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Costa MFFD, Bilobran MA, de Oliveira LC, Muniz AHR, Chelles PA, Sampaio SGDSM. Correlation Between Cancer Pain and Quality of Life in Patients With Advanced Cancer Admitted to a Palliative Care Unit. Am J Hosp Palliat Care 2024; 41:882-888. [PMID: 37559447 DOI: 10.1177/10499091231195318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Cancer pain is one of the most prevalent manageable symptoms in patients with advanced cancer, and it has a negative impact on quality of life (QoL). OBJECTIVE The aim of this study is to examine the correlation between cancer pain and QoL in patients with advanced cancer who are hospitalized in a palliative care unit. METHODS This study is a cross-sectional analysis of patients with advanced cancer who were hospitalized with cancer pain at a specialized palliative care unit between June 2021 and February 2022. Pain intensity and its impact on daily activities were assessed using the Brief Pain Inventory (BPI), while the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 PAL (QLQ-C15-PAL) was used to evaluate QoL. RESULTS A total of 104 patients with cancer pain were included, with a mean age of 53.6 years (±14.1). Most of the patients were female (65.38%), and the most common primary tumor site was in the gastrointestinal tract (22.11%). The most frequently reported site of cancer pain was the abdomen (32.69%). The mean duration of cancer pain was 52.3 days (±6.2). The domains of QoL most strongly correlated with cancer pain were weakness (coefficient = .52, P < .001), nausea (coefficient = .36, P < .001), and the physical domain (coefficient = -.30, P < .001). CONCLUSION Cancer pain is strongly correlated with a deterioration in QoL in patients with advanced cancer, and its management should be pursued as a strategy for optimizing QoL.
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Affiliation(s)
| | - Marcela Amitrano Bilobran
- Palliative Care Unit, National Cancer Institute, Rio de Janeiro, Brazil
- Prevent Senior, Palliative Care, Rio de Janeiro, Brazil
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Siddiqui MT, Shaukat F, Khan MR, Zahid N, Arbani S. Quality of Life of Colorectal Cancer Patients and Its Association With Anxiety and Depression: Cross-Sectional Study at a Tertiary Care Hospital in Low Middle Income Country. J Surg Res 2024; 301:336-344. [PMID: 39018953 DOI: 10.1016/j.jss.2024.06.015] [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: 01/18/2024] [Revised: 05/21/2024] [Accepted: 06/20/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Colorectal cancer (CRC) and its therapy profoundly affect the quality of life (QoL) of patients. The emotional distress: anxiety and depression also negatively affect wellbeing of these patients. This study aims to evaluate the QoL, anxiety, and depression in CRC patients and their association with clinic-pathological features at a tertiary care hospital in Karachi Pakistan, a low middle income country. METHODS An analytical cross-sectional study was conducted on adult CRC patients. QoL was assessed using the European Organization for Research and Treatment of Cancer QoL questionnaire C30 and CR29. Hospital Anxiety and Depression Score was used to evaluate the anxiety and depression. Analyses were performed using STATA version 12, including multivariable linear and multivariate analysis of variance. A P value of < 0.05 was considered as significant. RESULTS A total of 127 CRC patients with mean age of 53 ± 15 y participated. Mean global QoL score was 69.08 ± 1.78. Among symptoms scales: stoma care problem and among functional scales: sexual interest (women > men) were the most significantly affected aspect. Anxiety and depression were seen in 26 (20.9%) and 24 (18.9%) patients, respectively. Lower global QoL was significantly associated with depression (-25.33 [95% confidence interval: -34.4, -16.23]), on adjuvant treatment (-15.14 [-21.84, -8.44]), and neoadjuvant treatment (-11.75 [-19.84, -3.65]). CONCLUSIONS This is the first study assessing the QoL in CRC patients in Pakistan. Depression was found to be significantly associated with poor QoL. Numerous factors correlated with low QoL scores indicating the need to develop local guidelines to address psychological distress in our patients.
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Affiliation(s)
| | - Fatima Shaukat
- Department of Radiation Oncology, Cyberknife and Tomotherpay Centre, Jinnah Post-Graduate Medical Center, Karachi, Pakistan.
| | | | - Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shumaila Arbani
- Department of Oncology, Ziauddin University Hospital, Karachi, Pakistan
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Aapro M, Fogli S, Morlion B, Danesi R. Opioid metabolism and drug-drug interaction in cancer. Oncologist 2024:oyae094. [PMID: 38780124 DOI: 10.1093/oncolo/oyae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
Concomitant use of multiple drugs in most patients with cancer may result in drug-drug interactions (DDIs), potentially causing serious adverse effects. These patients often experience unrelieved cancer-related pain (CRP) during and after cancer treatment, which can lead to a reduced quality of life. Opioids can be used as part of a multimodal pain management strategy when non-opioid analgesics are not providing adequate pain relief, not tolerated, or are contraindicated. However, due to their narrow therapeutic window, opioids are more susceptible to adverse events when a DDI occurs. Clinically relevant DDIs with opioids are usually pharmacokinetic, mainly occurring via metabolism by cytochrome P450 (CYP). This article aims to provide an overview of potential DDIs with opioids often used in the treatment of moderate-to-severe CRP and commonly used anticancer drugs such as chemotherapeutics, tyrosine kinase inhibitors (TKIs), or biologics. A DDI-checker tool was used to contextualize the tool-informed DDI assessment outcomes with clinical implications and practice. The findings were compared to observations from a literature search conducted in Embase and PubMed to identify clinical evidence for these potential DDIs. The limited results mainly included case studies and retrospective reviews. Some potential DDIs on the DDI-checker were aligned with literature findings, while others were contradictory. In conclusion, while DDI-checkers are useful tools in identifying potential DDIs, it is necessary to incorporate literature verification and comprehensive clinical assessment of the patient before implementing tool-informed decisions in clinical practice.
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Affiliation(s)
- Matti Aapro
- Genolier Cancer Centre, Clinique de Genolier, 1272 Genolier, Switzerland
| | - Stefano Fogli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa PI, Italy
| | - Bart Morlion
- Department of Cardiovascular Sciences, Section Anesthesiology and Algology, University of Leuven, 3000 Leuven, Belgium
| | - Romano Danesi
- Department of Oncology and Hemato-Oncology, University of Milano, 20122 Milano MI, Italy
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Gerhardt S, Benthien KS, Herling S, Leerhøy B, Jarlbaek L, Krarup PM. Associations between health-related quality of life and subsequent need for specialized palliative care and hospital utilization in patients with gastrointestinal cancer-a prospective single-center cohort study. Support Care Cancer 2024; 32:311. [PMID: 38683444 PMCID: PMC11058934 DOI: 10.1007/s00520-024-08509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND We lack knowledge of which factors are associated with the risk of developing complex palliative care needs. The aim of this study was to investigate the associations between patient-reported health-related quality of life and subsequent referral to specialized palliative care (SPC) and hospital utilization. METHODS This was a prospective single-center cohort study. Data on patient-reported outcomes were collected through the European Organization of Research and Treatment of Cancer Questionnaire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) at the time of diagnosis. Covariates and hospital utilization outcomes were collected from medical records. Adjusted logistic and Poisson regression were applied in the analyses. Participants were newly diagnosed with incurable gastrointestinal cancer and affiliated with a palliative care case management intervention established in a gastroenterology department. RESULTS Out of 397 patients with incurable gastrointestinal cancer, 170 were included in the study. Patients newly diagnosed with incurable gastrointestinal cancer experienced a substantial burden of symptoms. Pain was significantly associated with subsequent referral to SPC (OR 1.015; 95% CI 1.001-1.029). Patients with lower education levels (OR 0.210; 95% CI 0.056-0.778) and a Charlson Comorbidity Index score of 2 or more (OR 0.173; 95% CI 0.041-0.733) were less likely to be referred to SPC. Pain (IRR 1.011; 95% CI 1.005-1.018), constipation (IRR 1.009; 95% CI 1.004-1.015), and impaired overall quality of life (IRR 0.991; 95% CI 0.983-0.999) were significantly associated with increased risk of hospital admissions. CONCLUSION The study indicates a need for interventions in hospital departments to identify and manage the substantial symptom burden experienced by patients, provide palliative care, and ensure timely referral to SPC.
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Affiliation(s)
- Stine Gerhardt
- Digestive Disease Center, Copenhagen University Hospital - Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - Kirstine Skov Benthien
- Palliative Care Unit, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | - Suzanne Herling
- The Neuroscience Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Bonna Leerhøy
- Digestive Disease Center, Copenhagen University Hospital - Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Centre for Translational Research, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark
| | - Lene Jarlbaek
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | - Peter-Martin Krarup
- Digestive Disease Center, Copenhagen University Hospital - Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
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Bickel EA, Schellekens MPJ, Smink JG, Mul VEM, Ranchor AV, Fleer J, Schroevers MJ. Looking at individual symptoms: the dynamic network structure of depressive symptoms in cancer survivors and their preferences for psychological care. J Cancer Surviv 2024; 18:479-488. [PMID: 35976556 PMCID: PMC9382609 DOI: 10.1007/s11764-022-01246-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The majority of depressed cancer survivors do not receive psychological care, possibly because offered care does not align with their experiences and preferences. We examined (1) which depressive symptoms cancer survivors would like to receive psychological care for; (2) how distinct depressive symptoms are related to each other in the contemporaneous and temporal network of depressive symptoms; and (3) whether survivors' care needs correspond to the interconnectedness of these specific symptoms. METHOD Fifty-two cancer survivors suffering from at least mild depressive symptoms and were not receiving psychological care filled out a baseline questionnaire about their care needs for distinct depressive symptoms, followed by ecological momentary assessments (EMA) assessing depressive symptoms (14 days, five times a day). Multi-level vector autoregression analysis was used to estimate associations between distinct depressive symptoms as well as their centrality within the network. RESULTS Cancer survivors most strongly preferred to receive care for fatigue, feeling down, little enjoyment, and sleep problems. Fatigue, together with worry and lack of concentration, most strongly predicted the onset of other symptoms. Little enjoyment and feeling down were two of the most central symptoms (i.e., strongly connected to other symptoms) in the contemporaneous network and were most strongly influenced by other symptoms in the temporal network. CONCLUSIONS Clinicians can offer specific interventions that target fatigue, as these played an important role in the onset of symptoms and would align with survivors' needs. IMPLICATIONS FOR CANCER SURVIVORS Offering such symptom-specific care may increase the uptake of psychological interventions in cancer survivors.
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Affiliation(s)
- E A Bickel
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - M P J Schellekens
- Centre for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, De Bilt, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - J G Smink
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - V E M Mul
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - A V Ranchor
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Fleer
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M J Schroevers
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Csuka SI, Rohánszky M, Konkolÿ Thege B. Gender differences in the predictors of quality of life in patients with cancer: A cross sectional study. Eur J Oncol Nurs 2024; 68:102492. [PMID: 38134495 DOI: 10.1016/j.ejon.2023.102492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE The aim of the present study was to explore potential differences in the sociodemographic (with a special focus on gender differences) and psychological predictors of quality of life in individuals diagnosed with cancer. METHODS A cross-sectional, observational study was carried out involving individuals struggling with different forms of cancer (N = 430). Linear regression was used to investigate the concurrent predictive role of the independent variables, stratified by gender, for each of the five cancer-specific quality of life domains and overall quality of life. RESULTS Sociodemographic characteristics had only a negligible to small role in predicting quality of life in both men and women. In contrast, the psychological variables explained a significantly larger portion of the variance in both genders. There were no statistically significant gender differences regarding the raw quality of life domain scores; however, their predictors were markedly different in the two groups. CONCLUSION The results of the present study indicate that it is imperative to take gender differences into consideration when planning psychosocial interventions also focusing on strengths, resources, and coping strategies. Considering the consistently emerging importance of family support in patients' quality of life, offering psychological interventions to caregivers/family members seems warranted to empower them to provide support to patients throughout the illness trajectory.
