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Li Y, Dong W, Tang H, Guo X, Wu S, Lu G, Li X, Chen C. Correlates of death anxiety for patients with cancer: A systematic review and meta-analysis. J Clin Nurs 2024; 33:1933-1947. [PMID: 38284499 DOI: 10.1111/jocn.17021] [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: 07/03/2023] [Revised: 11/24/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence. DESIGN This systematic review and meta-analysis followed the PRISMA 2020 guidelines. METHODS Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software. RESULTS In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs. CONCLUSIONS Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients. RELEVANCE TO CLINICAL PRACTICE Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals. NO PATIENT OR PUBLIC CONTRIBUTION This was a meta-analysis based on data from previous studies.
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Affiliation(s)
- Yuanyuan Li
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Wanglin Dong
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Haishan Tang
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Xiajun Guo
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Sijia Wu
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Guangli Lu
- Institute of Business Administration, School of Business, Henan University, Kaifeng, China
| | - Xia Li
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Chaoran Chen
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
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Jones KF, White G, Bennett A, Bulls H, Escott P, Orris S, Escott E, Fischer S, Hamm M, Krishnamurti T, Wong R, LeBlanc TW, Liebschutz J, Meghani S, Smith C, Temel J, Ritchie C, Merlin JS. Benefits, Harms, and Stakeholder Perspectives Regarding Opioid Therapy for Pain in Individuals With Metastatic Cancer: Protocol for a Descriptive Cohort Study. JMIR Res Protoc 2024; 13:e54953. [PMID: 38478905 PMCID: PMC10973954 DOI: 10.2196/54953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Opioids are a key component of pain management among patients with metastatic cancer pain. However, the evidence base available to guide opioid-related decision-making in individuals with advanced cancer is limited. Patients with advanced cancer or cancer that is unlikely to be cured frequently experience pain. Opioids are a key component of pain management among patients with metastatic cancer pain. Many individuals with advanced cancer are now living long enough to experience opioid-related harm. Emerging evidence from chronic noncancer pain literature suggests that longer-term opioid therapy may have limited benefits for pain and function, and opioid-related harms are also a major concern. However, whether these benefits and harms of opioids apply to patients with cancer-related pain is unknown. OBJECTIVE This manuscript outlines the protocol for the "Opioid Therapy for Pain in Individuals With Metastatic Cancer: The Benefits, Harms, and Stakeholder Perspectives (BEST) Study." The study aims to better understand opioid decision-making in patients with advanced cancer, along with opioid benefits and harms, through prospective examination of patients' pain experiences and opioid side effects and understanding the decision-making by patients, care partners, and clinicians. METHODS This is a multicenter, prospective cohort study that aims to enroll 630 patients with advanced cancer, 20 care partners, and 20 clinicians (670 total participants). Patient participants must have an advanced solid cancer diagnosis, defined by the American Cancer Society as cancer that is unlikely to be cured. We will recruit patient participants within 12 weeks after diagnosis so that we can understand opioid benefits, harms, and perspectives on opioid decision-making throughout the course of their advanced cancer (up to 2 years). We will also specifically elicit information regarding long-term opioid use (ie, opioids for ≥90 consecutive days) and exclude patients on long-term opioid therapy before an advanced cancer diagnosis. Lived-experience perspectives related to opioid use in those with advanced cancer will be captured by qualitative interviews with a subset of patients, clinicians, and care partners. Our data collection will be grounded in a behavioral decision research approach that will allow us to develop future interventions to inform opioid-related decision-making for patients with metastatic cancer. RESULTS Data collection began in October 2022 and is anticipated to end by November 2024. CONCLUSIONS Upon successful execution of our study protocol, we anticipate the development of a comprehensive evidence base on opioid therapy in individuals with advanced cancer guided by the behavioral decision research framework. The information gained from this study will be used to guide interventions to facilitate opioid decisions among patients, clinicians, and care partners. Given the limited evidence base about opioid therapy in people with cancer, we envision this study will have significant real-world implications for cancer-related pain management and opioid-related clinical decision-making. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54953.
