
- Department for Anesthesiology and Pain Management, The People's Hospital of Jizhou District, Tianjin, Tianjin, China
| | - Jun Ma
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guijun Lu
- Pain Medicine Department, Beijing Tsinghua Changgung Hospital, Bejing, China
| | - Zhi Dou
- Pain Medicine Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Jun Xia
- Systematic Review Solutions Ltd, The Ingenuity Centre, The University of Nottingham, Nottingham, UK
| | - Sai Zhao
- Systematic Review Solutions Ltd, The Ingenuity Centre, The University of Nottingham, Nottingham, UK
| | - Sitong Dong
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Liqiang Yang
- Pain Medicine Department, Xuanwu Hospital, Capital Medical University, Beijing, China
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Pain knowledge of patients and family caregivers as predictors of pain management outcomes in cancer patients: a multicenter study in China. Support Care Cancer 2021; 30:575-584. [PMID: 34347180 DOI: 10.1007/s00520-021-06457-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purposes of this study were to evaluate the current situation of pain management outcomes, patients' pain knowledge, and family caregivers' pain knowledge in China and explore the impact of pain knowledge of patients and family caregivers on pain management outcomes. METHODS A total of 410 patient-family caregiver dyads were assessed by Brief Pain Inventory (BPI), the Pain Knowledge subscales of Patient Pain Questionnaire (PPQ), and Family Pain Questionnaire (FPQ). The difference in pain management outcomes was analyzed using bivariate analysis first, and then variables with statistical significance in bivariate analysis were included in multivariable linear regression analysis. RESULTS The average patient pain score in the last 24 h was 3.23 (SD = 2.16). The total average scores on pain knowledge of 410 patients and family caregivers were 3.60 ± 1.90 and 3.57 ± 1.76. Multivariable linear regression analysis showed taking strong opioids, patients' perceived moderate health status, patients' pain knowledge, and family caregivers' pain knowledge were the main factors influencing the pain management outcomes. CONCLUSION Pain knowledge of patients and family caregivers were important indicators of pain management outcomes, indicating tailored cancer pain education program should be developed.
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227
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Tewes M, Baumann F, Teufel M, Ostgathe C. Symptoms During Outpatient Cancer Treatment and Options for Their Management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:arztebl.m2021.0028. [PMID: 33531117 DOI: 10.3238/arztebl.m2021.0028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cancer patients account for a large segment of the German healthcare system, with a 5-year prevalence of around 1.7 million persons. Advances in oncological treatment, now frequently performed on an outpatient basis, are granting many of these individuals a longer life span. At the same time, cancer patients often suffer disease-related symptoms and adverse effects from their tumor treatment, which may strongly impair their quality of life despite the improved techniques for management of side effects. METHODS This review is based on a selective literature search of the PubMed and Cochrane Library databases carried out in December 2019 and January 2020. Special attention was paid to guidelines, expert opinions, and recommendations from professional societies. RESULTS Alongside decreased well-being, cancer patients often suffer from fatigue (70-100%), loss of appetite (6-53%), pain (30-80 %), and dyspnea (10-70%). The prevalence and severity of the symptoms varies depending on the tumor entity and the patient's sex. A meta-analysis showed that besides causal treatment, physical activity achieves moderately strong effects in tumor-associated fatigue syndrome (Cohen's d = 0.30 [0.25; 0.36]). The WHO recommends early use of opioids in tumor-associated pain. A meta-analysis of randomized trials described symptom relief by means of opioids also in dyspnea (standardized mean difference: -0.32 [-0.53; -0.10]). Increasingly, guidelines are recommending regular palliative medical symptom screening. CONCLUSION Regular documentation of symptoms in outpatients offers the opportunity for targeted management of symptoms during treatment with the involvement of various disciplines such as palliative medicine, exercise therapy, and psychotherapy.
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228
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Strassels SA, Moss KO, Mallow PJ, Tamer RM, Monroe TB, Williams NO, Levine AS, Muench U. Hospital Admissions Associated With Cancer Pain in Older Adults With and Without Dementia. Pain Manag Nurs 2021; 22:496-502. [PMID: 33741261 PMCID: PMC9128229 DOI: 10.1016/j.pmn.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neoplasm-related pain is often suboptimally treated, contributing to avoidable suffering and increased medical resource use and costs. We hypothesized that dementia may contribute to increased resource use and costs in patients hospitalized for neoplasm-related pain in the United States. AIMS To examine how persons with cancer and dementia use medical resources and expenditures in US hospitals compared to ondividuals without dementia. DESIGN This study examined a retrospective cohort. SETTING Admissions to US hospitals for neoplasm-related pain from 2012-2016 PARTICIPANTS/SUBJECTS: METHODS: Data were obtained from the 2012-2016 National Inpatient Sample (NIS). The sample included hospital admissions of individuals aged 60 or older with a primary diagnosis of neoplasm-related pain. Dementia was defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and ICD-10-CM diagnosis codes. Primary outcomes were number of admissions, costs, and length of stay (LOS). Descriptive statistics and multivariable regression models were used to examine the relationships among dementia, costs, and LOS. RESULTS Of 12,034 admissions for neoplasm-related pain, 136 (1.1%) included a diagnosis of dementia and 11,898 (98.9%) did not. Constipation was present in 13.2% and 24.5% of dementia and nondementia admissions, respectively. The median LOS was 4 days in persons with dementia and three in those without. Mean costs per admission were higher in persons without dementia ($10,736 vs. $9,022, p = .0304). In adjusted regression results, increased costs were associated with nonelective admissions and longer LOS, and decreased costs with age above the mean. In contrast, decreased LOS was associated with age above the mean and nonelective admissions. Dementia was associated with neither endpoint. CONCLUSION This study provides nurses and other health care professionals with data to further explore opportunities for improvement in cancer pain management in patients with and without dementia that may optimize use of medical resources.