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Affiliation(s)
- Sára Imola Csuka
- School of PhD Studies, Semmelweis University, Budapest, Hungary; Institute of Psychology, University of Szeged, Hungary.
| | - Magda Rohánszky
- Firebird Foundation for the Psychosocial Support of Cancer Patients, Budapest, Hungary; Department of Oncology, Szent László Hospital, Budapest, Hungary
| | - Barna Konkolÿ Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Minimally Invasive Bleb Surgery for Glaucoma: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2024; 24:1-151. [PMID: 38332948 PMCID: PMC10849035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Background Glaucoma is the term for a group of eye disorders that causes progressive damage to the optic nerve, which can lead to visual impairment and, potentially, irreversible blindness. Minimally invasive bleb surgery (MIBS) reduces eye pressure through the implantation of a device that creates a new subconjunctival outflow pathway for eye fluid drainage. MIBS is a less invasive alternative to conventional/incisional glaucoma surgery (e.g., trabeculectomy). We conducted a health technology assessment of MIBS for people with glaucoma, which included an evaluation of effectiveness, safety, the budget impact of publicly funding MIBS, and patient preferences and values. Methods We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias 1.0 tool for randomized controlled trials (RCTs) and the Risk of Bias Assessment tool for Nonrandomized Studies (RoBANS) for comparative observational studies, and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We conducted an economic literature search and we estimated the budget impact of publicly funding MIBS in Ontario. We did not conduct a primary economic evaluation due to the limited long-term effectiveness data. We summarized the preferences and values evidence from previous health technology assessments to understand the perspectives and experiences of patients with glaucoma. Results We included 41 studies (2 RCTs and 39 comparative observational studies) in the clinical evidence review. MIBS may reduce intraocular pressure and the number of medications used, but we are uncertain if MIBS results in outcomes similar to trabeculectomy (GRADE: Moderate to Very low). Compared with trabeculectomy, MIBS may result in fewer follow-up visits and interventions, and adverse events (GRADE: Moderate to Very Low). MIBS may also reduce intraocular pressure and the number of antiglaucoma medications used, compared with other glaucoma treatments, but the evidence is uncertain (GRADE: Very low). Our economic evidence review identified two directly applicable studies. The results of these studies indicate that the cost-effectiveness of MIBS is highly uncertain, and the cost of glaucoma interventions are likely to vary across provinces. The annual budget impact of publicly funding MIBS in Ontario ranged from $0.11 million in year 1 to $0.67 million in year 5, for a total 5-year budget impact estimate of $1.93 million. Preferences and values evidence suggests that fear of ultimate blindness and difficulty managing medication for glaucoma led patients to explore other treatment options such as MIBS. Glaucoma patients found minimally invasive glaucoma surgery (MIGS) procedure beneficial, with minimal side effects and recovery time. Conclusions Minimally invasive bleb surgery reduces intraocular eye pressure and the number of antiglaucoma medications needed, but we are uncertain if the outcomes are similar to trabeculectomy (GRADE: Moderate to Very low). However, MIBS may be safer than trabeculectomy (GRADE: Moderate to Very low) and result in fewer follow-ups (GRADE: Moderate to Very low). MIBS may also improve glaucoma symptoms compared with other glaucoma treatments, but the evidence is very uncertain (GRADE: Very low).We estimate that publicly funding MIBS would result in an additional cost of $1.93 million over 5 years. Patients who underwent MIGS procedures found them to be generally successful and beneficial, with minimal side effects and recovery time. We could not draw conclusions about specific MIBS procedures or long-term outcomes.
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Intrathecal Drug Delivery Systems for Cancer Pain: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2024; 24:1-162. [PMID: 38344326 PMCID: PMC10855886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Background Pain is a common and very distressing symptom for adults and children with cancer. Compared with other routes of delivery, infusing pain medication directly into the intrathecal space around the spinal cord may reduce the incidence of systemic side effects and allow for more rapid and effective pain relief. We conducted a health technology assessment of intrathecal drug delivery systems (IDDSs) for adults and children with cancer pain, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding IDDSs, patient preferences and values, and ethical considerations. Methods We performed a systematic literature search of the clinical evidence to retrieve systematic reviews, and we selected and reported results from 2 recent reviews that were relevant to our research questions. We complemented the chosen systematic reviews with a literature search to identify primary studies published after December 2020. We used the Risk of Bias in Systematic Reviews (ROBIS) tool to assess the risk of bias of each included systematic review. We assessed the quality of the body of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and conducted a cost-effectiveness analysis comparing IDDSs with standard care (i.e., non-IDDS methods of pain management) from a public payer perspective. We also analyzed the budget impact of publicly funding IDDSs in Ontario. To contextualize the potential value of IDDSs, we spoke with patients with cancer pain and with caregivers of patients with cancer pain. We explored ethical considerations from a review of published literature on the use of IDDSs for the management of cancer pain in adults and children as well as a review of the other components of this health technology assessment to identify ethical considerations relevant to the Ontario context. Results We included 2 systematic reviews (1 on adults and 1 on children) in the clinical evidence review. In adults with cancer pain who have a life expectancy greater than 6 months, intrathecal drug delivery was associated with a significant reduction in pain intensity compared with before implantation up to a 1-year follow-up (GRADE: Moderate to Low). Improved pain management appeared to be maintained beyond a 4-week follow-up. IDDSs likely decrease the use of systemic opioids (GRADE: Moderate to Low). They may also improve health-related quality of life (GRADE: Low), functional outcomes (GRADE: Low), and survival (GRADE: Low to Very low). In children with cancer pain, IDDSs may reduce pain intensity, improve functional outcomes, and improve survival, but the evidence is very uncertain (all GRADEs: Very low). IDDS implantation carries certain rare risks related to mechanical errors, drug-related side effects, and surgical complications. There are inherent limitations in conducting research in patients with refractory cancer pain; therefore, it is unlikely that higher-quality evidence will emerge in the next few years. Our primary economic evaluation found that IDDSs are more effective and more costly than standard care. The incremental cost-effectiveness ratio of IDDSs compared with standard care is $57,314 per quality-adjusted life-year (QALY) gained. The probability of IDDSs being cost-effective versus standard care is 43.46% at a willingness-to-pay of $50,000 per QALY gained and 72.54% at a willingness-to-pay of $100,000 per QALY gained. Publicly funding IDDSs in Ontario would cost an additional $0.27 million per year, for a total of $1.34 million over the next 5 years. The patients with cancer pain and caregivers with whom we spoke described the debilitating nature of cancer pain and the difficulty of finding effective pain management options. Patients with experience of an IDDS spoke of its effectiveness and its positive impact on their quality of life and mental health. Implementing IDDSs for patients with cancer pain raises several ethical and equity considerations related to the experiences and management of cancer pain, how limitations in evidence may entail uncertainties in clinical and health system decision-making, as well as clinical, geographic, and health system access barriers. Conclusions Intrathecal drug delivery likely reduces pain intensity and decreases the use of systemic opioids in adults with cancer pain who have a life expectancy greater than 6 months. It may also improve health-related quality of life, functional outcomes, and survival, although the evidence for survival is very uncertain. The clinical evidence in children with cancer pain is very uncertain. IDDS implantation is reasonably safe. Intrathecal drug delivery is more effective and more costly than standard care. We estimate that funding IDDSs in Ontario will result in additional costs of $0.27 million per year, for a total of $1.34 million over the next 5 years. Considerations related to funding and implementing IDDSs for patients with cancer pain in Ontario will require explicit and focused attention to considerations of equity and access in the diagnosis and management of cancer pain and in the use, clinical uptake, and delivery of IDDS pain management.
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Heyda A, Księżniak-Baran D, Wygoda A, Składowski K. Low Post-Treatment Quality of Life and the High Incidence of Pain Are Common and Significantly Exacerbated in Depressed Head and Neck Patients Treated with Definitive Accelerated Radiotherapy. Cancers (Basel) 2023; 16:79. [PMID: 38201507 PMCID: PMC10777976 DOI: 10.3390/cancers16010079] [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: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: The goal of this study is to evaluate psychological tolerance and health-related quality of life (QOL) in head and neck (HN) cancer patients treated with definitive accelerated radiotherapy (DART). (2) Methods: 76 recurrence-free patients eligible for the study, who were treated with DART in the CAIR-2 phase III clinical study (median of follow-up = 47 months), completed EORTC QLQ-C30 with the H&N35 module, Hospital Anxiety and Depression Scale (HADS) and Visual-Analog Scales (VAS) of pain in HN and the neck/arm areas. (3) Results: The most dominant symptoms measured with QLQ-C30 were as follows: fatigue (44/100), sleeplessness (39/100), financial problems (38/100) and pain (32/100). Within the H&N35, the highest scores were reported on the subscales of sticky saliva (60/100), mouth dryness (65/100) and increased intake of painkillers (50/100). Pain (VAS) was reported by 87% (HN area) and 78% (shoulder area) of the patients, with a mean score of 3/10. One-third of the patients reported depressive moods (HADS ≥ 15 points) with an average score of 12.5/42 p. The depressed group, who smoked more as compared to the non-depressed group before DART (96% vs. 78%) and required steroids treatment (85% vs. 58%) during DART, also scored significantly worse on 23 of the 35 subscales of QLQ-C30 and H&N35 and experienced more intense pain (VAS). Women and less-advanced patients scored better in several aspects of quality of life. (4) Conclusions: Patients treated with DART struggle with low quality of life and persistent treatment-related symptoms including constant pain. HNC survivors, especially those who are depressed, may require additional psychosocial, rehabilitation and medical intervention programmes.
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Affiliation(s)
- Alicja Heyda
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
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Wang Y, Tian L, Liu X, Zhang H, Tang Y, Zhang H, Nie W, Wang L. Multidimensional Predictors of Cancer-Related Fatigue Based on the Predisposing, Precipitating, and Perpetuating (3P) Model: A Systematic Review. Cancers (Basel) 2023; 15:5879. [PMID: 38136423 PMCID: PMC10741552 DOI: 10.3390/cancers15245879] [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: 09/11/2023] [Revised: 10/22/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Cancer-related fatigue (CRF) is a widespread symptom with high prevalence in cancer patients, seriously affecting their quality of life. In the context of precision care, constructing machine learning-based prediction models for early screening and assessment of CRF is beneficial to this situation. To further understand the predictors of CRF for model construction, we conducted a comprehensive search in PubMed, Web of Science, Embase, and Scopus databases, combining CRF with predictor-related terms. A total of 27 papers met the inclusion criteria. We evaluated the above studies into three subgroups following the predisposing, precipitating, and perpetuating (3P) factor model. (1) Predisposing factors-baseline fatigue, demographic characteristics, clinical characteristics, psychosocial traits and physical symptoms. (2) Precipitating factors-type and stage of chemotherapy, inflammatory factors, laboratory indicators and metabolic changes. (3) Perpetuating factors-a low level of physical activity and poorer nutritional status. Future research should prioritize large-scale prospective studies with emerging technologies to identify accurate predictors of CRF. The assessment and management of CRF should also focus on the above factors, especially the controllable precipitating factors, to improve the quality of life of cancer survivors.
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Affiliation(s)
- Yiming Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, China; (Y.W.); (L.T.)
| | - Lv Tian
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, China; (Y.W.); (L.T.)
| | - Xia Liu
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China; (X.L.); (Y.T.); (H.Z.)
| | - Hao Zhang
- Yanda Medical Research Institute, Hebei Yanda Hospital, Sanhe 065201, China;
| | - Yongchun Tang
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China; (X.L.); (Y.T.); (H.Z.)
| | - Hong Zhang
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China; (X.L.); (Y.T.); (H.Z.)
| | - Wenbo Nie
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, China; (Y.W.); (L.T.)
| | - Lisheng Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, China; (Y.W.); (L.T.)