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Affiliation(s)
- Katie Fitzgerald Jones
- New England Geriatrics Research, Education, and Clinical Center (GRECC), Jamaica Plain, MA, United States
| | | | - Antonia Bennett
- University of North Carolina, Chapel Hill, NC, United States
| | - Hailey Bulls
- University of Pittsburgh, Pittsburgh, PA, United States
| | - Paula Escott
- University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah Orris
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Megan Hamm
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Risa Wong
- University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | | | - Cardinale Smith
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer Temel
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
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Mercadante S, Ferrera P, Lo Cascio A, Casuccio A. Pain Catastrophizing in Cancer Patients. Cancers (Basel) 2024; 16:568. [PMID: 38339319 PMCID: PMC10854960 DOI: 10.3390/cancers16030568] [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: 12/11/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Pain catastrophizing is a group of negative irrational cognitions in the context of anticipated or actual pain. The aim of this study was to decipher the possible role of catastrophism on pain expression and outcomes after a comprehensive palliative care treatment. METHODS A consecutive sample of patients with uncontrolled pain was assessed. Demographic characteristics, symptom intensity included in the Edmonton symptom assessment system (ESAS), and opioid drugs used were recorded at admission (T0). The Pain Catastrophizing Scale (PCS) was measured for patients. Patients were also asked about their personalized symptom goal (PSG) for each symptom of ESAS. One week after a comprehensive palliative care treatment (T7), ESAS and opioid doses used were recorded again, and the number of patients who achieved their PSG (PSGR) were calculated. At the same interval (T7), Minimal Clinically Important Difference (MCID) was calculated using patient global impression (PGI). RESULTS Ninety-five patients were eligible. A significant decrease in symptom intensity was reported for all ESAS items. PGI was positive for all symptoms, with higher values for pain, poor well-being, and poor sleep. Only the rumination subscale of catastrophism was significantly associated with pain at T0 (B = 0.540; p = 0.034). CONCLUSIONS Catastrophism was not associated with the levels of pain intensity, PSG, PSGR, and PGI for pain, except the rumination subscale that was associated with pain intensity at T0. A comprehensive palliative care management provided the relevant changes in symptom burden, undoing the pain expression associated with rumination.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy (A.L.C.)
| | - Patrizia Ferrera
- Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy (A.L.C.)
| | - Alessio Lo Cascio
- Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy (A.L.C.)
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy;
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Diernberger K, Clausen E, Murray G, Wee B, Kaasa S, Hall P, Fallon M. Cancer pain assessment and management: does an institutional approach individualise and reduce cost of care? BMJ Support Palliat Care 2024; 13:e1258-e1264. [PMID: 37236649 PMCID: PMC10850828 DOI: 10.1136/spcare-2022-003547] [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: 01/19/2022] [Accepted: 01/13/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To understand individual prescribing and associated costs in patients managed with the Edinburgh Pain Assessment and management Tool (EPAT). METHODS The EPAT study was a two-arm parallel group cluster randomised (1:1) trial, including 19 UK cancer centres. Study outcome assessments, including pain levels, analgesia and non-pharmacological and anaesthetic interventions, collected at baseline, 3-5 days and, if applicable, 7-10 days after admission. Costs calculated for inpatient length of stay (LoS), medications and complex pain interventions. Analysis accounted for the clustered nature of the trial design. In this post-hoc analysis, healthcare utilisation and costs are presented descriptively. PARTICIPANTS 10 centres randomised to EPAT (487 patients) and 9 (449 patients) to usual care (UC). MAIN OUTCOME MEASURES Pharmacological and non-pharmacological management, complex pain interventions, length of hospital stay and costs related to these outcomes. RESULTS The mean per patient hospital cost was £3866 with EPAT and £4194 with UC, reflecting a mean LoS of 2.9 days and 3.1 days, respectively. Costs were lower for non-opioids, Non-steroidal anti-inflammatories (NSAIDs) and opioids but slightly higher for adjuvants with EPAT than with UC. The mean per-patient opioid costs were £17.90 (EPAT) and £25.80 (UC). Mean per patient costs of all medication were £36 (EPAT) and £40 (UC).Complex pain intervention costs were £117 with EPAT per patient and £90 with UC. Overall mean cost per patient was £4018.3 (95% CI 3698.9 to 4337.8) with EPAT and £4323.8 (95% CI 4060.0 to 4587.7) with UC. CONCLUSIONS EPAT facilitated personalised medicine and may result in less opioids, more specific treatments, improved pain outcomes and cost savings.