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Affiliation(s)
- Scott A Strassels
- Department of Surgery, The Ohio State University, Columbus, Ohio; College of Nursing, Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, Columbus, Ohio.
| | | | - Peter J Mallow
- Xavier University, Department of Health Services Administration, Cincinnati, Ohio
| | - Robert M Tamer
- Department of Surgery, The Ohio State University, Columbus, Ohio; College of Nursing, Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, Columbus, Ohio
| | | | | | | | - Ulrike Muench
- University of California at San Francisco, School of Nursing, San Francisco, California
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229
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Leap KE, Chen GH, Lee J, Tan KS, Malhotra V. Identifying Prevalence of and Risk Factors for Abnormal Urine Drug Tests in Cancer Pain Patients. J Pain Symptom Manage 2021; 62:355-363. [PMID: 33276043 PMCID: PMC9364695 DOI: 10.1016/j.jpainsymman.2020.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022]
Abstract
CONTEXT Opioids have become a mainstay treatment for severe cancer pain. Although opioid prescribing has decreased, opioid mortality continues to rise. Utilizing urine drug tests (UDT) can help monitor medication adherence and identify use of unprescribed or illicit substances. OBJECTIVES To identify the prevalence of abnormal UDT among oncologic pain patients, associated demographic and clinical factors, and the most common abnormal substances. METHODS A retrospective chart review of 2472 patients with a cancer diagnosis and documented UDT in a single center was conducted from January 1, 2018 to February 15, 2020. Multivariable analyses were conducted for 10 baseline patient factors on each of the two primary outcomes-illicit drugs excluding tetrahydrocannabinol and amphetamines and detected-not-prescribed. RESULTS Of the 2472 patients, 840 patients (34%) had abnormal results. For illicit drugs, the significant factors (incidence rate ratio [95% CI]) were age (45-54 vs. ≥ 65 years: 7.27 [2.27-23.23]), race (black vs. white: 2.99 [1.39-6.42]), smoking status (current vs. former: 2.63 [1.41-4.90]); never vs. former: 0.27 (0.10-0.76), and benzodiazepine use (use vs. no use: 2.06 [1.03-4.12]). For detected-not-prescribed, the significant factors (incidence rate ratio [95% CI]) were race (black vs. white: 1.37 [1.01-1.85]), smoking status (current vs. former: 1.27 [1.00-1.62]); never vs. former: 0.82 (0.67-1.00), log-transformed morphine milligram equivalence (1.04 [1.01-1.07]), and benzodiazepine use (use vs. no use: 1.64 [1.35-1.98]). CONCLUSIONS This study demonstrates that oncologic pain patients are not a risk-free population for abnormal UDT, thus recommends a UDT with initial opioid prescriptions and annually thereafter, with more frequent tests for patients suspected to be at higher risk for misuse.
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Affiliation(s)
- Kelly E Leap
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
| | - Grant H Chen
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jasme Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivek Malhotra
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Cancer-Related Cognitive Impairment or “Chemobrain:” Emerging Assessments, Treatments, and Targets for Intervention. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00319-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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231
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The Experience of Complex Pain Dynamics in Oncology Outpatients: A Longitudinal Qualitative Analysis. Cancer Nurs 2021; 44:136-144. [PMID: 31569180 DOI: 10.1097/ncc.0000000000000747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few qualitative studies of cancer patients' everyday experiences with pain exist within the large body of cancer pain research. Longitudinal qualitative studies are particularly sparse, and no studies have qualitatively described patients' pain experience over time during participation in a self-management intervention. OBJECTIVE To longitudinally describe patients' pain experiences during a 10-week pain self-management intervention. METHODS This qualitative study was embedded in a randomized controlled trial of a psychoeducational pain management intervention. The data consisted of transcribed audio recordings of each intervention session. An emergent, interpretive approach was used in this longitudinal qualitative analysis. RESULTS Forty-two adult patients were included. The analysis revealed the strikingly dynamic nature of individual patient's pain experiences. Multiple facets of pain contributed to its dynamic nature, including pain in changing locations, co-occurring sources of pain, and varying patterns of pain intensity over time. For individual patients, the cumulative effect of these multiple facets resulted in a phenomenon we termed "complex pain dynamics." CONCLUSION The results contribute to knowledge about the dynamic nature of cancer patients' pain experiences over a relatively short period. They suggest the need for a new paradigm for management of pain in cancer patients and raise questions about the interpretation of randomized controlled trial results in the absence of qualitative data. IMPLICATIONS FOR PRACTICE Frequent assessments and reassessments of pain are needed in cancer patients with the ongoing development of highly individualized self-management strategies. A large repertoire of interventions is needed to effectively manage pain in cancer patients over time.
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232
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Conta G, Libanori A, Tat T, Chen G, Chen J. Triboelectric Nanogenerators for Therapeutic Electrical Stimulation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2007502. [PMID: 34014583 DOI: 10.1002/adma.202007502] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/03/2020] [Indexed: 06/12/2023]
Abstract
Current solutions developed for the purpose of in and on body (IOB) electrical stimulation (ES) lack autonomous qualities necessary for comfortable, practical, and self-dependent use. Consequently, recent focus has been placed on developing self-powered IOB therapeutic devices capable of generating therapeutic ES for human use. With the recent invention of the triboelectric nanogenerator (TENG), harnessing passive human biomechanical energy to develop self-powered systems has allowed for the introduction of novel therapeutic ES solutions. TENGs are especially effective at providing ES for IOB therapeutic systems given their bioconformability, low cost, simple manufacturability, and self-powering capabilities. Due to the key role of naturally induced electrical signals in many physiological functions, TENG-induced ES holds promise to provide a novel paradigm in therapeutic interventions. The aim here is to detail research on IOB TENG devices applied for ES-based therapy in the fields of regenerative medicine, neurology, rehabilitation, and pharmaceutical engineering. Furthermore, considering TENG-produced ES can be measured for sensing applications, this technology is paving the way to provide a fully autonomous personalized healthcare system, capable of IOB energy generation, sensing, and therapeutic intervention. Considering these grounds, it seems highly relevant to review TENG-ES research and applications, as they could constitute the foundation and future of personalized healthcare.