- Yanda Medical Research Institute, Hebei Yanda Hospital, Sanhe 065201, China;
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Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
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Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
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12
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Calvert CM, Burgess D, Erickson D, Widome R, Jones-Webb R. Cancer pain and alcohol self-medication. J Cancer Surviv 2023; 17:1561-1570. [PMID: 35567710 DOI: 10.1007/s11764-022-01215-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cancer survivors are at increased risk of pain due to their either cancer and/or treatments. Substances like alcohol may be used to self-medicate cancer pain; however, these substances pose their own health risks that may be more pronounced for cancer survivors. METHODS We used cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) 2012-2019 to quantify the association between cancer pain and alcohol use. We used negative binomial regression, with interaction terms added to examine variations across age, sex, and race. We also examined whether alcohol use relates to cancer pain control status. RESULTS Cancer survivors with cancer pain were more likely to be younger, female, Black, and to have been diagnosed with breast cancer. Cancer pain was associated with lower alcohol consumption (incidence rate ratio (IRR): 0.88, confidence interval (CI): 0.77, 0.99). This association was primarily among people 65 and older, women, and white and Hispanic people. Cancer pain control status was not related to alcohol use. CONCLUSIONS Lower alcohol use among cancer survivors with pain has many possible explanations, including several alternative pain management strategies or a decrease in social engagement. Our findings of racial and gender disparities in cancer pain are consistent with the broader evidence on disparities in pain. IMPLICATIONS FOR CANCER SURVIVORS Cancer pain management for marginalized groups should be improved. Healthcare providers should screen cancer survivors for both pain and substance use, to prevent unhealthy self-medication behaviors.
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Affiliation(s)
- Collin M Calvert
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454-1015, USA.
| | - Diana Burgess
- Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Mail code: 152, Bldg. 9, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Darin Erickson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454-1015, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454-1015, USA
| | - Rhonda Jones-Webb
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454-1015, USA
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13
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Zahid N, Asad N, El-Metwally A. Editorial: Resilience, quality of life and psychosocial outcomes of cancer patients and their caregivers. Front Psychol 2023; 14:1324977. [PMID: 38022922 PMCID: PMC10679664 DOI: 10.3389/fpsyg.2023.1324977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | - Ashraf El-Metwally
- Department of Public Health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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14
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Hsieh YL, Chen HY, Lin CR, Wang CF. Efficacy of epidural analgesia for intractable cancer pain: A systematic review. Pain Pract 2023; 23:956-969. [PMID: 37455298 DOI: 10.1111/papr.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Epidural analgesia is a common technique for managing perioperative and obstetric pain. Patients with cancer who cannot tolerate opioids or not responding to conventional treatment may benefit from epidural analgesia. Therefore, this systematic review aimed to analyze the efficacy and safety of epidural analgesia in patients with intractable cancer pain. METHODS We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify studies on patients with cancer who received epidural analgesia. We assessed the quality of all included studies using the risk-of-bias tool or Newcastle-Ottawa scale. The primary outcome was pain relief after epidural analgesia, and the secondary outcome was quality of life, analgesic consumption, and adverse events. The studies were grouped based on the medications used for epidural analgesia. A descriptive synthesis was performed following the Synthesis Without Meta-analysis reporting guideline. RESULTS Our systematic review included nine randomized controlled trials (n = 340) and 15 observational studies (n = 926). Two randomized controlled trials suggested that epidural opioids were not superior to systemic opioids in relieving pain. Epidural opioids combined with local anesthetics or adjuvants, including calcitonin, clonidine, ketamine, neostigmine, methadone, and dexamethasone, offered better analgesic effects. No significant difference in pain relief between an intermittent bolus and a continuous infusion of epidural morphine was observed. Epidural opioids had more analgesic effects on nociceptive pain than neuropathic pain. The methods used to evaluate the quality of life and the corresponding results were heterogeneous among studies. Six observational studies demonstrated that some patients could have decreased opioid consumption after epidural analgesia. Adverse events, including complications and drug-related side effects, were reported in 23 studies. Five serious complications, such as epidural abscess and hematoma, required surgical management. The heterogeneity and methodological limitations of the studies hindered meta-analysis and evidence-level determination. CONCLUSION Coadministration of epidural opioids, local anesthetics, and adjuvants may provide better pain relief for intractable cancer pain. However, we must assess the patients to ensure that the benefits outweigh the risks before epidural analgesia. Therefore, further high-quality studies are required.
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Affiliation(s)
- Yu-Lien Hsieh
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Yu Chen
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ren Lin
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Fei Wang
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Košir U, van de Wal D, Husson O, Zablith N, Turcotte RE. Patient-physician agreement on function and pain is associated with long-term outcomes in sarcoma: findings from a longitudinal study. J Cancer Surviv 2023:10.1007/s11764-023-01473-3. [PMID: 37847463 DOI: 10.1007/s11764-023-01473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE We aimed to describe the level of agreement between patients and physicians on the ratings of daily functioning and pain in a cohort of sarcoma patients and assess how (dis)agreement and its change over time predicted patient-reported outcomes in survivorship. METHOD We performed secondary analysis of longitudinal data from a sarcoma-specialty clinic in Montreal, Canada. Demographics, clinical characteristics and patient-physician agreement were summarized descriptively. Linear mixed models were used to assess the effects of time, baseline agreement, change in agreement over time, interaction of time and change in agreement and 12-month daily functioning, quality of life, and fatigue. RESULTS Data were available for 806 patients (57.7% male, x̄ = 53.3 years) who completed at least one questionnaire. Patient-physician disagreement was common on the level of function (43.4%) and pain (45.7%). Baseline physician-patient agreement was associated with better 12-month outcomes. Improvement in agreement on function over time was significantly associated with daily functioning (F(2, 212) = 3.18, p = 0.043) and quality of life (F(2, 212) = 3.17, p < 0.044). The pattern was similar though less pronounced for the agreement on pain. CONCLUSIONS Our study offers novel insights into the importance of patient-physician agreement and communication's role in long-term patient-reported outcomes in sarcoma. IMPLICATIONS FOR CANCER SURVIVORS The results emphasize the importance of mutual understanding of symptoms and patients' needs and suggest that further consultation in cases of discordance of ratings and opinions might be beneficial for optimal survivorship.
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Affiliation(s)
- Urška Košir
- Division of Orthopedic Surgery, McGill University Health Centre (MUHC), Montreal, QC, Canada.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Deborah van de Wal
- Medical Oncology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olga Husson
- Medical Oncology Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nadine Zablith
- Division of Orthopedic Surgery, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Robert E Turcotte
- Division of Orthopedic Surgery, McGill University Health Centre (MUHC), Montreal, QC, Canada
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16
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Hiratsuka Y, Tagami K, Inoue A, Sato M, Matsuda Y, Kosugi K, Kubo E, Natsume M, Ishiki H, Arakawa S, Shimizu M, Yokomichi N, Chiu SW, Shimoda M, Hirayama H, Nishijima K, Ouchi K, Shimoi T, Shigeno T, Yamaguchi T, Miyashita M, Morita T, Satomi E. Prevalence of opioid-induced adverse events across opioids commonly used for analgesic treatment in Japan: a multicenter prospective longitudinal study. Support Care Cancer 2023; 31:632. [PMID: 37843639 PMCID: PMC10579154 DOI: 10.1007/s00520-023-08099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Although opioids have been shown to be effective for cancer pain, opioid-induced adverse events (AEs) are common. To date, little is known about the differences in risks of AEs by opioid type. This study was performed to compare the prevalence of AEs across opioids commonly used for analgesic treatment in Japan. METHODS This study was conducted as a preplanned secondary analysis of a multicenter prospective longitudinal study of inpatients with cancer pain who received specialized palliative care for cancer pain relief. We assessed daily AEs until termination of follow-up. We rated the severity of AEs based on the Common Terminology Criteria for Adverse Events version 5.0. We computed adjusted odds ratios for each AE (constipation, nausea and vomiting, delirium, and drowsiness) with the following variables: opioid, age, sex, renal dysfunction, and primary cancer site. RESULTS In total, 465 patients were analyzed. Based on the descriptive analysis, the top four most commonly used opioids were included in the analysis: oxycodone, hydromorphone, fentanyl, and tramadol. With respect to the prevalence of AEs among all analyzed patients, delirium (n = 25, 6.3%) was the most frequent, followed by drowsiness (n = 21, 5.3%), nausea and vomiting (n = 19, 4.8%), and constipation (n = 28, 4.6%). The multivariate logistic analysis showed that no single opioid was identified as a statistically significant independent predictor of any AE. CONCLUSION There was no significant difference in the prevalence of AEs among oxycodone, fentanyl, hydromorphone, and tramadol, which are commonly used for analgesic treatment in Japan.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mamiko Sato
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasufumi Matsuda
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Emi Kubo
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Maika Natsume
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Sayaka Arakawa
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Masaki Shimizu
- Department of Palliative Care, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shih-Wei Chiu
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mayu Shimoda
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideyuki Hirayama
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaoru Nishijima
- Department of Palliative Care, Kyowakai Medical Corporation, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Kota Ouchi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Shigeno
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- Research Association for Community Health, Hamamatsu, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
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17
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Roicke A, Esser P, Hornemann B, Ernst J. [Pain-related stigma in patients with breast, colon, prostate or lung cancer : Results of a bicentric register-based cross-sectional study]. Schmerz 2023:10.1007/s00482-023-00752-3. [PMID: 37710022 DOI: 10.1007/s00482-023-00752-3] [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: 06/21/2022] [Revised: 04/22/2023] [Accepted: 06/20/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Studies on cancer patients show a moderately high relevance of perceived stigmatization. However, no studies have explored the perceived stigmatization in relation to cancer-associated pain. In this work, we analysed the relationship between pain and perceived stigmatization across a large sample of four major cancer entities. METHODS Quantitative data of 858 patients (45.6% women, mean age 60.7 years) with breast, bowel, lung and prostate cancer were evaluated in a register-based, bicentric study. Perceived stigmatization was measured using the social impact cale (SIS-D), including a total score and four subscales. Pain was assessed with the brief pain inventory (BPI). The data were analysed using correlation und multiple regression with various sociodemographic and medical predictors. RESULTS Of all 858 cancer patients, those with lung and breast cancer were characterized by the greatest pain. The intensity of the pain was a predictor of the perceived stigma in patients with breast and colorectal cancer. In addition, younger age was also a predictor for perceived stigmatization. A good quality of life resulted as a protective factor. The final models showed a high goodness of the fit (corr. R2 > 0.35), except for the lung cancer patients. CONCLUSIONS Our findings support the assumption that the experience of pain can have an impact on the perceived stigmatization of cancer patients. Depression might influence the perceived stigmatization. Therefore, this group of patients should receive special attention and psycho-oncological care in clinical practice. Further research on the course and mechanisms of action of pain-related perceived stigmatization is also required.
