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Stormoen DR, Taarnhøj GA, Friis RB, Johansen C, Pappot H. Association of patient-reported pain with survival in bladder cancer: a post-hoc analysis of the iBLAD trial. Acta Oncol 2023; 62:814-819. [PMID: 37071772 DOI: 10.1080/0284186x.2023.2199461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Affiliation(s)
| | | | | | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Roy S, Morgan SC, Wallis CJD, Sun Y, Spratt DE, Malone J, Grimes S, Mukherjee D, Kishan AU, Saad F, Malone S. Association of dynamic change in patient-reported pain with survival in metastatic castrate sensitive prostate cancer-exploratory analysis of LATITUDE study. Prostate Cancer Prostatic Dis 2023; 26:96-104. [PMID: 36097167 DOI: 10.1038/s41391-022-00529-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pain is an important dimension of quality-of-life in patients with metastatic castrate-sensitive prostate cancer (mCSPC). However, it is unclear if dynamic change in pain over time can predict for overall survival (OS) or progression-free survival (PFS) in these patients. METHODS This is an exploratory analysis of LATITUDE, a phase III randomized study, in which men with de novo mCSPC were randomized to receive either ADT plus abiraterone versus ADT alone. Information was collected on patient-reported worst pain score (WPS) and pain-interference score (PIS) from the Brief Pain Inventory-Short Form. A Bayesian joint modelling approach was used determine the association of dynamic change in WPS and PIS with OS and PFS. RESULTS Overall, 1125 patients with at least 3 measurements on pain scores were eligible. On Cox multivariable regression, increase in baseline WPS was associated with inferior OS (hazard ratio [HR] 1.049 [95% confidence intervals [CI] 1.015-1.085]; time dependent area under curve [tAUC] 0.64) and PFS (HR 1.045 [1.011-1.080]; tAUC: 0.64). Increase in baseline PIS was associated with inferior OS (HR 1.062 [1.020-1.105]; tAUC: 0.63) but not with PFS (HR 1.038 [0.996-1.08]). On independent joint models, an increase in the current value of WPS by 1-unit was associated with inferior OS (HR 1.316 [1.258-1.376]; tAUC 0.74) and PFS (HR 1.319 [1.260-1.382]; tAUC 0.70). Similar association was seen for increase in the current value of PIS with OS (HR 1.319 [1.261-1.381]; tAUC 0.73) and PFS (HR 1.282 [1.224-1.344]; tAUC 0.73). CONCLUSIONS The above findings highlight the potential dynamic interplay between patient-reported pain with OS and PFS in mCSPC. Compared to baseline pain, such dynamic assessment of pain was found to have superior predictive ability and thus has the potential to tailor subsequent treatment based on response to initial therapy beyond its role as a very important dimension of quality-of-life.
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Affiliation(s)
- Soumyajit Roy
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA.
| | - Scott C Morgan
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | | | - Yilun Sun
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel E Spratt
- University Hospital Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | | | - Scott Grimes
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | | | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Fred Saad
- Department of surgery, Université de Montréal, Montreal, QC, Canada
| | - Shawn Malone
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
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Colosia A, Njue A, Bajwa Z, Dragon E, Robinson RL, Sheffield KM, Thakkar S, Richiemer SH. The Burden of Metastatic Cancer-Induced Bone Pain: A Narrative Review. J Pain Res 2022; 15:3399-3412. [PMID: 36317162 PMCID: PMC9617513 DOI: 10.2147/jpr.s371337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
Bone pain is one of the most common forms of pain reported by cancer patients with metastatic disease. We conducted a review of oncology literature to further understand the epidemiology of and treatment approaches for metastatic cancer–induced bone pain and the effect of treatment of painful bone metastases on the patient’s quality of life. Two-thirds of patients with advanced, metastatic, or terminal cancer worldwide experience pain. Cancer pain due to bone metastases is the most common form of pain in patients with advanced disease and has been shown to significantly reduce patients’ quality of life. Treatment options for cancer pain due to bone metastases include nonsteroidal anti-inflammatory drugs, palliative radiation, bisphosphonates, denosumab, and opioids. Therapies including palliative radiation and opioids have strong evidence supporting their efficacy treating cancer pain due to bone metastases; other therapies, like bisphosphonates and denosumab, do not. There is sufficient evidence that patients who experience pain relief after radiation therapy have improved quality of life; however, a substantial proportion are nonresponders. For those still requiring pain management, even with available analgesics, many patients are undertreated for cancer pain due to bone metastases, indicating an unmet need. The studies in this review were not designed to determine why cancer pain due to bone metastases was undertreated. Studies specifically addressing cancer pain due to bone metastases, rather than general cancer pain, are limited. Additional research is needed to determine patient preferences and physician attitudes regarding choice of analgesic for moderate to severe cancer pain due to bone metastases.