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Affiliation(s)
- Giorgio Conta
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Alberto Libanori
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Trinny Tat
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Guorui Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
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Giannitrapani KF, Silveira MJ, Azarfar A, Glassman PA, Singer SJ, Asch SM, Midboe AM, Zenoni MA, Gamboa RC, Becker WC, Lorenz KA. Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study. J Gen Intern Med 2021; 36:1867-1874. [PMID: 33948790 PMCID: PMC8298631 DOI: 10.1007/s11606-021-06747-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer pain is highly prevalent and often managed in primary care or by oncology providers in combination with primary care providers. OBJECTIVES To understand interdisciplinary provider experiences coordinating opioid pain management for patients with chronic cancer-related pain in a large integrated healthcare system. DESIGN Qualitative research. PARTICIPANTS We conducted 20 semi-structured interviews with interdisciplinary providers in two large academically affiliated VA Medical Centers and their associated community-based outpatient clinics. Participants included primary care providers (PCPs) and oncology-based personnel (OBPs). APPROACH We deductively identified 94 examples of care coordination for cancer pain in the 20 interviews. We secondarily used an inductive open coding approach and identified themes through constant comparison coming to research team consensus. RESULTS Theme 1: PCPs and OBPs generally believed one provider should handle all opioid prescribing for a specific patient, but did not always agree on who that prescriber should be in the context of cancer pain. Theme 2: There are special circumstances where having multiple prescribers is appropriate (e.g., a pain crisis). Theme 3: A collaborative process to opioid cancer pain management would include real-time communication and negotiation between PCPs and oncology around who will handle opioid prescribing. Theme 4: Providers identified multiple barriers in coordinating cancer pain management across disciplines. CONCLUSIONS Our findings highlight how real-time negotiation about roles in opioid pain management is needed between interdisciplinary clinicians. Lack of cross-disciplinary role agreement may result in delays in clinically appropriate cancer pain management.
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Affiliation(s)
- K F Giannitrapani
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. .,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
| | - M J Silveira
- Geriatric Research Education Clinical Center (GRECC), Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI, USA.,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - A Azarfar
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,University of Central Florida, Orlando, FL, USA
| | - P A Glassman
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - S J Singer
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - S M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - A M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - M A Zenoni
- Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Health Care System, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - R C Gamboa
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - W C Becker
- Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Health Care System, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - K A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Arnaud A, Grenier J, Boustany R, Kirscher S, Mege A, de Rauglaudre G, Vazquez L, Debourdeau P. Role of supportive care in improving the quality of life and reducing unscheduled hospital care in patients with metastatic breast cancer. Support Care Cancer 2021; 29:3735-3742. [PMID: 33205324 DOI: 10.1007/s00520-020-05877-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Metastatic breast cancer (MBC) patients experience long survival and report poorer quality of life than localized breast cancer patients. Comprehensive supportive care (CSC) has been shown to improve the quality of life (QoL) of MBC. The respective part of each support care has not been fully examined, and little is known about whether meeting patients' needs is accompanied by decreased unscheduled hospital care (UHC). METHODS This prospective monocentric study included women who started a new treatment line for MBC between January 2018 and December 2018. The endpoints were factors associated with UHC and QoL (SF36) at month 12. RESULTS 100 patients were offered CSC, 78 were included (21 refusals, 1 no MBC). CSC was provided to 60 patients: pain (43%), psychological (37%), kinesitherapy (30%), social assistance (22%), esthetic (18%), nutrition (18%), massage (13%), and none (10%). CSC rate was not statistically different among patients with (58%) and without UHD (49%). Factors associated with a decrease of UHC were age > 65 years (p = 0.01), no previous treatment for MBC (p = 0.0001) with a trend for the lack of CSC (p = 0.054). Among the 8 domains of the SF36 scale, only health change perception was improved (p = 0.01) and its predictive factors were treatment carried out as planned (p = 0.0004), pain care (p = 0.003), and lack of MBC progression (p = 0.0035). CONCLUSION CSC can improve QoL in MBC. Painful patients might benefit more from CSC. UHC did not decrease for patients receiving CSC as expected possibly because of their important needs for clinical care.
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Affiliation(s)
- Antoine Arnaud
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Julien Grenier
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Rania Boustany
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Sylvie Kirscher
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | - Alice Mege
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
| | | | - Léa Vazquez
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France.
| | - Philippe Debourdeau
- Institut Sainte Catherine, 250 chemin de baigne-pieds, 84918, Avignon, France
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235
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Bossi P, Antonuzzo A, Armento G, Consoli F, Giuliani J, Giusti R, Lucchesi M, Mirabile A, Palermo L, Scagliarini S. What to Do and What Not to Do in the Management of Cancer Pain: A Physician Survey and Expert Recommendations. Cancer Manag Res 2021; 13:5203-5210. [PMID: 34234563 PMCID: PMC8256821 DOI: 10.2147/cmar.s310651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite the prevalence of pain among patients with cancer and the availability of pertinent guidelines, the clinical management of oncological pain is decisively insufficient. To address this issue, we evaluated current trends in clinical practice and subsequently generated a list of ten corrective actions-five things to do and five things not to do-for the diagnosis, management, and monitoring of cancer pain. METHODS The survey included 18 questions about clinical practice surrounding background pain and breakthrough cancer pain (BTcP). Survey questions were developed by a scientific board of 10 physician experts and communicated via email to an expanded panel of physicians in Italy. Responses were tabulated descriptively for analysis. RESULTS Of 51 invited physicians, 32 (63%) provided complete survey responses. The responses revealed several incongruencies with current guideline recommendations: physicians did not always diagnose or monitor pain using diagnostically validated or disease-specific instruments; frequently based clinical decision-making on time availability or convenience; and pharmacological therapy was often inappropriate (eg, prescribing NSAIDs or corticosteroids for BTcP). The list of corrective actions generated by the scientific board favored a guideline-oriented approach that systematically characterizes oncological pain and implements treatment based on pain characteristics (eg, fast-acting transmucosal opioids for BTcP) and evidence-based recommendations. CONCLUSION Oncologists require better education and training about the diagnosis, treatment, and monitoring of oncological pain. Physicians should be aware of current guideline recommendations as well as available pharmacological tools for BTcP.