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Affiliation(s)
- A Roicke
- Abteilung Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 55, Haus W, 04103, Leipzig, Deutschland.
| | - P Esser
- Abteilung Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 55, Haus W, 04103, Leipzig, Deutschland
| | - B Hornemann
- Universitäts KrebsCentrum (UCC), Psychoonkologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - J Ernst
- Abteilung Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 55, Haus W, 04103, Leipzig, Deutschland
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18
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Zahid N, Martins RS, Dawood ZS, Zahid W, Azam I, Ikram M, Hassan A, Bhamani SS, Asad N, Jabbar AA, Akhtar S, Siddiqui MI, Awan MS, Ahmad K. Clinical and psychosocial factors associated with quality of life in patients with head and neck cancer: an analytical cross-sectional study from a lower-middle-income country. BMC Psychol 2023; 11:265. [PMID: 37670380 PMCID: PMC10478451 DOI: 10.1186/s40359-023-01264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION The disease course of head and neck (H&N) cancer can severely impair patients' quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may impact QoL. We aimed to assess QoL and associated factors amongst patients with H&N cancer in Pakistan. METHODS An analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), anxiety and depression (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was performed for analysis. RESULTS A total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family members was associated with better global QoL (0.34). CONCLUSION The QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such the number of household family members. Given that poorer QoL is associated with worse mental health outcomes, there is a need to develop and implement psychosocial interventions to improve the QoL of patients with H&N cancer in Pakistan, particularly during active treatment.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, JFK University Medical Center, Hackensack Meridian Health, Edison, NJ, 08820, United States of America.
| | | | - Wajeeha Zahid
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Mubasher Ikram
- Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
| | - Aneesa Hassan
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Nargis Asad
- Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Shabbir Akhtar
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Khabir Ahmad
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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19
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Adams JL, Goble G, Johnson A. Multidisciplinary Approaches: Cingulotomy in an Adult With Refractory Neuropathic Cancer-Related Pain. J Palliat Med 2023; 26:1297-1301. [PMID: 37192484 DOI: 10.1089/jpm.2022.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Background: Oral medications, intravenous medications, and invasive interventions are effective means of neuropathic pain control. In patients with pain refractory to more conventional approaches, cingulum bundle ablation is an alternative treatment modality not routinely considered by providers. Case Description: A 42-year-old woman with history of cervical cancer in remission presented with intractable left lower extremity pain. Workup revealed radiation-induced left iliopsoas osteosarcoma complicated by deep venous occlusion and thrombosis. Her pain remained intractable to pharmacologic therapies and more invasive pain control interventions. A multidisciplinary decision was made to pursue bilateral subcortical cingulum bundle radiofrequency ablation. After a technically successful surgery, the patient exhibited improved pain control as evidenced by a decline in her numerical rating scale of pain and analgesic medication requirements. Conclusion: Cancer-related neuropathic pain often requires treatment with multiple modalities involving multidisciplinary teams. In select refractory cases, cingulum bundle ablation may be an effective alternative treatment modality.
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Affiliation(s)
- Jessica L Adams
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gretchen Goble
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy Johnson
- Department of Palliative Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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20
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Somers TJ, Winger JG, Fisher HM, Hyland KA, Davidian M, Laber EB, Miller SN, Kelleher SA, Vilardaga JCP, Majestic C, Shelby RA, Reed SD, Kimmick GG, Keefe FJ. Behavioral cancer pain intervention dosing: results of a Sequential Multiple Assignment Randomized Trial. Pain 2023; 164:1935-1941. [PMID: 37079854 PMCID: PMC10733867 DOI: 10.1097/j.pain.0000000000002915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/06/2023] [Indexed: 04/22/2023]
Abstract
ABSTRACT Behavioral pain management interventions are efficacious for reducing pain in patients with cancer. However, optimal dosing of behavioral pain interventions for pain reduction is unknown, and this hinders routine clinical use. A Sequential Multiple Assignment Randomized Trial (SMART) was used to evaluate whether varying doses of Pain Coping Skills Training (PCST) and response-based dose adaptation can improve pain management in women with breast cancer. Participants (N = 327) had stage I-IIIC breast cancer and a worst pain score of > 5/10. Pain severity (a priori primary outcome) was assessed before initial randomization (1:1 allocation) to PCST-Full (5 sessions) or PCST-Brief (1 session) and 5 to 8 weeks later. Responders ( > 30% pain reduction) were rerandomized to a maintenance dose or no dose and nonresponders (<30% pain reduction) to an increased or maintenance dose. Pain severity was assessed again 5 to 8 weeks later (assessment 3) and 6 months later (assessment 4). As hypothesized, PCST-Full resulted in greater mean percent pain reduction than PCST-Brief (M [SD] = -28.5% [39.6%] vs M [SD]= -14.8% [71.8%]; P = 0.041). At assessment 3 after second dosing, all intervention sequences evidenced pain reduction from assessment 1 with no differences between sequences. At assessment 4, all sequences evidenced pain reduction from assessment 1 with differences between sequences ( P = 0.027). Participants initially receiving PCST-Full had greater pain reduction at assessment 4 ( P = 0.056). Varying PCST doses led to pain reduction over time. Intervention sequences demonstrating the most durable decreases in pain reduction included PCST-Full. Pain Coping Skills Training with intervention adjustment based on response can produce sustainable pain reduction.
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Affiliation(s)
- Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Joseph G. Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Hannah M. Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Kelly A. Hyland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Marie Davidian
- Department of Statistics, North Carolina State University, Raleigh, NC
| | - Eric B. Laber
- Department of Statistical Sciences, Duke University, Durham, NC
| | - Shannon N. Miller
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Sarah A. Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - Catherine Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Rebecca A. Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Shelby D. Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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21
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Perceau-Chambard E, Roche S, Tricou C, Mercier C, Barbaret C, Davies A, Webber K, Filbet M, Serge Economos GP. Validation of a French version of the Breakthrough Pain Assessment Tool in cancer patients: Factorial structure, reliability and responsiveness. PLoS One 2023; 18:e0286947. [PMID: 37428747 DOI: 10.1371/journal.pone.0286947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/28/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE Breakthrough cancer pain should be properly assessed for better-personalized treatment plan. The Breakthrough Pain Assessment Tool is a 14-item tool validated in English developed for this purpose; no French version is currently available and validated. This study aimed to translate it in French and assess the psychometric properties of a French version of the Breakthrough Pain Assessment Tool (BAT-FR). METHODS First, translation and cross-cultural adaptation of the 14 items (9 ordinal and 5 nominal) of the original BAT tool in French language was made. Second, assessments of validity (convergent, divergent and discriminant validity), factorial structure (exploratory factor analysis) and test-retest reliability of the 9 ordinal items were done with data of 130 adult cancer patients suffering from breakthrough pain in a hospital-academic palliative care center. Test-retest reliability and responsiveness of total and dimension scores derived from these 9 items were also assessed. Acceptability of the 14 items was also assessed on the 130 patients. RESULTS The 14 items had good content and face validity. Convergent and divergent validity, discriminant validity and test-retest reliability of the ordinal items were acceptable. Test-retest reliability and responsiveness of total and dimensions derived from ordinal items were also acceptable. The factorial structure of the ordinal items had two dimensions similar to the original version: "1-pain severity and impact" and "2-pain duration and medication". Items 2 and 8 had a low contribution to the dimension 1 they were assigned and item 14 clearly changed of dimension compared with the original tool. The acceptability of the 14 items was good. CONCLUSION The BAT-FR has shown acceptable validity, reliability and responsiveness supporting its use for assessing breakthrough cancer pain in French-speaking populations. Its structure needs nevertheless further confirmation.
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Affiliation(s)
| | - Sylvain Roche
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
| | - Colombe Tricou
- Palliative Care Center, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Catherine Mercier
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
| | - Cécile Barbaret
- Palliative Care Unit, Centre Hospitalier Universitaire de Grenoble, La Tronche, France
| | | | | | - Marilène Filbet
- Palliative Care Center, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
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22
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Rolbiecki AJ, Craig K, Megan Polniak, Smith J, Ghosh P, Mehr DR. Virtual Reality and Neurofeedback for Management of Cancer Symptoms: A Feasibility Pilot. Am J Hosp Palliat Care 2023; 40:291-298. [PMID: 35723043 DOI: 10.1177/10499091221109900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evidence suggests the usefulness of complementary and alternative medicine approaches, like neurofeedback and virtual reality, for the management of cancer-related pain and mood. It is not well-understood whether neurofeedback delivered through virtual reality is feasible and acceptable to patients actively undergoing cancer treatment. Objective: The purpose of this study was to explore the feasibility and acceptability of a nature-based virtual reality combined with neurofeedback as a non-pharmacologic strategy for managing cancer-related pain and anxiety. Methods: This study utilized a mixed-methods approach. Participants included 15 cancer patients undergoing treatment. Patients engaged in a 22-minute nature-based virtual reality experience, wearing a virtual reality headset with a Brainlink headband measuring EEG activity. Participants were asked to complete the Edmonton Symptom Assessment System revised version (ESAS-r) before (T1) and after (T3) the experience to measure pain and anxiety. They were asked their level of pain midway through the experience (T2) and completed a follow-up interview afterward. Results: This study revealed feasible delivery of a virtual reality intervention combined with neurofeedback for patients seeking cancer treatment. All participants (100%) completed the intervention experience. Patients report this is an acceptable approach to managing cancer-related pain and anxiety. Comparisons between patients' pain scores at T1, T2, and T3 reveal statistically significant reductions in pain (p .001). Patients also report decreased depression and anxiety. Conclusion: This is the first study examining virtual reality combined with neurofeedback as a non-pharmacologic intervention for managing cancer symptoms during treatment. The study reveals it is a promising for managing cancer-symptoms.
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Affiliation(s)
- Abigail J Rolbiecki
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Kevin Craig
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Megan Polniak
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Jamie Smith
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Parijat Ghosh
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - David R Mehr
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
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23
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McCaffrey N, Cheah SL, Luckett T, Phillips JL, Agar M, Davidson PM, Boyle F, Shaw T, Currow DC, Lovell M. Treatment patterns and out-of-hospital healthcare resource utilisation by patients with advanced cancer living with pain: An analysis from the Stop Cancer PAIN trial. PLoS One 2023; 18:e0282465. [PMID: 36854021 PMCID: PMC9974128 DOI: 10.1371/journal.pone.0282465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND About 70% of patients with advanced cancer experience pain. Few studies have investigated the use of healthcare in this population and the relationship between pain intensity and costs. METHODS Adults with advanced cancer and scored worst pain ≥ 2/10 on a numeric rating scale (NRS) were recruited from 6 Australian oncology/palliative care outpatient services to the Stop Cancer PAIN trial (08/15-06/19). Out-of-hospital, publicly funded services, prescriptions and costs were estimated for the three months before pain screening. Descriptive statistics summarize the clinico-demographic variables, health services and costs, treatments and pain scores. Relationships with costs were explored using Spearman correlations, Mann-Whitney U and Kruskal-Wallis tests, and a gamma log-link generalized linear model. RESULTS Overall, 212 participants had median worst pain scores of five (inter-quartile range 4). The most frequently prescribed medications were opioids (60.1%) and peptic ulcer/gastro-oesophageal reflux disease (GORD) drugs (51.6%). The total average healthcare cost in the three months before the census date was A$6,742 (95% CI $5,637, $7,847), approximately $27,000 annually. Men had higher mean healthcare costs than women, adjusting for age, cancer type and pain levels (men $7,872, women $4,493, p<0.01) and higher expenditure on prescriptions (men $5,559, women $2,034, p<0.01). CONCLUSIONS In this population with pain and cancer, there was no clear relationship between healthcare costs and pain severity. These treatment patterns requiring further exploration including the prevalence of peptic ulcer/GORD drugs, and lipid lowering agents and the higher healthcare costs for men. TRIAL REGISTRATION ACTRN12615000064505. World Health Organisation unique trial number U1111-1164-4649. Registered 23 January 2015.