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Affiliation(s)
| | - Eleanor Clausen
- The International Spine Centre, Adelaide, South Australia, Australia
| | - Gordon Murray
- Public Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Bee Wee
- University of Oxford, Oxford, UK
| | - Stein Kaasa
- University of Oslo Faculty of Medicine, Oslo, Norway
| | - Peter Hall
- University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Marie Fallon
- Department of Palliative Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
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Jones KF, Malinowski J, Paice J, Childers J, Bulls HW, Morrison J, Ho JJ, Alsbrook K, Nugent S, Broglio K, Nickels K, Holbein M, Parajuli J, Merlin JS. Opioid-prescribing considerations in patients with cancer and substance misuse or substance use disorder: a scoping review protocol. JBI Evid Synth 2023; 21:812-825. [PMID: 36404752 PMCID: PMC10260276 DOI: 10.11124/jbies-22-00007] [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] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This scoping review aims to describe factors in the existing literature that may inform opioid-prescribing decisions for patients with a past or present history of cancer and past or present substance misuse or substance use disorder. INTRODUCTION Opioids and opioid-related decisions are critical components of cancer care. Most individuals with cancer will experience pain during cancer care, and over half of patients will receive an opioid prescription. Opioid-prescribing decisions require weighing the benefits and harms. The presence of substance misuse or substance use disorder may elevate the risk of opioid-related harms, but there is a lack of consensus on managing patients at this intersection. INCLUSION CRITERIA This review will consider studies that include adult patients with a past or present history of cancer who also have pain and current or historical substance misuse or substance use disorder. The pain may be cancer-related or non-cancer-related. Studies of patients with all types of cancer will be eligible for inclusion, with the exception of non-melanoma skin cancers. Eligible studies will explore factors that inform opioid-prescribing decisions in this patient population. METHODS The review will be conducted according to JBI methodology for scoping reviews. Studies written in English since database inception will be included. The databases to be searched include MEDLINE (Ovid), CINAHL (EBSCO), Embase, APA PsycINFO, and Google Scholar. Eligible studies will undergo data extraction by 2 independent reviewers using a data extraction tool created by the authors. A narrative summary will describe study characteristics, population details, and strategies used to determine appropriate pain management in the patient population.
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Affiliation(s)
| | | | - Judith Paice
- Division Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics and Palliative Research Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hailey W. Bulls
- Section of Palliative Care and Medical Ethics and Palliative Research Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeni Morrison
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - J. Janet Ho
- University of California San Francisco, San Francisco, CA, USA
| | - Karen Alsbrook
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shannon Nugent
- Division of Clinical Psychology, School of Medication at the VA Portland Healthcare System, Portland, ME, USA
| | | | - Katrina Nickels
- Department of Psychiatry, University of Kentucky, Lexington, KY, USA
| | - Monika Holbein
- Section of Hematology/Oncology, West Virginia University, Morgantown, WV, USA
| | | | - Jessica S. Merlin
- MBA Section of Palliative Care and Medical Ethics and Palliative Research Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Belayneh M, Fainsinger R, Nekolaichuk C, Muller V, Bouchard S, Downar J, Galloway L, Ghosh S, Hawley P, Herx L, Kmet A, Lawlor P. Edmonton Classification System for Cancer Pain: Comparison of Pain Classification Features and Pain Intensity across Diverse Palliative Care Settings in Canada. J Palliat Med 2023; 26:366-375. [PMID: 36282783 DOI: 10.1089/jpm.2022.0187] [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: 11/13/2022] Open
Abstract
Background: The goal of the Edmonton Classification System for Cancer Pain (ECS-CP) is to create an international classification system for cancer pain. Previous studies reinforce the need for standardized training to ensure consistency across assessors. There is no universally accepted classification for neuropathic pain. Objectives: Our primary objective was to describe the prevalence of ECS-CP features in a diverse sample of advanced cancer patients, using assessors with standardized training. The secondary objectives were to: (1) determine the prevalence of neuropathic pain using the Neuropathic Pain Special Interest Group (NeuPSIG) criteria and (2) examine the relationship between specific predictors: ECS-CP features, age, Palliative Performance Scale, Morphine Equivalent Daily Dose (MEDD), setting, and pain intensity; and neuropathic pain. Methods: A total of 1050 adult patients with advanced cancer were recruited from 11 Canadian sites. A clinician completed the ECS-CP and NeuPSIG criteria, and collected additional information including demographics and pain intensity (now). All assessors received standardized training. Results: Of 1050 evaluable patients, 910 (87%) had cancer pain: nociceptive (n = 626; 68.8%); neuropathic (n = 227; 24.9%); incident (n = 329; 36.2%); psychological distress (n = 209; 23%); addictive behavior (n = 51; 5.6%); and normal cognition (n = 639; 70.2%). The frequencies of ECS-CP features and pain intensity scores varied across sites and settings, with more acute settings having higher frequencies of complex pain features. The overall frequency of neuropathic pain was 24.9%, ranging from 11% (hospices) to 34.2% (palliative outpatient clinic) across settings. Multivariate logistic regression analysis revealed that age <60 years, MEDD ≥19 mg, pain intensity ≥7/10, and incident pain were significant independent predictors of neuropathic pain (p < 0.05). Conclusion: The ECS-CP was able to detect salient pain features across settings. Furthermore, the frequencies of neuropathic pain utilizing the NeuPSIG criteria fits within the lower-end of literature estimates (13%-40%). Further research is warranted to validate the NeuPSIG criteria in cancer pain.