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Affiliation(s)
- Paolo Bossi
- Department of Medical Oncology, ASST-Spedali Civili, Brescia, Italy
| | - Andrea Antonuzzo
- Medical Oncology Unit 1 SSN, Oncology Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Grazia Armento
- Department of Medical Oncology, Campus Bio-Medico University Hospital, Rome, Italy
| | | | - Jacopo Giuliani
- Unit Department Medical Oncology, Mater Salutis, Hospital, Legnago, Italy
| | - Raffaele Giusti
- Unit Department Medical Oncology, Sant ‘Andrea University Hospital, Rome, Italy
| | - Maurizio Lucchesi
- Pneumology Unit - Thoracic Oncology Service, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Aurora Mirabile
- Department of Oncology, San Raffaele University Hospital, Milan, Italy
| | - Loredana Palermo
- Unit Department Medical Oncology, IRCCS Giovanni Paolo, Bari, Italy
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di Biase L, Falato E, Caminiti ML, Pecoraro PM, Narducci F, Di Lazzaro V. Focused Ultrasound (FUS) for Chronic Pain Management: Approved and Potential Applications. Neurol Res Int 2021; 2021:8438498. [PMID: 34258062 PMCID: PMC8261174 DOI: 10.1155/2021/8438498] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/19/2021] [Indexed: 02/08/2023] Open
Abstract
Chronic pain is one of the leading causes of disability and disease burden worldwide, accounting for a prevalence between 6.9% and 10% in the general population. Pharmacotherapy alone results ineffective in about 70-60% of patients in terms of a satisfactory degree of pain relief. Focused ultrasound is a promising tool for chronic pain management, being approved for thalamotomy in chronic neuropathic pain and for bone metastases-related pain treatment. FUS is a noninvasive technique for neuromodulation and for tissue ablation that can be applied to several tissues. Transcranial FUS (tFUS) can lead to opposite biological effects, depending on stimulation parameters: from reversible neural activity facilitation or suppression (low-intensity, low-frequency ultrasound, LILFUS) to irreversible tissue ablation (high-intensity focused ultrasounds, HIFU). HIFU is approved for thalamotomy in neuropathic pain at the central nervous system level and for the treatment of facet joint osteoarthritis at the peripheral level. Potential applications include HIFU at the spinal cord level for selected cases of refractory chronic neuropathic pain, knee osteoarthritis, sacroiliac joint disease, intervertebral disc nucleolysis, phantom limb, and ablation of peripheral nerves. FUS at nonablative dosage, LILFUS, has potential reversible and tissue-selective effects. FUS applications at nonablative doses currently are at a research stage. The main potential applications include targeted drug and gene delivery through the Blood-Brain Barrier, assessment of pain thresholds and study of pain, and reversible peripheral nerve conduction block. The aim of the present review is to describe the approved and potential applications of the focused ultrasound technology in the field of chronic pain management.
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Affiliation(s)
- Lazzaro di Biase
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, Rome 00128, Italy
- Brain Innovations Lab, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, Rome 00128, Italy
| | - Emma Falato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, Rome 00128, Italy
| | - Maria Letizia Caminiti
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, Rome 00128, Italy
| | - Pasquale Maria Pecoraro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, Rome 00128, Italy
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, Rome 00128, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, Rome 00128, Italy
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237
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Bienfait F, Jubier-Hamon S, Seegers V, Pluchon YM, Lebrec N, Jaoul V, Boré F, Delorme T, Robert J, Bellanger M, Sorrieul J, Dupoiron D. First Evaluation Switching From Ropivacaine to Highly Concentrated Bupivacaine in Intrathecal Mixtures for Cancer Pain. Neuromodulation 2021; 24:1215-1222. [PMID: 34181790 DOI: 10.1111/ner.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intrathecal drug delivery is widely used for intractable cancer pain treatment. A combination of drugs with morphine and bupivacaine is recommended in first line therapy. In France, we use ropivacaine 10 mg/mL instead of bupivacaine 5 mg/mL, the only concentration available. Bupivacaine 40 mg/mL has been available in France only since July 2020 under temporary authorization of use. OBJECTIVES The main objective of the study was to evaluate the safety, efficacy by pain assessment, to analyze drug dosage changes, to report adverse events (AEs) and conversion ratios switching from ropivacaine to bupivacaine. Secondary objective was to evaluate costs differences. MATERIALS AND METHODS We conducted this retrospective follow-up monocentric study within the Institut de Cancérologie de l'Ouest (ICO) Pain Department in Angers, France. We included 14 patients aged 18 years and above, implanted with an Intrathecal Drug Delivery Systems (IDDS) for cancer pain treatment and followed up at ICO from July 2020 to February 2021 after switching from ropivacaine to bupivacaine. We used a continuous infusion mode and Bolus could be added through Personal Therapy Manager (PTM). RESULTS The median conversion ratio between ropivacaine and bupivacaine was 0.68 (0.65; 0.69) and resulted in no significant change in numeric rating scale evaluation (p = 0.10). We observed moderate and rapidly reversible AEs such as clinical hypotension (29%) and motor block after bolus (21%). The estimated median hospital cost per day was significantly lower (p = 0.05) for the bupivacaine refills than for the last ropivacaine pump refill, decreasing from US$ 61.7 (49.6; 70.5) to US$ 50.4 (45.9; 60.4). The median reimbursement per day from the National Health Insurance (NHI) was three times lower for bupivacaine pump refill when compared to the last ropivacaine pump refill (p < 0.01), decreasing from US$ 179.10 (156.79; 182.91) to US$ 64.59 (59.85; 71.89). CONCLUSION Switching from ropivacaine to bupivacaine in IDDS appears more efficacious while remaining just as secure, and at lower cost.
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Affiliation(s)
- Florent Bienfait
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Sabrina Jubier-Hamon
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Valérie Seegers
- Department of Epidemiology and Biostatistics, Institut de Cancerologie De l'Ouest, Angers, France
| | | | - Nathalie Lebrec
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Virginie Jaoul
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - François Boré
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Thierry Delorme
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Julien Robert
- Pharmacy, Institut de Cancerologie de l'Ouest, Angers, France
| | - Martine Bellanger
- Department of Human and Social Sciences, Institut de Cancerologie de l'Ouest, Nantes, France.,EHESP School of Public Health, Paris, France
| | - Jérémy Sorrieul
- Pharmacy, Institut de Cancerologie de l'Ouest, Angers, France
| | - Denis Dupoiron
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
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238
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Cata JP, Uhelski ML, Gorur A, Dougherty PM. Nociception and Pain: New Roles for Exosomes. Neuroscientist 2021; 28:349-363. [PMID: 34166130 DOI: 10.1177/10738584211027105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The interchange of information from one cell to another relies on the release of hundreds of different molecules including small peptides, amino acids, nucleotides, RNA, steroids, retinoids, or fatty acid metabolites. Many of them are released to the extracellular matrix as free molecules and others can be part of the cargo of cellular vesicles. Small extracellular vesicles (30-150 nm), also known as exosomes, are a known mechanism of cell-to-cell communication in the nervous system. Exosomes participate in the pathogenesis of several neurological conditions including Alzheimer's and Parkinson's disease. However, exciting emerging evidence demonstrates that exosomes also regulate mechanisms of the sensory process including nociception. The goal of this review is to summarize the literature on exosome biogenesis, methods of small vesicle isolation and purification, and their role in nociception. We also provide insights on the potential applications of exosomes as pain biomarkers or as novel therapeutics.