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Affiliation(s)
- Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood Campus, Burwood, VIC, Australia
- * E-mail:
| | - Seong Leang Cheah
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Tim Luckett
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Jane L. Phillips
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove Brisbane, Queensland
| | - Meera Agar
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Patricia M. Davidson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital North Sydney, and University of Sydney, Sydney, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - David C. Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Melanie Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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24
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Shrestha S, Blebil AQ, Teoh SL, Sapkota S, KC B, Paudyal V, Gan SH. Clinical pharmacists' intervention on pain management in cancer patients (PharmaCAP trial): study protocol for a randomized controlled trial. J Pharm Policy Pract 2023; 16:14. [PMID: 36694232 PMCID: PMC9875431 DOI: 10.1186/s40545-022-00505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/12/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Evidence-based services to support cancer patients with pain via clinical pharmacy services are currently lacking. Therefore, there is a need to undertake a randomized controlled trial (RCT) to explore the effectiveness of clinical pharmacists (CPs)' input into the multidisciplinary team (MDT) in providing better therapeutic outcomes for cancer pain management. OBJECTIVES The main aim of this pilot RCT is to determine the feasibility and preliminary efficacy of integrating CPs into the MDT for cancer pain management on the clinical outcomes of cancer patients experiencing pain. METHODS This study protocol outlines two-armed multicenter pilot RCT. Cancer patients suffering from pain will be randomly allocated to receive either clinical pharmacy services, i.e., PharmaCAP trial intervention from the CP, or the usual standard care (i.e., control group). Patients will be recruited consecutively from two hospitals in Kathmandu valley, Nepal. The outcomes will be assessed at baseline (pre-intervention) and 4 weeks post-intervention. The primary feasibility outcomes will include eligibility rate, recruitment rate, willingness to participate, acceptability of screening procedures and random allocation, possible contamination between the groups, intervention fidelity and compliance, treatment satisfaction, and patient understanding of the provided interventions. Subsequently, the primary clinical outcome, i.e., pain intensity of cancer patients, will be assessed. The secondary clinical outcomes will include health-related quality of life (HRQoL), anxiety, depression, adverse drug reactions, and patient medication compliance following the integration of CP into the healthcare team. DISCUSSION The feasibility and potential for integrating CP involvement in MDT to improve clinical outcomes of cancer patients with pain will be evaluated through the PharmaCAP trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05021393. Registered on 25th August 2022.
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Affiliation(s)
- Sunil Shrestha
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Ali Qais Blebil
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Siew Li Teoh
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Simit Sapkota
- Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal ,grid.459414.90000 0004 7535 1294Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal
| | - Bhuvan KC
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia ,grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia ,grid.1002.30000 0004 1936 7857Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Parkville Campus Parkville, Melbourne, VIC 3052 Australia
| | - Vibhu Paudyal
- grid.6572.60000 0004 1936 7486School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, B15 2TT UK
| | - Siew Hua Gan
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
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25
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Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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26
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Nakatani T, Shiosakai K, Hashimoto T, Shionoya M, Akasaka T, Toyama K, Ishizuka H, Saito Y. Steady-State Pharmacokinetics of Intravenous Hydromorphone in Japanese Patients with Renal Impairment and Cancer Pain. J Palliat Med 2022. [PMID: 36579915 DOI: 10.1089/jpm.2022.0289] [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: 12/30/2022] Open
Abstract
Background: The opioid analgesic hydromorphone has a low renal excretion ratio; however, exposure after oral administration is several times higher in those with moderate or severe renal impairment. Objectives: We evaluated the impact of renal impairment on the steady-state pharmacokinetics of intravenously administered hydromorphone in patients with cancer being treated for pain. Design: This was an open-label, prospective, parallel-comparison, interventional clinical pharmacology study. Setting/Subjects: This study was conducted at one hospital in Japan. Using creatinine clearance (CLcr) values, patients were grouped according to kidney function: CLcr ≥90 mL/min (normal), 60-<90 mL/min (mild impairment), 30-<60 mL/min (moderate impairment), or <30 mL/min (severe impairment). Measurements: Hydromorphone was administered by constant infusion to patients at the same constant dose rate as at the time of enrollment. Hydromorphone and its glucuronide metabolite concentrations in plasma and urine were measured by liquid chromatography-mass spectrometry. Pharmacokinetic parameters at steady state were assessed using noncompartmental analysis. Results: Thirty-two patients were enrolled (normal, n = 3; mild, n = 10; moderate, n = 15; and severe, n = 4). Adjusted geometric mean ratios for hydromorphone steady-state clearance (CLss) for patients with impaired versus normal renal function were 0.69 (90% confidence interval [CI], 0.41-1.14), 0.52 (90% CI, 0.31-0.84), and 0.55 (90% CI, 0.30-1.02) for mild, moderate, or severe impairment, respectively. Exposures to the metabolite hydromorphone-3-glucuronide generally increased with renal impairment. No adverse event was reported. Conclusion: Hydromorphone CLss in patients with impaired renal function (moderate and severe) was decreased ∼50% of that of normal renal function.
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Affiliation(s)
- Toshihiko Nakatani
- Department of Palliative Care, Shimane University Faculty of Medicine, Izumo, Japan
| | | | - Tatsuya Hashimoto
- Department of Anesthesiology, Palliative Care Center, Shimane University Hospital, Izumo, Japan
| | - Masao Shionoya
- Statistical Analysis Department, Mebix, Inc., Tokyo, Japan
| | - Takaaki Akasaka
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Kaoru Toyama
- Quantitative Clinical Pharmacology Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Hitoshi Ishizuka
- Quantitative Clinical Pharmacology Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Yoji Saito
- Department of Anesthesiology, Shimane University Faculty of Medicine, Izumo, Japan
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27
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Uehara Y, Matsumoto Y, Kosugi T, Sone M, Nakamura N, Mizushima A, Miyashita M, Morita T, Yamaguchi T, Satomi E. Availability of and factors related to interventional procedures for refractory pain in patients with cancer: a nationwide survey. Palliat Care 2022; 21:166. [PMID: 36154936 PMCID: PMC9511722 DOI: 10.1186/s12904-022-01056-6] [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: 08/16/2021] [Accepted: 09/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Cancer pain may be refractory to standard pharmacological treatment. Interventional procedures are important for quality of analgesia. The aim of the present study was to clarify the availability of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathecal analgesia), the number of procedures performed by specialists, and their associated factors. In addition, we aimed to establish how familiar home hospice physicians and oncologists are with the different interventional procedures available to manage cancer pain. Methods A cross-sectional survey using a self-administered questionnaire was conducted. Subjects were certified pain specialists, interventional radiologists, home hospice physicians, and clinical oncologists. Results The numbers of valid responses/mails were 545/1,112 for pain specialists, 554/1,087 for interventional radiology specialists, 144/308 for home hospice physicians, and 412/800 for oncologists. Among pain specialists, depending on intervention, 40.9-75.2% indicated that they perform each procedure by themselves, and 47.5-79.8% had not performed any of the procedures in the past 3 years. Pain specialists had performed the four procedures 4,591 times in the past 3 years. Among interventional radiology specialists, 18.1% indicated that they conduct celiac plexus neurolysis/splanchnic nerve neurolysis by themselves. Interventional radiology specialists had performed celiac plexus neurolysis/splanchnic nerve neurolysis 202 times in the past 3 years. Multivariate analysis revealed that the number of patients seen for cancer pain and the perceived difficulty in gaining experience correlated with the implementation of procedures among pain specialists. Among home hospice physicians and oncologists, depending on intervention, 3.5-27.1% responded that they were unfamiliar with each procedure. Conclusions Although pain specialists responded that the implementation of each intervention was possible, the actual number of the interventions used was limited. As interventional procedures are well known, it is important to take measures to ensure that pain specialists and interventional radiology physicians are sufficiently utilized to manage refractory cancer pain.
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Affiliation(s)
- Yuko Uehara
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan; 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. .,Department of Palliative Therapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Toshifumi Kosugi
- Department of Palliative Care, Saga-ken Medical Centre Koseikan, Saga, Japan; 400 Kasemachinakabaru, Saga, Saga, 840-8571, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology/Interventional Radiology Center, National Cancer Center Hospital, Tokyo, Japan; 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Naoki Nakamura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan; 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan; 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Morita
- Division of Supportive and Palliative Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan; 3453 Mikatahara-cho, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan; 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan; 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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28
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Bovero A, Digiovanni Y, Botto R, Leombruni P. End-of-life cancer patients' total pain: the necessity to supplement pharmacology with psycho-socio-spiritual treatments. Pain Manag 2022; 12:895-906. [PMID: 36065852 DOI: 10.2217/pmt-2022-0015] [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: 11/21/2022] Open
Abstract
Aim: To analyze pain considering its different bio-psycho-social-spiritual manifestations and to assess the effectiveness of the analgesic treatments in end-of-life cancer patients. Materials & methods: The study was cross-sectional. A total of 376 end-of-life cancer inpatients participated in the research. Their socio-demographic and clinical data were collected and, during the first psychological consultancy, they filled in a set of validated rating scales assessing pain, anxiety, depression and quality of life. Results: The results show that physical pain was well managed for almost all patients. Nevertheless, the majority showed clinically significant levels of psychological distress. Conclusion: Treating pain means caring for all its possible manifestations including psychological symptoms and reduced wellbeing. Thus, integrating pharmacological treatment with psycho-socio-spiritual interventions, in other words, psychological, social and spiritual support, could be effective and desirable.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, Hospital 'Città della Salute e della Scienza', Turin, Italy
| | - Ylenia Digiovanni
- Clinical Psychology Unit, Hospital 'Città della Salute e della Scienza', Turin, Italy
| | - Rossana Botto
- Clinical Psychology Unit, Hospital 'Città della Salute e della Scienza', Turin, Italy.,Department of Neuroscience, University of Turin, Turin, Italy
| | - Paolo Leombruni
- Clinical Psychology Unit, Hospital 'Città della Salute e della Scienza', Turin, Italy.,Department of Neuroscience, University of Turin, Turin, Italy
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29
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Wen FH, Chou WC, Chen JS, Chang WC, Hsu MH, Tang ST. Sufficient Death Preparedness Correlates to Better Mental Health, Quality of Life, and EOL Care. J Pain Symptom Manage 2022; 63:988-996. [PMID: 35192878 DOI: 10.1016/j.jpainsymman.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT Patients can prepare for end of life and their forthcoming death to enhance the quality of dying. OBJECTIVES We aimed to longitudinally evaluate the never-before-examined associations of cancer patients' death-preparedness states by conjoint cognitive prognostic awareness and emotional preparedness for death with psychological distress, quality of life (QOL), and end-of-life care received. METHODS In this cohort study, we simultaneously evaluated associations of four previously identified death-preparedness states (no-death-preparedness, cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) with anxiety symptoms, depressive symptoms, and QOL over 383 cancer patients' last six months and end-of-life care received in the last month using multivariate hierarchical linear modeling and logistic regression modeling, respectively. Minimal clinically important differences (MCIDs) have been established for anxiety- (1.3-1.8) and depressive- (1.5-1.7) symptom subscales (0-21 Likert scales). RESULTS Patients in the no-death-preparedness and cognitive-death-preparedness-only states reported increases in anxiety symptoms and depressive symptoms that exceed the MCIDs, and a decline in QOL from those in the sufficient-death-preparedness state. Patients in the emotional-death-preparedness-only state were more (OR [95% CI]=2.38 [1.14, 4.97]) and less (OR [95% CI]=0.38 [0.15, 0.94]) likely to receive chemotherapy/immunotherapy and hospice care, respectively, than those in the sufficient-death-preparedness state. Death-preparedness states were not associated with life-sustaining treatments received in the last month. CONCLUSION Conjoint cognitive and emotional preparedness for death is associated with cancer patients' lower psychological distress, better QOL, reduced anti-cancer therapy, and increased hospice-care utilization. Facilitating accurate prognostic awareness and emotional preparedness for death is justified when consistent with patient circumstances and preferences.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taiwan, China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; Chang Gung University College of Medicine, Taiwan, China
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Taiwan, China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan, China; School of Nursing, Chang Gung University, Taiwan, China; Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, China.