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Affiliation(s)
- Mathieos Belayneh
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robin Fainsinger
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Viki Muller
- Covenant Health, Palliative Institute, Network of Excellence in Seniors' Health and Wellness (NESHW), Edmonton, Alberta, Canada
| | - Sylvie Bouchard
- Department of Oncology, Montreal Institute for Palliative Care/Teresa Dellar Palliative Care Residence, McGill University, Montreal, Québec, Canada
| | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lyle Galloway
- Division of Palliative Care, Departments of Oncology and Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Department of Oncology, Alberta Health Services-Cancer Care, University of Alberta, Edmonton, Alberta, Canada
| | - Pippa Hawley
- Division of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leonie Herx
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexander Kmet
- Division of Palliative Care, Department of Medicine, University of British Columbia, Whitehorse, Yukon, Canada
| | - Peter Lawlor
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Soqia J, Al-shafie M, Agha LY, Alameer MB, Alhomsi D, Saadoun R, Saifo M. Depression, anxiety and related factors among Syrian breast cancer patients: a cross-sectional study. BMC Psychiatry 2022; 22:796. [PMID: 36528568 PMCID: PMC9759902 DOI: 10.1186/s12888-022-04469-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Breast cancer represents a traumatic experience with a psychological burden. The prevalence of psychological distress (which include depression and anxiety) among breast cancer patients is estimated to be 15 to 54%, but studies have shown that applying some psychological treatments has contributed to decreasing depression and anxiety. So, it is crucial to diagnose and treat patients with the appropriate means. After reviewing the literature, no studies discussed depression and anxiety among Syrian breast cancer patients. METHODS A cross-sectional study in Al-Bairouni hospital in Damascus, Syria carried out using face-to-face interviews based on a structured questionnaire. All breast cancer patients were included, except who refused to participate, and responses with missing data were excluded. The questionnaire consisted of 2 sections: the first included Socio-demographic characteristics, and the other evaluated patients' depression using PHQ-2 and GAD-2 scales. Data were gathered using the Kobo toolbox app and then entered into an Excel sheet. RESULTS Five hundred patients were interviewed. 35.6% of the patients had a GAD-2 score greater than or equal to 3.00, while 35% had a PHQ-2 score greater than or equal to 3.00. There is a significant negative relationship between the age of the patient and the GAD-2 score and PHQ-2 score, which means the older the patient is, the lower the GAD-2 and PHQ-2 scores are. A multivariable regression model showed that younger (age ≤ 45 years) and being widowed were associated with being positive for further evaluation for generalized anxiety disorder. Similarly, patients younger than 45 are significantly associated with the need for further evaluation for major depressive disorder (MDD). Social status had a stronger association with the need for further assessment for MDD, with divorced women showing the strongest association, followed by widowed and married women compared to single women. CONCLUSION This study showed high anxiety and depression among breast cancer patients. The patient's age and social status were significant factors in determining the need for further psychological assessment. In General, Younger patients showed higher levels of depression and anxiety, the size of the tumor did not show significant association with psychological distress.