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Affiliation(s)
- Ann Colosia
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Annete Njue
- Department of Market Access and Outcomes Strategy, RTI Health Solutions, Manchester, UK
| | - Zahid Bajwa
- Medical Affairs, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Rebecca L Robinson
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, IN, USA,Correspondence: Rebecca L Robinson, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA, Tel +1 3174331323, Fax +1 3172777444, Email
| | | | | | - Steven H Richiemer
- Division of Pain Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Yan Z, MuRong Z, Huo B, Zhong H, Yi C, Liu M, Liu M. Acupuncture as a Complementary Therapy for Cancer-Induced Bone Pain: A Systematic Review and Meta-Analysis. FRONTIERS IN PAIN RESEARCH 2022; 3:925013. [PMID: 35978992 PMCID: PMC9377524 DOI: 10.3389/fpain.2022.925013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer-induced bone pain (CIBP) is a special type of cancer pain and lacks safe and effective treatments. Acupuncture is a potentially valuable treatment for CIBP, studies evaluating the effect of acupuncture on CIBP have increased significantly, but the safety and efficacy of acupuncture to control CIBP remains controversial.ObjectiveTo provide the first meta-analysis to evaluate the safety and efficacy of acupuncture in CIBP management.Data SourcesCNKI, CBM, Wanfang, VIP Database, PubMed, Embase, and Cochrane Library were searched from their inception until 1 June 2022.Study SelectionRCTs with primary bone tumor patients or other types of primary cancer companied by bone metastases as the research subjects and to evaluate the efficacy of acupuncture treatment alone or combined with the control treatment were included. Meanwhile, RCTs should choose the pain score as the primary outcome and pain relief rate, frequency of breakthrough pain, analgesic onset time, analgesia duration, quality of life, and adverse events as reference outcomes.Data Collection and AnalysisWe designed a data-extraction form that was used to extract key information from the articles. Data extraction study evaluation was conducted independently by two reviewers, and a third reviewer would resolve any disagreements. The risk of bias was assessed by the Cochrane Collaboration's tool for assessing the risk bias. The quality of the evidence for main outcomes was evaluated by the GRADE system. Mean differences (MD), relative risk (RR), and 95% confidence intervals (CIs) were calculated. The forest plots were performed using the Review Manager Software (5.3 version). Subgroup analysis was used to investigate the possible sources of potential heterogeneity. Descriptive analysis was performed in case of unacceptable clinical heterogeneity.ResultsThirteen RCTs (with 1,069 patients) were included, and all studies were at high risk of bias owing to lack of blinding or other bias. Eleven studies evaluated the effectiveness of acupuncture as a complementary therapy, and showed that acupuncture plus control treatment (compared with control treatment) was connected with reduced pain intensity (MD = −1.34, 95% CI −1.74 to −0.94; Q < 0.1; I2 = 98%, P < 0.01). Subgroup analyses based on acupoints type partly explain the potential heterogeneity. The results also showed that acupuncture plus control treatment (compared with control treatment) was connected with relieving pain intensity, increasing the pain relief rate, reducing the frequency of breakthrough pain, shortening analgesic onset time, extending the analgesic duration, and improving the quality of life. We have no sufficient evidence to prove the effectiveness of acupuncture alone. Four RCTs reported only adverse events related to opioids' side effects. Evidence was qualified as “very low” because of low methodological quality, considerable heterogeneity, or a low number of included studies.ConclusionAcupuncture has a certain effect as a complementary therapy on pain management of CIBP, which not only mitigates the pain intensity but also improves the quality of life and reduces the incidence of opioids' side effects, although the evidence level was very low. In future, a larger sample size and rigorously designed RCTs are needed to provide sufficient evidence to identify the efficacy and safety of acupuncture as a treatment for CIBP.