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30
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Dela Pena JC, Marshall VD, Smith MA. Impact of NCCN Guideline Adherence in Adult Cancer Pain on Length of Stay. J Pain Palliat Care Pharmacother 2022; 36:95-102. [PMID: 35652581 DOI: 10.1080/15360288.2022.2066746] [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: 10/18/2022]
Abstract
To improve the management of cancer related pain, the National Comprehensive Cancer Network (NCCN) publishes the Adult Cancer Pain guideline on an annual basis. However, a large majority of oncology patients still report inadequate pain control. Single-center, retrospective cohort study of adult patients admitted for uncontrolled pain or pain crisis between 3/1/19 and 06/30/20 were assigned to cohorts of either adherent or non-adherent to NCCN guideline recommendations for management of pain crises based on their initial opioid orders. Patients must have reported a pain score >/= 4 and received at least one dose of opioids within 24 hours upon admission. The length of stay (LOS), pain scores, and naloxone administration were compared between both groups. Patients in the adherent group had a shorter median LOS (3.7 days [range: 1 to 18.93] vs 5.4 days [range: 1.45 to 19.64 days], p = 0.04). Patients that received lower doses than recommended had longer LOS compared to adherent group (6.1 vs. 3.7 days; p = 0.009). When adjusted for confounders, this significance did not remain. The lowest reported pain score within 24 hours of admission was lower in the adherent group (median 3 vs 4, p = 0.04). Predictors of LOS included opioid tolerance and a pain or palliative care consult. Adherence to NCCN guidelines for acute pain crisis management in adult patients with cancer remains poor. Patients who received guideline adherent initial opioid regimens demonstrated a trend toward a shorter LOS. Opioid-tolerant patient outcomes remain inadequate; appropriate pain management for these patients need to improve.
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31
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Prevost V, Lefevre-Arbogast S, Leconte A, Delorme C, Benoit S, Tran T, Clarisse B. Shared meditation involving cancer patients, health professionals and third persons is relevant and improves well-being: IMPLIC pilot study. BMC Complement Med Ther 2022; 22:138. [PMID: 35585593 PMCID: PMC9116698 DOI: 10.1186/s12906-022-03599-w] [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: 09/08/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alleviating suffering and improving quality of life are universally shared goals. In this context, we implemented a pilot study to assess the feasibility and acceptability of a mindfulness intervention in the form of meditation involving together cancer patients, health professionals, and third persons. METHODS Two groups of 15 participants equally composed of patients, health professionals and third persons were constituted. A dedicated programme on mindfulness and compassion was constructed, including 12 weekly sessions of 1.5 h and a half-day retreat. Adherence and satisfaction with the programme were evaluated. All participants completed questionnaires on perceived stress, quality of life, mindfulness, empathy, and self-efficacy. Burnout was assessed in health professionals. RESULTS Shared meditation was feasible as 70% of participants attended ≥ 80% of the 13 meditation sessions. Satisfaction with the programme was high (median satisfaction score: 9.1 out of 10) and all participants expressed positive attitudes towards shared meditation and a benefit on their global quality of life. Participants reported significant improvement in stress (p < 0.001), global quality of life (p = 0.004), self-efficacy (p < 0.001), and mindfulness skills (p < 0.001) from baseline to post-programme. CONCLUSIONS This study demonstrated the feasibility of a shared dedicated meditation programme in terms of participation and acceptability of participants. The measured benefits observed among participants furthermore justify the interest of a subsequent randomized study aiming to demonstrate the potential added value of shared meditation by promoting bridge-building between cancer patients, health professionals and others. TRIAL REGISTRATION ClinicalTrials.gov. NCT04410185 . Registered on June 1, 2020.
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Affiliation(s)
- Virginie Prevost
- Normandie University, UNICAEN, INSERM U1086, ANTICIPE, 14000, Caen, France. .,Centre François Baclesse, 14000, Caen, France.
| | - Sophie Lefevre-Arbogast
- Normandie University, UNICAEN, INSERM U1086, ANTICIPE, 14000, Caen, France.,Centre François Baclesse, 14000, Caen, France.,National Clinical Research Platform for Quality of Life in Oncology, 162 rue Gabriel Péri, 94250, Gentilly, France
| | | | | | | | - Titi Tran
- Centre François Baclesse, 14000, Caen, France
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Katta MR, Valisekka SS, Agarwal P, Hameed M, Shivam S, Kaur J, Prasad S, Bethineedi LD, Lavu DV, Katamreddy Y. Non-pharmacological integrative therapies for chronic cancer pain. J Oncol Pharm Pract 2022; 28:1859-1868. [DOI: 10.1177/10781552221098437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Chronic pain is one of the most detrimental symptoms exhibited by cancer patients, being an indication for opioid therapy in up to half of the patients’ receiving chemotherapy and in 90% of advanced cases. Various successful non-pharmacological integrative therapy options have been explored and implemented to improve the quality of life in these patients. This review aims to highlight the mechanisms implicated; assessment tools used for cancer pain and summarize current evidence on non-pharmacological approaches in the treatment of chronic cancer pain. Data sources A review of the literature was conducted using a combination of MeSH keywords including “Chronic cancer pain,” “Assessment,” “Non-pharmacological management,” and “Integrative therapy.” Data summary Data on the approach and assessment of chronic cancer pain as well as non-pharmacological integrative options have been displayed with the help of figures and tables. Of note, non-pharmacological integrative management was divided into three subcategories; physical therapy (involving exercise, acupuncture, massage, and transcutaneous electric nerve stimulation), psychosocial therapy (e.g. mindful practices, supportive therapy), and herbal supplementation. Conclusions The use of non-pharmacological integrative therapy in the management of chronic cancer pain has been grossly underestimated and must be considered before or as an adjuvant of other treatment regimens to ensure appropriate care.
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Affiliation(s)
| | | | - Pahel Agarwal
- Bhaskar Medical College, Hyderabad, Telangana, India
| | - Maha Hameed
- AlFaisal University, College of Medicine, Riyadh, Kingdom of Saudi Arabia
| | - Swadha Shivam
- Bhaskar Medical College, Hyderabad, Telangana, India
| | | | - Sakshi Prasad
- Faculty of Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
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Implementing collaborative care for major depression in a cancer center: An observational study using mixed-methods. Gen Hosp Psychiatry 2022; 76:3-15. [PMID: 35305403 DOI: 10.1016/j.genhosppsych.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the implementation of a collaborative care (CC) screening and treatment program for major depression in people with cancer, found to be effective in clinical trials, into routine outpatient care of a cancer center. METHOD A mixed-methods observational study guided by the RE-AIM implementation framework using quantitative and qualitative data collected over five years. RESULTS Program set-up took three years and required more involvement of CC experts than anticipated. Barriers to implementation were uncertainty about whether oncology or psychiatry owned the program and the hospital's organizational complexity. Selecting and training CC team members was a major task. 90% (14,412/16,074) of patients participated in depression screening and 61% (136/224) of those offered treatment attended at least one session. Depression outcomes were similar to trial benchmarks (61%; 78/127 patients had a treatment response). After two years the program obtained long-term funding. Facilitators of implementation were strong trial evidence, effective integration into cancer care and ongoing clinical and managerial support. CONCLUSION A CC program for major depression, designed for the cancer setting, can be successfully implemented into routine care, but requires time, persistence and involvement of CC experts. Once operating it can be an effective and valued component of medical care.
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The burden of a brain tumor: guiding patient centric care in neuro-oncology. J Neurooncol 2022; 157:487-498. [PMID: 35394618 DOI: 10.1007/s11060-022-03993-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Brain tumor patients report an overwhelming sense of uncertainty when navigating the course of their terminal disease. Historically, organizational experts and/or treating physicians have established neuro-oncology programs. However, given the disease burden and incurable nature of current medical treatments, patient-centric care should be prioritized alongside institutional and academic objectives. Integrating patient perspectives into interdisciplinary programmatic development can improve comprehensive care and empower patients to advocate for their own quality healthcare needs. METHODS Data was derived from four focus groups with adult brain tumor patients (N = 15; Mage = 46 years, 53% female). A trained moderator led each 90-min group and posed semi-structured questions regarding patients' care needs throughout their neuro-oncological disease trajectory. Emphasis was placed on quality of life and psychological distress reduction for both patients and their loved ones. Common themes were identified via thematic content analysis using NVivo software. A high inter-rater reliability (Mkappa = 0.92, range= 0.85-0.93) was achieved. RESULTS Six distinct themes emerged, where the frequency of each theme ranged from 12.5 to 23.3%. Specifically, patients discussed relational concerns, navigation of interdisciplinary care, neurobehavioral impacts, emotional responses to stressors, existential concerns, and caregiver support. A discussion of themes follows. CONCLUSIONS It is imperative that we include the patient perspective in the development of neuro-oncology programs; considering the quality of survival in addition to quantity. Neuro-oncology quality care themes identified were relational concerns, navigating interdisciplinary care, neurobehavioral impact, emotional response to stressors, existential concerns, and caregiver support. A paramount concentration for comprehensive neuro-oncology programs must include patients' quality needs.
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Siconolfi D, Edelen MO, McMullen TL, Martino S, Ahluwalia SC, Chen EK, Dalton SE, Paddock S, Rodriguez A, Saliba D, Mandl S, Mota T. Standardized assessment of depression symptoms in post-acute care: A screening threshold approach. J Am Geriatr Soc 2022; 70:1023-1034. [PMID: 35235215 DOI: 10.1111/jgs.17646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/09/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression symptoms have impacts on quality of life, rehabilitation and treatment adherence, and resource utilization among patients in post-acute care (PAC) settings. The PHQ-2 and PHQ-9 are instruments for the assessment of depression, previously used in PAC settings, that have tradeoffs in terms of measurement depth versus respondent/assessor burden. Therefore, the present study tested a gateway version of the protocol (PHQ-2 to 9). METHODS In 143 PAC settings in 14 U.S. markets across 10 states from November 2017 to August 2018, facility and research nurses administered the PHQ-2 to communicative patients (n = 3010). Nurses administered the full PHQ-9 if the patient screened positive for either of the two cardinal symptoms assessed by the PHQ-2 (depressed mood and anhedonia). We assessed the prevalence and frequency of depression symptoms using the PHQ-2 to 9, associations between depression screening results and patient characteristics and clinical conditions, and feasibility indicators. RESULTS More than 1 in 4 patients (28%) screened positive on the PHQ-2. Only 6% of those completing the full PHQ-9 had a score indicating "minimal" severity. The average score (M = 11.9) met the threshold for moderate depression. Positive PHQ-2 screening was associated with age, female gender, disposition at discharge, septicemia/severe sepsis, and dependence for ADLs of toileting and lying to sitting mobility. Age was also associated with full PHQ-9 scores; patients ages 45-64 had the highest mean score. Length of stay was not associated with PHQ-2 screening results or full PHQ-2 to 9 scores. Missing data were minimal (<2.4%). The average time to complete was 2.3 min. Interrater reliability and percent agreement were excellent. CONCLUSIONS These findings suggest the feasibility of a gateway scoring approach to standardized assessment of depression symptoms among PAC patients, and that depression symptoms are relatively common among this inpatient population.