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Affiliation(s)
- Jameel Soqia
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Mohammed Al-shafie
- grid.8192.20000 0001 2353 3326Faculty of Medicine, Damascus University, Damascus, Syria
| | - Laila Yakoub Agha
- grid.8192.20000 0001 2353 3326Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mhd Basheer Alameer
- grid.8192.20000 0001 2353 3326Faculty of Medicine, Damascus University, Damascus, Syria
| | - Dima Alhomsi
- grid.8192.20000 0001 2353 3326Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rakan Saadoun
- grid.7700.00000 0001 2190 4373Medical Faculty Mannheim, Ruprecht Karls University Heidelberg, Mannheim, Germany ,Department of Otorhinolaryngology-Head and Neck Surgery, Mannheim Medical Center, Mannheim, Germany ,grid.412689.00000 0001 0650 7433 Department of Plastic Surgery, The University of Pittsburgh, Pittsburgh, USA
| | - Maher Saifo
- grid.8192.20000 0001 2353 3326Faculty of Medicine, Damascus University, Damascus, Syria
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Bulls HW, Hamm M, Wasilko R, de Abril Cameron F, Belin S, Goodin BR, Liebschutz JM, Wozniak A, Sabik LM, Merlin JS, Schenker Y. Manifestations of Opioid Stigma in Patients With Advanced Cancer: Perspectives From Patients and Their Support Providers. JCO Oncol Pract 2022; 18:e1594-e1602. [PMID: 35878073 PMCID: PMC9835931 DOI: 10.1200/op.22.00251] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Stigma surrounding prescription opioids, or opioid stigma, is increasingly recognized as a barrier to effective and guideline-concordant cancer pain management. Patients with advanced cancer report high rates of pain and prescription opioid exposure, yet little is known about how opioid stigma may manifest in this population. METHODS We conducted in-depth qualitative interviews with 20 patients with advanced cancer and 11 support providers between March 2020, and May 2021. We took a rigorous inductive, qualitative descriptive approach to characterize how opioid stigma manifests in the lives of patients with advanced cancer. RESULTS Patients and their support providers described three primary manifestations of opioid stigma: (1) direct experiences with opioid stigma and discrimination in health care settings (eg, negative, stigmatizing interactions in pharmacies or a pain clinic); (2) concerns about opioid stigma affecting patient care in the future, or anticipated stigma; and (3) opioid-restricting attitudes and behaviors that may reflect internalized stigma and fear of addiction (eg, feelings of guilt). CONCLUSION This qualitative study advances our understanding of opioid stigma manifestations in patients with advanced cancer, as well as coping strategies that patients may use to alleviate their unease (eg, minimizing prescription opioid use, changing clinicians, and distancing from perceptions of addiction). In recognition of the costs of undermanaged cancer pain, it is important to consider innovative treatment strategies to address opioid stigma and improve pain management for patients with advanced cancer. Future research should examine opportunities to build an effective, multilevel opioid stigma intervention targeting patients, clinicians, and health care systems.
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Affiliation(s)
- Hailey W. Bulls
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
- Challenges in Managing and Preventing Pain Clinical Research Center (CHAMPP), University of Pittsburgh, Pittsburgh, PA
| | - Megan Hamm
- Qualitative, Evaluation, and Stakeholder Engagement Services (QualEASE), Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Rachel Wasilko
- Qualitative, Evaluation, and Stakeholder Engagement Services (QualEASE), Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Flor de Abril Cameron
- Qualitative, Evaluation, and Stakeholder Engagement Services (QualEASE), Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Shane Belin
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Antoinette Wozniak
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lindsay M. Sabik
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
- Challenges in Managing and Preventing Pain Clinical Research Center (CHAMPP), University of Pittsburgh, Pittsburgh, PA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
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Shkodra M, Brunelli C, Zecca E, Infante G, Miceli R, Caputo M, Bracchi P, Lo Dico S, Kaasa S, Caraceni A. Cancer pain: Results of a prospective study on prognostic indicators of pain intensity including pain syndromes assessment. Palliat Med 2022; 36:1396-1407. [PMID: 36113091 PMCID: PMC9606010 DOI: 10.1177/02692163221122354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain is a prevalent symptom in patients with advanced cancer. Recognition of prognostic factors associated with pain intensity, could help provide better assessment, leading to better pain management. AIM identifying prognostic factors which could guide improvements on cancer pain classification. DESIGN a prospective observational study on chronic cancer pain, exploring the association between average mean pain intensity during a 