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Affiliation(s)
- Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas-MD Anderson Cancer Center, Houston, TX, USA.,Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Megan L Uhelski
- Department of Pain Medicine, The University of Texas-MD Anderson Cancer Center, Houston, TX, USA
| | - Aysegul Gorur
- Department of Anesthesiology and Perioperative Medicine, The University of Texas-MD Anderson Cancer Center, Houston, TX, USA.,Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas-MD Anderson Cancer Center, Houston, TX, USA
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239
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Liou KT, Chen C, Emard N, Lynch KA, Hou YN, Mao JJ. Herbal Topical Analgesic for Pain Management: Perspectives from Cancer Patients. PAIN MEDICINE 2021; 22:1435-1440. [PMID: 33620470 DOI: 10.1093/pm/pnab072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Herbs and natural products are increasingly used by cancer patients for pain management, but few studies have examined their integration within conventional cancer care. This study describes the characteristics, experiences, and perspectives of cancer patients who were prescribed an herbal topical analgesic for pain management. DESIGN AND SETTING Program evaluation of a pilot herbal dispensary at a National Cancer Institute-designated comprehensive cancer center. SUBJECTS Cancer patients who were prescribed the Tibetree Pain-Relieving Plaster (PRP) by an integrative medicine physician. METHODS Sociodemographic and clinical characteristics of patients were abstracted from medical records. Semistructured phone interviews were conducted 1-2 weeks after PRP prescription to evaluate patient experiences with using PRP for pain. Interviews were analyzed through thematic content analysis. RESULTS From February 2019 to February 2020, 50 patients were prescribed PRP. Median age (range) was 63 years (21-86), 37 patients (74%) were female, 14 (28%) were non-White, and 38 (76%) were using oral analgesics. During interviews, the majority of patients reported that the PRP improved pain and health-related outcomes, was convenient to use, and addressed pain management needs that were not fulfilled by oral analgesics. However, a few patients described adverse experiences with PRP, including skin irritation. CONCLUSIONS Understanding patient experiences and perspectives is a critical step toward evidence-based integration of herbs and natural products into cancer pain management. Findings from this program evaluation will inform the design of a randomized clinical trial on the efficacy and safety of PRP for pain in patients with cancer.
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Connie Chen
- Department of Medicine, NYU Winthrop Hospital, Mineola, NY, USA
| | - Nicholas Emard
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen A Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yen Nien Hou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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240
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Kuroda Y, Nonaka M, Kamikubo Y, Ogawa H, Murayama T, Kurebayashi N, Sakairi H, Miyano K, Komatsu A, Dodo T, Nakano-Ito K, Yamaguchi K, Sakurai T, Iseki M, Hayashida M, Uezono Y. Inhibition of endothelin A receptor by a novel, selective receptor antagonist enhances morphine-induced analgesia: Possible functional interaction of dimerized endothelin A and μ-opioid receptors. Biomed Pharmacother 2021; 141:111800. [PMID: 34175819 DOI: 10.1016/j.biopha.2021.111800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The misuse of opioids has led to an epidemic in recent times. The endothelin A receptor (ETAR) has recently attracted attention as a novel therapeutic target to enhance opioid analgesia. We hypothesized that endothelin A receptors may affect pain mechanisms by heterodimerization with μ opioid receptors. We examined the mechanisms of ETAR-mediated pain and the potential therapeutic effects of an ETAR antagonist, Compound-E, as an agent for analgesia. METHODS Real-time in vitro effect of Compound-E on morphine response was assessed in HEK293 cells expressing both endothelin A and μ opioid receptors through CellKey™ and cADDis cAMP assays. Endothelin A/μ opioid receptor dimerization was assessed by immunoprecipitation and live cell imaging. The in vivo effect of Compound-E was evaluated using a morphine analgesia mouse model that observed escape response behavior, body temperature, and locomotor activity. RESULTS In CellKey™ and cAMP assays, pretreatment of cells with endothelin-1 attenuated morphine-induced responses. These responses were improved by Compound-E, but not by BQ-123 nor by bosentan, an ETAR and endothelin B receptor antagonist. Dimerization of ETARs and μ opioid receptors was confirmed by Western blot and total internal reflection fluorescence microscopy in live cells. In vivo, Compound-E potentiated and prolonged the analgesic effects of morphine, enhanced hypothermia, and increased locomotor activity compared to morphine alone. CONCLUSION The results suggest that attenuation by endothelin-1 of morphine analgesia may be caused by dimerization of Endothelin A/μ opioid receptors. The novel ETAR antagonist Compound-E could be an effective adjunct to reduce opioid use.
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Affiliation(s)
- Yui Kuroda
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Miki Nonaka
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kamikubo
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Haruo Ogawa
- Institute of Molecular and Cellular Biosciences, The University of Tokyo, Tokyo, Japan
| | - Takashi Murayama
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nagomi Kurebayashi
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hakushun Sakairi
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako Miyano
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan; Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, Japan
| | - Akane Komatsu
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsushi Dodo
- Strategy Planning & Operations, Medicine Development Center, Eisai Co., Ltd., Ibaraki, Japan
| | - Kyoko Nakano-Ito
- Global Drug Safety, Medicine Development Center, Eisai Co., Ltd., Ibaraki, Japan
| | - Keisuke Yamaguchi
- Department of Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Sakurai
- Department of Cellular and Molecular Pharmacology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masako Iseki
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasuhito Uezono
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan; Department of Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Supportive and Palliative Care Research Support Office, National Center Hospital East, Chiba, Japan; Project for Supportive Care Research, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan.