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Affiliation(s)
- Zhaobo Yan
- College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Hunan, China
| | - Zhimiao MuRong
- College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Hunan, China
| | - Bixiu Huo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huan Zhong
- College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Hunan, China
| | - Chun Yi
- Department of Pathology, Hunan University of Chinese Medicine, Hunan, China
| | - Mailan Liu
- College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Hunan, China
- *Correspondence: Mi Liu
| | - Mi Liu
- College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Hunan, China
- Mailan Liu
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Acupuncture for Cancer-Induced Bone Pain in Animal Models: A Systemic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:5606823. [PMID: 32802130 PMCID: PMC7414378 DOI: 10.1155/2020/5606823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 12/09/2022]
Abstract
Background Cancer-induced bone pain (CIBP) is a highly prevalent symptom, which afflicts vast majority of patients who suffer from cancer. The current treatment options failed to achieve satisfactory effect and the side effects were prominent. Recent randomized controlled trials (RCTs) of animal demonstrate the benefit of acupuncture for CIBP. We sought to determine if the pooled data from available RCTs supports the use of acupuncture for CIBP. Methods A literature search for randomized controlled trials was conducted in six electronic databases from inception to May 31, 2019. Meta-analysis was performed with Review Manager 5.3 software; the publication bias was assessed by Stata 12.0 software. We used random effects model for pooling data because heterogeneity is absolute among studies to some extent. Results Twenty-four trials were included in the review, of which 12 trials provided detailed data for meta-analyses. Preliminary evidence indicates that compared to wait list/sham group, acupuncture was effective on increasing paw withdrawal threshold (PWT) and paw withdrawal latency (PWL). Compared to medicine, acupuncture was less effective on PWT, but as effective as medicine on PWL. Acupuncture can reinforce medicine's effect on PWT and PWL. Compared to the control group, acupuncture was superior to increase body weight (BW), decrease spinal cord glial fibrillary acidic protein (GFAP), and interleukin-1β (IL-1β). Furthermore, some studies showed acupuncture delay or partially reverse morphine tolerance. Three studies found acupuncture has no effect on PWT, but 2 of them found acupuncture could enhance small dose of Celebrex's effect on CIBP. Conclusions Acupuncture was superior to wait list/sham acupuncture on increasing PWT and has no less effect on increasing PWL compared to medicine; acupuncture improved the efficacy of drugs, increased the CIBP animals' body weight, and decreased their spinal cord GFAP and IL-1β. High-quality studies are necessary to confirm the results.
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SEOM clinical guideline for treatment of cancer pain (2017). Clin Transl Oncol 2017; 20:97-107. [PMID: 29127593 PMCID: PMC5785609 DOI: 10.1007/s12094-017-1791-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/23/2022]
Abstract
Pain is a highly prevalent symptom in patients with cancer. Despite therapeutic advances and well-accepted treatment guidelines, a percentage of patients with pain are under-treated.
Currently, it has been recognized that several barriers in pain management still exist and, in addition, there are new challenges surrounding complex subtypes of pain, such as breakthrough and neuropathic pain, requiring further reviews and recommendations. This is an update of the guide our society previously published and represents the continued commitment of SEOM to move forward and improve supportive care of cancer patients.
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