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Affiliation(s)
| | - Maria O Edelen
- RAND Corporation, Boston, Massachusetts, USA.,Patient Reported Outcomes Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tara L McMullen
- Pain Management, Opioid Safety, and PDMP Program Office, Veterans Health Administration, Washington, District of Columbia, USA
| | | | - Sangeeta C Ahluwalia
- RAND Corporation, Santa Monica, California, USA.,UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | | | - Susan Paddock
- NORC at the University of Chicago, Chicago, Illinois, USA
| | | | - Debra Saliba
- RAND Corporation, Santa Monica, California, USA.,UCLA Borun Center, Los Angeles, California, USA.,Los Angeles VA GRECC, Los Angeles, California, USA
| | - Stella Mandl
- Division of Health Care Financing, Office of Health Policy in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, District of Columbia, USA
| | - Teresa Mota
- Abt Associates, Cambridge, Massachusetts, USA
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Chambergo-Michilot D, Corcuera-Ciudad R, Runzer-Colmenares FM, Navarrete-Reyes AP, Parodi JF. Pain management, activities of daily living and the assessment of the WHOQOL-OLD module: results of a cross-sectional analysis of a cohort of older men with oncological diagnoses. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bickel EA, Fleer J, Ranchor A, Schroevers MJ. Are cancer patients with high depressive symptom levels able to manage these symptoms without professional care? The role of coping and social support. Psychooncology 2022; 31:1102-1109. [PMID: 35133052 PMCID: PMC9542510 DOI: 10.1002/pon.5896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
Abstract
Objective Around 25% of cancer patients experiences depressive symptoms. However, the majority does not receive formal psychological care because patients often prefer managing symptoms alone or with informal social support. Previous research has shown that adaptive coping and social support can indeed be effective in managing relatively mild depressive symptoms. However, higher depressive symptom levels rarely improve without psychological treatment. This longitudinal study examined how and to what extent coping and social support are related to reductions in depressive symptoms in cancer patients with moderate to severe depressive symptoms. Methods Respondents were diagnosed with cancer in the past five years, experienced high depressive symptom levels (PHQ‐9 ≥ 10) and were not receiving psychological care at baseline. We collected data with self‐report questionnaires (including PHQ‐9, brief COPE and Social Support List) at two assessments, taken three months apart. Results Although depressive symptoms decreased significantly between baseline and follow‐up, the average level at follow‐up was still moderate to severe. Patients using less avoidant coping, specifically less substance use, were more likely to report a reduction of depressive symptoms. We found no significant beneficial effects of approach coping and social support (coping) on the course of depressive symptoms. Conclusions A significant group of cancer patients with high levels of depressive symptoms do not seem able to effectively manage depressive symptoms by themselves, especially those more likely to avoid dealing with their symptoms. Cancer patients can be educated about avoidant coping and its possible detrimental effects, as well as being informed about possibilities of psychosocial services.
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Affiliation(s)
- E. A. Bickel
- University of Groningen University Medical Center Groningen Department of Health Psychology the Netherlands
| | - J. Fleer
- University of Groningen University Medical Center Groningen Department of Health Psychology the Netherlands
| | - A.V. Ranchor
- University of Groningen University Medical Center Groningen Department of Health Psychology the Netherlands
| | - M. J. Schroevers
- University of Groningen University Medical Center Groningen Department of Health Psychology the Netherlands
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Hino C, Ran-Castillo D, Akhtari M, Cao H, Silvestre J. Role of Ketamine and Opioid Rotation in the Management of Opioid Induced Hyperalgesia in a Patient With Acute Promyelocytic Leukemia. J Oncol Pharm Pract 2022:10781552221074285. [DOI: 10.1177/10781552221074285] [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]
Abstract
Introduction Opioid analgesics are commonly used to manage moderate to severe cancer related pain. However long-term use of opioids has been known to lead to several unintended side effects, including opioid induced hyperalgesia (OIH) which is defined as the paradoxical increase in pain sensitization to pain stimulus following opioid exposure. Currently there are limited reports on the association between patients with cancer and OIH, and this phenomenon is rarely described in patients with leukemia or lymphoma. Here we report a patient with acute promyelocytic leukemia who developed opioid induced hyperalgesia following rapid escalation of opioids. Case report A 36-year-old female being treated for acute promyelocytic leukemia presented with rapidly worsening acute on chronic hip pain requiring increasing opioid requriements. Given the rapid escalation of opioid dose with minimal response and physical exam findings consistent with allodynia/hyperalgesia a diagnosis of opioid induced hyperalgesia was made. Management and outcome Following recognition of opioid induced hyperalgesia, the patient was managed with opioid rotation and ketamine, which resulted in prompt alleviation of pain. Discussion Opioid induced hyperalgesia is likely an underrecognized phenomenon in patients with cancer-related pain. A high index of clinical suspicion are necessary for diagnosis and proper management of this disease entity.
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Affiliation(s)
- Christopher Hino
- Department of Internal Medicine, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Dan Ran-Castillo
- Department of Oncology/Hematology, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Mojtaba Akhtari
- Department of Oncology/Hematology, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Huynh Cao
- Department of Oncology/Hematology, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Julio Silvestre
- Department of Palliative care, Loma Linda University, Loma Linda, California, USA
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Wheeler JJ, Davis JM, Mishra SK. A Calcium Imaging Approach to Measure Functional Sensitivity of Neurons. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2022; 2413:97-106. [PMID: 35044658 DOI: 10.1007/978-1-0716-1896-7_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pain associated with chemotherapy and radiation therapy is one of the most common reasons for discontinuation of these treatments and has a dramatic effect on the quality of life in cancer patients. However, the mechanisms underlying chemotherapy and radiation therapy associated with pain are not well understood. Pain sensations are mediated through sensory neurons whose cell bodies are located in the dorsal root ganglia (DRG). Pain mediators activate these sensory neurons causing an influx of ions, including calcium. One common technique to study pain is to use primary cell culturing mouse DRG to study this calcium influx in vitro. This protocol details from an isolation to culture and maintenance of DRG neurons and functional recording using calcium imaging caused by either pain mediators or neuronal sensitization that are induced by drugs that are often used in the treatment of cancer.
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Affiliation(s)
- Joshua J Wheeler
- Department of Molecular Biomedical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA
| | - John M Davis
- Department of Psychology, University of Chicago, Chicago, IL, USA
| | - Santosh K Mishra
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA. .,Comparative Pain Research and Education Center, North Carolina State University, Raleigh, NC, USA.
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Park YJ, Lee MK. Effects of nurse-led nonpharmacological pain interventions for patients with cancer: A systematic review and meta-analysis. J Nurs Scholarsh 2021; 54:422-433. [PMID: 34847285 DOI: 10.1111/jnu.12750] [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: 08/04/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE The purposes of this study were to review the types of nurse-led nonpharmacological pain interventions (NPI) offered to cancer patients and/or family caregivers, and to determine a comprehensive and robust estimate of the effect size of nurse-led NPI for cancer patients on various pain-related outcomes. DESIGN Systematic review and meta-analysis. Studies assessing nurse-led NPIs targeting cancer patients and published between January 2008 and December 2020 were identified by searching multiple literature databases, including MEDLINE® , EMBASE, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL® . METHODS This review was conducted in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-analyses guidelines. The selected randomized clinical trials were independently assessed for methodological quality. The effect sizes (ESs) of treatment were presented as standardized mean differences (Hedges' g) and 95% confidence intervals (CIs). FINDINGS A meta-analysis was performed to analyze data from 22 randomized clinical trials. Three types of nurse-led NPI were offered, mainly to cancer patients but also to some caregivers: music, physical, and psycho-educational interventions. The dose and duration of nonpharmacological interventions varied widely. The study participants ranged in age from 44.1 to 67.3 years. Meta-analysis indicated that, although these interventions had small effects in long-term (g = 0.24, 95% CI: 0.06-0.43, p = 0.011) to medium effects in short-term (g = 0.43, 95% CI: 0.32-0.53, p < 0.001), they significantly reduced patients' pain, increased their knowledge of pain management, reduced barriers to pain management and pain coping, and improved other physical and emotional symptoms. The significance of the ES differed according to the type of intervention, with psycho-educational and physical NPIs having a significant but medium short-term ES, whereas music NPI had a significant but large short-term ES. Only psycho-educational NPIs had significant long-term effects. CONCLUSION The combined ES showed that these nurse-led NPIs were significantly effective in both the short and long-term. Types of intervention as a potential moderator were associated with short-term and long-term effects of nonpharmacological interventions on patient outcomes. CLINICAL RELEVANCE Research-tested interventions should be provided to help patients cope effectively with pain.
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Affiliation(s)
- Youn Jin Park
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea
| | - Myung Kyung Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea
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Depression Moderates Physical Functioning Over Time in Survivors of Cancer. REHABILITATION ONCOLOGY 2021; 39:E98-E105. [DOI: 10.1097/01.reo.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zahid N, Zahid W, Khalid W, Azam I, Ikram M, Hassan A, Iftikar H, Bhamani SS, Jabbar AA, Akhtar S, Siddiqui MI, Awan MS, Asad N, Ahmad K. Resilience and its associated factors in head and neck cancer patients in Pakistan: an analytical cross-sectional study. BMC Cancer 2021; 21:888. [PMID: 34344346 PMCID: PMC8330007 DOI: 10.1186/s12885-021-08624-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan. METHODS An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young's Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed by Enriched Social Support Instrument (ESSI). RESULTS The data was analyzed by linear regression modeling. Unadjusted and adjusted beta coefficients with 95% CI were reported. A total of 250 head and neck cancer patients were recruited, 79% of them were males. Mean age of the patients was 51.59 years with 93% having high social support and only 8% having severe depression and 3% having severe anxiety. After adjusting for the covariates in multivariable analysis resilience was associated with severe depression (- 17[- 20.98,-12.93]) or borderline depression (- 4[- 8.41,-0.39]), severe anxiety (- 11 [- 17.88,-4.18]), low social support (- 6[- 9.62,-1.71]), having family members of > 6 in the household (- 2[- 4.31,-0.29), smokeless tobacco users post- treatment (10[5.79, 14.45]), and those who underwent tracheotomy (- 4[- 7.67,-0.21]). There was a significant interaction between education and role in the family (decision maker). CONCLUSION In Pakistan, a South Asian LMIC, collectivist culture prevails, family ties are greatly promoted thus resilience and social support is highly prevalent in head and neck cancer patients resulting in lower prevalence of depression and anxiety. Our study highlights that higher resilience is prevalent among small families less than six members, as the welfare of the individual is prioritized over multiple needs of the family. Formal Education and role in household/decision making power are effect modifiers in our study, demonstrating its protective effect on the mental health of head and neck cancer patients. High resilience scores were reported among current smokeless tobacco users as compared to quitters post treatment. Resilience-building interventions should be formulated to aid head and neck cancer patients to cope with the disease and its sequel.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Wajeeha Zahid
- Department of Community Health Sciences, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Wardah Khalid
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Mubasher Ikram
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Aneesa Hassan
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Haissan Iftikar
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Shireen Shehzad Bhamani
- School of Nursing and Midwifery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Adnan Abdul Jabbar
- Department of Oncology, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Shabbir Akhtar
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | | | - Mohammad Sohail Awan
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Khabir Ahmad
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
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Yeager KA, Lee H, Bai J, Paul S, Johnson KB, Waldrop D. Congruence of pain perceptions between Black cancer patients and their family caregivers. Support Care Cancer 2021; 30:543-553. [PMID: 34338855 DOI: 10.1007/s00520-021-06448-7] [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: 04/05/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This cross-sectional study evaluated congruence in pain assessment among Black cancer patients taking opioids for pain and their family caregivers and the effects of patient-reported depressive symptoms and cognitive complaints on the congruence. METHODS Patient-reported pain scores (current, average, and worst pain severity and pain interference) and caregiver proxy scores were independently assessed (Brief Pain Inventory). Patient-reported depressive symptoms (Patient Health Questionnaire-8) and cognitive complaints (Cognitive Difficulties Scale) were also assessed. Paired t-test, intraclass correlation coefficient (ICC), and Bland-Altman (BA) plots were used to evaluate group and dyad level congruence in pain assessment. The influence of patient depressive symptoms and cognitive complaints on congruence was examined using bivariate analyses and BA plots. RESULTS Among 50 dyads, 62% of patients and 56% of caregivers were female. Patients were older than caregivers (57 vs. 50 years, p = .008). Neither statistically significant (t-test) nor clinically relevant mean differences in pain severity and interference were found at a group level. At the dyad level, congruence was poor in pain now (ICC = 0.343) and average pain severity (ICC = 0.435), but moderate in worst pain severity (ICC = 0.694) and pain interference (ICC = 0.603). Results indicated better congruence in pain severity between patients with depressive symptoms and their caregivers, compared to patients without depressive symptoms. Patient CDS scores had no significant correlations with score differences between patients and caregivers in any pain variables. CONCLUSION Congruence varied depending on how the analysis was done. More information is needed to understand pain assessment between patients and caregivers.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA. .,Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA.