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241
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Rich BJ, Schumacher LED, Sargi ZB, Masforroll M, Kwon D, Zhao W, Rueda-Lara MA, Freedman LM, Elsayyad N, Samuels SE, Abramowitz MC, Samuels MA. Opioid use patterns in patients with head and neck cancer receiving radiation therapy: Single-institution retrospective analysis characterizing patients who did not require opioid therapy. Head Neck 2021; 43:2973-2984. [PMID: 34143542 DOI: 10.1002/hed.26785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/06/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We had previously analyzed the variables that determine the rates of opioid use at 1-year postradiotherapy in patients with head and neck cancer. Here we analyze the variables associated with opioid abstinence during and in the 12 months after radiotherapy at our institution. METHODS We identified a cohort of patients with head and neck cancer who received radiotherapy as part of curative treatment at our institution. Logistic regression analyses were performed to determine socioeconomic and clinical factors associated with opioid abstinence. RESULTS The cohort included 376 patients. On multivariable analysis, patients from an upper-income class (p = 0.004), black race (p = 0.004), older (p = 0.008), with dependent children (p < 0.001) or receiving surgery (p = 0.002) were more likely to abstain from opioids, while patients using analgesic mouthwash (p = 0.009) or higher pain scale (p = 0.002) were less likely. CONCLUSION Socioeconomic and treatment characteristics are associated with opioid abstinence during and following radiation treatment in patients with head and neck cancer.
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Affiliation(s)
- Benjamin J Rich
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Leif-Erik D Schumacher
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Deukwoo Kwon
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Wei Zhao
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria A Rueda-Lara
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laura M Freedman
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nagy Elsayyad
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stuart E Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Matthew C Abramowitz
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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242
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Gabapentin enhances the antinociceptive effect of intrathecal morphine in refractory cancer pain patients. Support Care Cancer 2021; 29:7611-7616. [PMID: 34131845 DOI: 10.1007/s00520-021-06350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Morphine infusion through Intrathecal Drug Delivery System (IDDS) is widely used to relieve refractory cancer pain. However, continuous escalation of morphine dose caused by opioid tolerance and/or progress of cancer was commonly observed. Combining morphine with medications of different analgesic mechanisms is applied to blunt the rate of morphine increase. The purpose of this study was to determine the analgesic efficacy and safety of combining gabapentin with morphine after IDDS implantation. METHODS This study compared patients that received IDDS implantation from January 1, 2017 to November 10, 2018 in our institute. Key outcomes included change in mean pain score, dose of morphine used in patients, percentage of patients with 30% and 50% reduction in mean pain score, Patient Global Impression of Change scores, breakthrough pain characters and side effects. RESULTS 34 patients in the combination group (morphine + gabapentin) and 40 patients in the monotherapy group(morphine)were analyzed. The results showed that both therapy groups achieved similar analgesic efficacy, demonstrated by Numerical rating scale (2.42 ± 0.88 vs 2.57 ± 0.85; Combination vs Monotherapy), PGIC and responder status. Mean daily dose of morphine was significantly lower in combination group compared to monotherapy group (3.54 ± 1.29 mg vs 4.64 ± 1.28 mg, P = 0.007). More patients experienced dizziness and somnolence after receiving combination therapy compared to morphine-alone treatment although no statistical significance was found (P = 0.49). CONCLUSION Addition of gabapentin achieved similar analgesic efficacy with lower dose of morphine compared to morphine alone accompanying with higher incidence of dizziness and somnolence.
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243
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Dziedzic KL, Albert RH. Management of Intractable Symptoms in Oncologic Care. Curr Oncol Rep 2021; 23:93. [PMID: 34125305 DOI: 10.1007/s11912-021-01082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW For patients undergoing evaluation and treatment of cancers, symptom management is a critical component of their treatment plan. For some patients, symptoms may become intractable or refractory to common therapies. Here, we review treatment options for these severe symptom conditions. RECENT FINDINGS Medication options and regimens have improved to treat refractory symptoms. Medications can be tailored to treat chemotherapy-induced nausea and vomiting based on current guidelines. Interventions such as venting gastrostomy can mitigate symptoms associated with malignant bowel obstruction, when life expectancy is long enough to realize this benefit. Opiates can reduce refractory dyspnea, consistent with guidelines from the American Thoracic Society. Interventional therapies for intractable pain, such as neurolytic blocks and intrathecal pumps, have shown promise in managing symptoms when traditional therapies have been ineffective. Refractory symptoms can be managed in cancer care. The use of multimodal therapies delivered by interdisciplinary teams appears to be the most effective way to approach these clinical situations.
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Affiliation(s)
| | - Ross H Albert
- Hospice and Palliative Care Medical Director, Hartford Healthcare at Home, 1290 Silas Deane Hwy, Suite 4B, Wethersfield, Hartford, CT, 06109, USA.
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244
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Bonsaksen T, Ekeberg Ø, Schou-Bredal I, Skogstad L, Heir T, Grimholt TK. Use of Alcohol and Addictive Drugs During the COVID-19 Outbreak in Norway: Associations With Mental Health and Pandemic-Related Problems. Front Public Health 2021; 9:667729. [PMID: 34195169 PMCID: PMC8236640 DOI: 10.3389/fpubh.2021.667729] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/29/2021] [Indexed: 01/16/2023] Open
Abstract
Background: The outbreak of COVID-19 has had a major impact on people's daily life. This study aimed to examine use of alcohol and addictive drugs during the COVID-19 outbreak in Norway and examine their association with mental health problems and problems related to the pandemic. Methods: A sample of 4,527 persons responded to the survey. Use of alcohol and addictive drugs were cross-tabulated with sociodemographic variables, mental health problems, and problems related to COVID-19. Logistic regression analyses were used to examine the strength of the associations. Results: Daily use of alcohol was associated with depression and expecting financial loss in relation to the COVID-19 outbreak. Use of cannabis was associated with expecting financial loss in relation to COVID-19. Use of sedatives was associated with anxiety, depression, and insomnia. Use of painkillers was associated with insomnia and self-reported risk of complications if contracting the coronavirus. Conclusion: The occurrence of mental health problems is more important for an understanding of the use of alcohol and addictive drugs during the COVID-19 outbreak in Norway, compared to specific pandemic-related worries.
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Affiliation(s)
- Tore Bonsaksen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Faculty of Health Studies, VID Specialized University, Sandnes, Norway
| | - Øivind Ekeberg
- Psychosomatic and Consultation-Liaison Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Inger Schou-Bredal
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department for Cancer, Oslo University Hospital, Oslo, Norway
| | - Laila Skogstad
- Department of Research, Sunnaas Rehabilitation Hospital HF, Bjørnemyr, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Trond Heir
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tine K. Grimholt
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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245
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Sun C, Wang YT, Dai YJ, Liu ZH, Yang J, Cheng ZQ, Dong DS, Wang CF, Zhao GL, Lu GJ, Song T, Jin Y, Kaye AD, Imani F, Sadegi K, Sun LL, Sun YH. Programmable Pump for Intrathecal Morphine Delivery to Cisterna Magna: Clinical Implications in Novel Management of Refractory Pain Above Middle Thoracic Vertebrae Level Utilizing a Prospective Trial Protocol and Review. Anesth Pain Med 2021; 11:e115873. [PMID: 34540643 PMCID: PMC8438709 DOI: 10.5812/aapm.115873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cisterna Intrathecal Drug Delivery system (IDDS) with morphine has proven to be effective in treating refractory cancer pain above the middle thoracic vertebrae level in some countries. However, it has not been fully investigated in others. We designed the current project to investigate the efficacy and safety of cisterna IDDS for pain relief in refractory pain above the middle thoracic vertebrae level in advanced cancer patients. METHODS This study protocol allows for eligible cancer patients to receive the cisterna IDDS operation. Pain intensity (Visual Analogue scale, VAS), quality of life (36-Item Short-Form Health Survey, SF-36), and depression (Self-Rating Depression scale, SDS) are assessed along with side effects in the postoperative follow-up visits. Recent literature suggests a potential role for cisterna IDDS morphine delivery for refractory pain states above the middle thoracic level. CONCLUSION The results of this study may provide further evidence that cisterna IDDS of morphine can serve as an effective and safe pain relief strategy for refractory pain above the middle thoracic vertebrae level in advanced cancer patients.
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Affiliation(s)
- Chang Sun
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an, China
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Yu-Tong Wang
- Department of Emergency, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Yu-Jie Dai
- Department of Clinical Nutrition, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Zhi-Hui Liu
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Yang
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Zhu-Qiang Cheng
- Department of Anesthesiology, Pain Medicine Center, Jinling Hospital, Nanjing, China
| | - Dao-Song Dong
- Department of Pain Medicine, The First Affiliated Hospital of Chinese Medical University, Shenyang, China
| | - Cheng-Fu Wang
- Department of Pain Medicine, The First Affiliated Hospital of Chinese Medical University, Shenyang, China
| | - Guo-Li Zhao
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Gui-Jun Lu
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
| | - Tao Song
- Department of Pain Medicine, The First Affiliated Hospital of Chinese Medical University, Shenyang, China
| | - Yi Jin
- Department of Anesthesiology, Pain Medicine Center, Jinling Hospital, Nanjing, China
| | - Alan D. Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, USA
- Corresponding Author: Department of Anesthesiology, LSU Health Shreveport, Shreveport, USA.
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kambiz Sadegi
- Department of Anesthesiology, Zabol University of Medical Sciences, Zabol, Iran
- Corresponding Author: Department of Anesthesiology, Zabol University of Medical Sciences, Zabol, Iran.
| | - Li-Li Sun
- Department of Neurology, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Yong-Hai Sun
- Department of Anesthesiology, Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China
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246
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Musavi M, Jahani S, Asadizaker M, Maraghi E, Razmjoo S. The Effect of Pain Self-Management Education on Pain Severity and Quality of Life in Metastatic Cancer Patients. Asia Pac J Oncol Nurs 2021; 8:419-426. [PMID: 34159235 PMCID: PMC8186386 DOI: 10.4103/apjon.apjon-2097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/16/2021] [Indexed: 11/06/2022] Open
Abstract
Objective: Proper pain control in cancer patients is one of the prime needs of metastatic cancer patients. It is, then, one of the essential objectives of health care workers. The present study aimed to pinpoint the impact of pain self-management education on the pain severity and the quality of life in patients with metastatic cancers using complementary medicine approaches. Methods: This clinical trial study was performed in the Oncology Specialty Clinic of Ahvaz Golestan Hospital on 82 metastatic cancer patients picked based on inclusion criteria. They were randomly assigned to two groups: the intervention group and one as the control group. In the intervention group, pain self-management was taught in the three steps of providing information, skill development, and guidance. Self-management approaches were also practically taught face to face along with feedback. Furthermore, the quality of life was measured at 1-and 3-month follow-ups and the pain severity was measured during 7 weeks. In the control group, the quality of life questionnaire and the pain severity checklist were given to the participants to fill out. Finally, data were analyzed through SPSS version 22 in general and repeated-measures ANOVA and Friedman tests. Results: It was observed that after the intervention, the trend of pain severity during weeks 1–7 was significantly different in the intervention and control groups (P < 0.0001). In addition, a significant difference was observed for the quality of life at 1 and 3 months after the intervention between the two studied groups (P < 0.0001). Conclusions: Findings of the present study indicate a positive impact of pain self-management on improving pain severity and the indicators of quality of life in metastatic cancer patients. Accordingly, the current study findings can help nurses, nursing students, and other team members improve pain control skills and subsequently increase the quality of life in patients with metastatic cancers.
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Affiliation(s)
- Mahsa Musavi
- Chronic Diseases Care Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Simin Jahani
- Department of Medical and Surgical Nursing, Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marziyeh Asadizaker
- Department of Medical and Surgical Nursing, Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Maraghi
- Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sasan Razmjoo
- Department of Clinical Oncology, Clinical Research Development Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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247
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Jain D, Goyal T, Paswan AK, Verma N. Sequential Supraclavicular Brachial Plexus and Stellate Ganglion Neurolysis for Upper Limb Pain in Metastatic Breast Cancer. Indian J Palliat Care 2021; 27:180-182. [PMID: 34035637 PMCID: PMC8121234 DOI: 10.4103/ijpc.ijpc_89_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/01/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022] Open
Abstract
Neuropathic pain in cancer can result in severe debilitation to a patient with limited treatment options. Interventional modalities like nerve destruction can provide relief but at the expense of motor paralysis. Sympathetic pain is often an undiagnosed and undertreated condition that may accompany cases of chronic pain. We describe a case of severe neuropathic pain in brachial plexopathy in a middle-aged woman caused by metastatic breast cancer that was managed by chemical neurolysis of brachial plexus. Residual pain was treated by neurolysis of stellate ganglion due to the presence of sympathetic pain. This case report highlights the importance of the dual nature of pain and its management by chemical neurolysis in severe refractory neuropathic and sympathetic mediated pain.