| | - Haerim Lee
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA.,Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Room 228, 1520 Clifton Road, Atlanta, GA, 30322, USA
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Clinically significant symptoms prevalence in breast and colon cancers and leukemia patients: a comparison analysis of patient-reported outcomes. Support Care Cancer 2021; 30:439-446. [PMID: 34302547 DOI: 10.1007/s00520-021-06434-z] [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: 03/23/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the prevalence and severity of clinically significant symptoms (CSSs) for breast cancer, colon cancer, and leukemia patients undergoing chemotherapy. METHODS A retrospective review of the Edmonton Symptom Assessment System scores reported by patients from the database of our previous large-scale study, which was collected between May 2018 and January 2019. We described the prevalence of CSSs in proportion and severity in mean ± SD. RESULTS Of 546 cancer patients, 209 were breast cancer, 159 were colon cancer, and 178 were leukemia. The majority of participants were females 345 (63.2%), and the mean age of the entire study sample was 49.4 ± 13.93. Diminished feeling of well-being was the most prevalent CSS across the three cancers, with a statistically significant difference (p < 0.001). Fatigue (6.59 ± 2.07), pain (6.55 ± 2.01), and loss of appetite were the most distressing CSSs (6.49 ± 1.99) across the whole sample. Loss of appetite (6.34 ± 2.05) was the most distressing CSS in breast cancer, fatigue (6.97 ± 2.07) in leukemia, and pain (7.00 ± 2.11) in colon cancer. Statistically significant differences were found in the severity between the three cancer in pain (p < 0.001), fatigue (p = 0.010), nausea (p = 0.001), and diminished feeling of well-being (p = 0.033). Cancer type, sleeping hours, dependence on caregiver, female gender, level of education, and employment were significantly associated with higher odds of CSS severity. CONCLUSION Breast and colon cancer and leukemia patients undergoing chemotherapy experience multiple distressing CSSs. Our study validates CSSs as a discrete set of distressing symptoms that may serve and guide quality of care assessment and cancer clinical research, particularly among patients undergoing chemotherapy.
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Query mandates in prescription drug monitoring programs reduce opioid use among commercially insured patients with cancer. J Am Pharm Assoc (2003) 2021; 62:363-369. [PMID: 34246576 DOI: 10.1016/j.japh.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/29/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMPs) have been shown to reduce opioid use in the general and noncancer populations. However, evidence of PDMP impacts on patients with cancer remains limited. OBJECTIVE The aim of the study was to examine the impact of PDMP mandates on individual-level opioid use among patients with cancer. METHODS This is a retrospective cohort study of patients with newly diagnosed cancer aged 18-65 years in the IQVIA PharMetrics Plus database (IQVIA Inc; nationally representative data of the U.S. commercially insured population in 49 states) between 2013 and 2015. The primary exposure was PDMP rigor (ranked from highest to lowest rigor): provider query + registration, query only, registration only, and unexposed. The study outcomes included (1) prevalent use among all individuals; and among opioid users (2) total days supplied, (3) daily morphine equivalent dose (MED), and (4) cumulative MED. RESULTS Of the eligible cohort (n=28,353), 37.5% (10,656) received opioids after a cancer diagnosis. The individuals exposed to these mandates were as follows: query + registration: 3899 (13.8%); query only: 3459 (12.2%); registration only: 2764 (9.7%); and no mandates: 18,231 (64.3%). The PDMP mandates had no effect on prevalent opioid use. Compared with unexposed patients, those subject to query mandates-alone or with registration mandates-experienced 12 fewer opioid days supplied and a lower mean cumulative MED (-662 mg and -702 mg, respectively), P < 0.01. Registration-only mandates were associated with 21 days more (P < 0.01) total days supplied and lower daily MED (1.1 mg; P < 0.05) but had no statistically significant effect on cumulative MED (-46 mg, P > 0.05). CONCLUSION Query mandates are a stronger PDMP tool than registration mandates in reducing opioid days supplied and cumulative MED. Initiatives should target PDMP mandates toward intended patient groups to reduce high-risk opioid use without compromising adequate pain treatment.
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Durosier Mertilus DS, Lengacher CA, Rodriguez CS. A Review and Conceptual Analysis of Cancer Pain Self-Management. Pain Manag Nurs 2021; 23:168-173. [PMID: 34006496 DOI: 10.1016/j.pmn.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In this concept analysis article, we will clarify the concept "self-management of cancer pain" by identifying related antecedents, attributes, and consequences to further refine the conceptual and operational definitions of the concept. DESIGN A review was conducted. REVIEW/ANALYSIS METHODS The Walker and Avant method was used for this concept analysis. DATA SOURCES CINAHL, PubMed, and PsycInfo were searched systemically.A total of eight studies on "self-management of cancer pain or self-care of cancer pain" published between 2004 and 2019 were identified. RESULTS Attributes for self-management of cancer pain include self-efficacy, integration of methods for pain relief into daily life, decision-making related to pain management, process for solving pain-related issues, and initiation of interactions with healthcare professionals. Antecedents include knowledge regarding pain assessment and management, cognitive abilities, motivation, undergoing pain treatment, patient education and counseling, social support, and accountability from all parties involved. Consequences include pain control, improved quality of life, and increased opioid intake. CONCLUSIONS Self-management of cancer pain was reported to be a self-regulation process with the aim to encourage patients to use skills attained through development of self-efficacy, so they can actively participate in their pain management. This outcome may enhance their quality of life by decreasing their pain, depression, and anxiety and increasing the availability of social support.
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Interventional Therapies for Pain in Cancer Patients: a Narrative Review. Curr Pain Headache Rep 2021; 25:44. [PMID: 33961156 DOI: 10.1007/s11916-021-00963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Pain is a prevalent symptom in the lives of patients with cancer. In light of the ongoing opioid epidemic and increasing awareness of the potential for opioid abuse and addiction, clinicians are progressively turning to interventional therapies. This article reviews the interventional techniques available to mitigate the debilitating effects that untreated or poorly treated pain have in this population. RECENT FINDINGS A range of interventional therapies and technical approaches are available for the treatment of cancer-related pain. Many of the techniques described may offer effective analgesia with less systemic toxicity and dependency than first- and second-line oral and parenteral agents. Neuromodulatory techniques including dorsal root ganglion stimulation and peripheral nerve stimulation are increasingly finding roles in the management of oncologic pain. The goal of this pragmatic narrative review is to discuss interventional approaches to cancer-related pain and the potential of such therapies to improve the quality of life of cancer patients.
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Reflections of Healthcare Experiences of African Americans With Sickle Cell Disease or Cancer: A Qualitative Study. Cancer Nurs 2021; 44:E53-E61. [PMID: 31743153 DOI: 10.1097/ncc.0000000000000750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The experiences of African American adult patients before, during, and after acute care utilization are not well characterized for individuals with sickle cell disease (SCD) or cancer. OBJECTIVE To describe the experiences of African Americans with SCD or cancer before, during, and after hospitalization for pain control. METHODS We conducted a qualitative study among African American participants with SCD (n = 15; 11 male; mean age, 32.7 ± 10.9 years; mean pain intensity, 7.8 ± 2.6) or cancer (n = 15; 7 male; mean age, 53.7 ± 15.2 years; mean pain intensity, 4.9 ± 3.7). Participants completed demographic questions and pain intensity using PAINReportIt and responded to a 7-item open-ended interview, which was recorded and transcribed verbatim. We used content analysis to identify themes in the participants' responses. RESULTS Themes identified included reason for admission, hospital experiences, and discharge expectations. Pain was the primary reason for admission for participants with SCD (n = 15) and for most participants with cancer (n = 10). Participants of both groups indicated that they experienced delayed treatment and a lack of communication. Participants with SCD also reported accusations of drug-seeking behavior, perceived mistreatment, and feeling of not being heard or believed. Participants from both groups verbalized concerns about well-being after discharge and hopeful expectations. CONCLUSIONS Race-concordant participants with SCD but not with cancer communicated perceived bias from healthcare providers. IMPLICATIONS FOR PRACTICE Practice change interventions are needed to improve patient-provider interactions, reduce implicit bias, and increase mutual trust, as well as facilitate more effective pain control, especially for those who with SCD.
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Martins-Klein B, Bamonti PA, Owsiany M, Naik A, Moye J. Age differences in cancer-related stress, spontaneous emotion regulation, and emotional distress. Aging Ment Health 2021; 25:250-259. [PMID: 31851838 PMCID: PMC7299731 DOI: 10.1080/13607863.2019.1693972] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/10/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Cancer risk increases with age, cancer-related stress is common and devastating to mental health of patients, yet little work has explored age differences in cancer-related stress. This study investigated sources of stress related to cancer diagnosis and treatment and its association with age and emotional health. Though not an a priori aim of the study, adaptive strategies mentioned within discussions of stress-which we classify as spontaneous emotion regulation (ER) - were also investigated. METHOD Participants (N = 147, aged 27-88) recruited from the VA (98% male) with oral-digestive cancers participated in semi-structured interviews regarding sources of stress 6-months post-diagnosis (T1) and treatment-related stress at 12-months post-diagnosis (T2). Patients also reported their emotional distress at T2 via the PROMIS-29. Inductive content analysis was used to classify sources of stress and ER into semantic themes and relative frequencies. RESULTS The greatest source of stress at diagnosis was psychological; physical symptoms were the greatest source of stress at treatment. Older adults less frequently reported psychological uncertainty, social stress, and situational stress, whereas age groups reported similar rates of physical stress. When describing stress, older adults more often made spontaneous references to emotion regulation (ER). Across age groups, those who reported stress without ER in qualitative comments had higher emotional distress on the PROMIS-29 than those reporting stress with ER or no stress. CONCLUSION ER may be key to psychological adjustment to cancer, especially in later-life. implications for assessment of stress at pivotal visits and mental health referral are discussed.
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Affiliation(s)
- Bruna Martins-Klein
- Department of Psychological and Brain Sciences, University of Massachusetts-Amherst, Amherst, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Patricia A. Bamonti
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Montgomery Owsiany
- VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research, Education and Clinical Center, Boston, MA, USA
| | - Aanand Naik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Moye
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- New England Geriatric Research, Education and Clinical Center, Boston, MA, USA
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Kim H, Choi S, Kim S, Lee J, Kim SH, Lee I, Shin Y, Jang HY. The Knowledge, Attitudes, Performance, and Barriers of Nurses to Pain in Oncology Settings: A Multi-Center Study. ASIAN ONCOLOGY NURSING 2021. [DOI: 10.5388/aon.2021.21.1.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hyekyung Kim
- Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Soeun Choi
- Department of Nursing, Mokpo National University, Muan, Korea
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul, Korea
| | - Jiyeon Lee
- College of Nursing, Yonsei University, Seoul, Korea
| | - Sun-Hee Kim
- Seoul Women's College of Nursing, Seoul, Korea
| | - Insook Lee
- Department of Nursing, Changwon National University, Changwon, Korea
| | - Yoonjung Shin
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
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