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Affiliation(s)
- Dhruv Jain
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Titiksha Goyal
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anil Kumar Paswan
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nimisha Verma
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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248
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Mutebi M, Anderson BO, Duggan C, Adebamowo C, Agarwal G, Ali Z, Bird P, Bourque JM, DeBoer R, Gebrim LH, Masetti R, Masood S, Menon M, Nakigudde G, Ng'ang'a A, Niyonzima N, Rositch AF, Unger-Saldaña K, Villarreal-Garza C, Dvaladze A, El Saghir NS, Gralow JR, Eniu A. Breast cancer treatment: A phased approach to implementation. Cancer 2021; 126 Suppl 10:2365-2378. [PMID: 32348571 DOI: 10.1002/cncr.32910] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low- and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana.
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Affiliation(s)
- Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University Hospital, Nairobi, Kenya
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Clement Adebamowo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.,Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,Center for Bioethics and Research, Ibadan, Nigeria
| | - Gaurav Agarwal
- Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | | | - Jean-Marc Bourque
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rebecca DeBoer
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Luiz Henrique Gebrim
- Department of Mastology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Referência da Saúde da Mulher, São Paulo, Brazil
| | - Riccardo Masetti
- Department of Women and Child Health, Catholic University, Rome, Italy
| | - Shahla Masood
- University of Florida Health Jacksonville Breast Center, Jacksonville, Florida
| | - Manoj Menon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Anne Ng'ang'a
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Nixon Niyonzima
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Uganda Cancer Institute, Kampala, Uganda
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karla Unger-Saldaña
- Epidemiology Unit, Instituto Nacional de Cancerología - México, Mexico City, Mexico
| | - Cynthia Villarreal-Garza
- Tecnologico de Monterrey, Centro de Cancer de Mama, Hospital Zambrano Hellion, Monterrey, Mexico
| | - Allison Dvaladze
- Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | | | - Julie R Gralow
- Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | - Alexandru Eniu
- Hopital Riviera Chablais, Vaud-Valais, Rennaz, Switzerland
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249
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Kuguyo O, Misi FD, Chibonda S, Matimba A, Nhachi C, Tsikai N. Pain management strategies among cervical cancer patients in Zimbabwe. Pain Manag 2021; 11:715-729. [PMID: 34008417 DOI: 10.2217/pmt-2020-0108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe pain management regulations, prevalence of pain and pain management practices in a Zimbabwean setting. Materials & methods: A multi-methods approach was used, consisting of: policy and guideline review; review of 410 cervical cancer patient records for pain symptoms and pain management data; and semistructured interviews with oncology healthcare practitioners. Results: We found a lack of policies that are specific for cervical cancer pain management. Although prevalence of pain was 68% (n = 278), only 42% of the patient records indicated pain drugs had been prescribed. Barriers to pain management included inadequate use of pain assessment tools, inaccessibility of key drugs and limited capacity. Conclusion: Cancer pain management in Zimbabwe can be improved by tailoring assessment protocols, improving drug accessibility and strengthening healthcare systems.
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Affiliation(s)
- Oppah Kuguyo
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Box A178, Avondale, Harare, Zimbabwe
| | - Frances Desales Misi
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Box A178, Avondale, Harare, Zimbabwe
| | - Shirley Chibonda
- Department of Oncology, College of Health Sciences, University of Zimbabwe, Box A178, Avondale, Harare, Zimbabwe
| | - Alice Matimba
- Advanced Courses & Scientific Conferences, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Charles Nhachi
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Box A178, Avondale, Harare, Zimbabwe
| | - Nomsa Tsikai
- Department of Oncology, College of Health Sciences, University of Zimbabwe, Box A178, Avondale, Harare, Zimbabwe
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250
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Sica A, Casale B, Sagnelli C, Di Dato MT, Rispoli M, Santagata M, Buonavolontà P, Fiorelli A, Vitiello P, Caccavale S, Creta M, Salzano AM, Sagnelli E, Saracco E, Gazzerro G, Famiglietti V, Tammaro D, Papa A. Chronic Chest Pain Control after Trans-Thoracic Biopsy in Mediastinal Lymphomas. Healthcare (Basel) 2021; 9:589. [PMID: 34069774 PMCID: PMC8157245 DOI: 10.3390/healthcare9050589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/01/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022] Open
Abstract
Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patients with lymphomas. Pathological neuronal mechanisms integrate with an overproduction of IL-6, TNF-α, IL1-β by macrophages and monocytes, which amplifies inflammation and pain. In consideration of this complex pathogenesis, international guidelines recommend diversified analgesia protocols: thoracic epidural, paravertebral block, and systemic administration of opioids. This study reports an attempt to reduce chest pain and prevent chronic pain in 51 patients undergoing trans-thoracic biopsy for mediastinal lymphoma. The entity of pain, measured 72nd hour after biopsy by the Numerical Rating Scale (NRS), was compared with that seen at a 6th month checkpoint in 46 patients. The pain decreased in all cases. At the 6th month checkpoint, among 31 opioid-treated patients, none of the 16 patients with NRS < 6 within the 72nd hour post biopsy had developed chronic chest pain, while 8 of the 15 with higher values did (p < 0.01). Of 10 patients undergoing thoracotomy and treated with opioids, eight had a NRS of no more than 2, of which six had no chronic pain. Of the twenty-one patients who underwent VATS biopsy and were treated with opioids, fifteen had NRS no greater than 2, of which ten had no chronic pain. Subgroups of patients biopsied under mediastinotomy or video-assisted thoracoscopic surgery (VATS) and treated with thoracic epidural analgesia (TEA) or PVB were too small for such analysis.
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Affiliation(s)
- Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Beniamino Casale
- Department of Pneumology and Tisiology, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy;
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.S.); (E.S.)
| | - Maria Teresa Di Dato
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Marco Rispoli
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Mario Santagata
- Multidisciplinary Department of Medical Surgery and Dental Specialties, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Pietro Buonavolontà
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Paola Vitiello
- Dermatology Unit, University of Campania, 80131 Naples, Italy; (P.V.); (S.C.)
| | - Stefano Caccavale
- Dermatology Unit, University of Campania, 80131 Naples, Italy; (P.V.); (S.C.)
| | - Massimiliano Creta
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Anna Maria Salzano
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.S.); (E.S.)
| | - Elisabetta Saracco
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Giuseppe Gazzerro
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Vincenzo Famiglietti
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Dario Tammaro
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Alfonso Papa
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
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