28 days study follow-up and patients' clinical and pain-related characteristics, including pain syndromes. To evaluate these associations, a mixed model was built. SETTING/PARTICIPANTS Patients attending a Palliative Care and Pain Outpatient Clinic from May 2015 to June 2019 were screened. Patients with moderate to severe cancer pain who were already receiving or needed treatment with third step WHO ladder opioids were enrolled in the study. Data from 342 patients with at least one follow-up visit were analyzed. RESULTS Pain intensity decreased significantly for all patients during time (p < 0.001). Age, sex, emotional distress, pain duration and neuropathic pain presence evaluated by the Douleur Neuropathique 4 Questions (DN4) questionnaire were not significantly associated to pain intensity. Breakthrough/episodic pain was associated with higher pain intensity during follow-up (p < 0.001). The diagnosis of pain syndrome was overall significantly associated with mean pain intensity during follow-up (p = 0.016). Particularly, the concurrent presence of visceral and soft (p = 0.026) or soft and nervous tissue pain (p = 0.043) were significantly related to worse outcome, whereas pain due to only soft tissue damage with better outcome (p = 0.032). CONCLUSIONS The recognition of specific pain syndromes may help to better classify cancer pain.
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Affiliation(s)
- Morena Shkodra
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,University of Oslo, Oslo, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Gabriele Infante
- Clinical Epidemiology and Trial Organization Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Rosalba Miceli
- Clinical Epidemiology and Trial Organization Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mariangela Caputo
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paola Bracchi
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stein Kaasa
- University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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10
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Gomes-Ferraz CA, Rezende G, Fagundes AA, De Carlo MMRDP. Assessment of total pain in people in oncologic palliative care: integrative literature review. Palliat Care Soc Pract 2022; 16:26323524221125244. [PMID: 36172038 PMCID: PMC9511321 DOI: 10.1177/26323524221125244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
The promotion of comfort and quality of life of people with cancer in palliative care requires flawless evaluation and management of pain, understood in its multidimensionality and integrality. The objective of this study was to present an overview of the scientific production referring to evaluation of the pain and total pain of patients with advanced cancer in palliative care. The study involved an integrative literature review, searching the databases PubMed, Embase, Cinahl, Lilacs and Web of Science using the descriptors 'Total Pain', 'Cancer Pain', 'Pain', 'Symptom Assessment', 'Pain Measurement', 'Pain Evaluation', 'Neoplasms', 'Cancer', 'Tumor', 'Palliative Care', 'Hospice Care', and 'Terminal Care'. To select the studies, the authors used the reference manager Mendeley and the application Rayyan™, as well as blind and independent peer review. Twenty-two articles were selected, published between 2002 and 2020 in different countries, and classified into two thematic units: 'Physical, social, emotional, and spiritual factors related to pain in cancer' (N = 13) and 'Importance of the overall evaluation and multidisciplinary team in the management of pain' (N = 9). Advanced cancer is associated with high mortality, a decline in health status, the presence of pain, and complex psychosocial concerns. Pain and symptoms in patients in palliative care should be evaluated as a whole and controlled thorough the work of an interdisciplinary team. The qualitative synthesis of the results demonstrates that most of the evaluated studies have a mixed nature; there are significant methodological differences among them and a low level of evidence in studies relating to the subject of pain evaluation in palliative care.
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Affiliation(s)
- Cristiane Aparecida Gomes-Ferraz
- Curso de Terapia Ocupacional, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, Monte Alegre, CEP 14058-190 Ribeirão Preto, SP, BrazilNursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
| | - Gabriela Rezende
- Nursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
| | - Amanda Antunes Fagundes
- Nursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
| | - Marysia Mara Rodrigues do Prado De Carlo
- Curso de Terapia Ocupacional, Departamento de Ciências da Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, Monte Alegre, CEP 14058-190 Ribeirão Preto, SP, BrazilRibeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil Nursing School of Ribeirão Preto, University of São Paulo (EERP/USP), Ribeirão Preto, Brazil
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11
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Sabik LM, Eom KY, Sun Z, Merlin JS, Bulls HW, Moyo P, Pruskowski JA, van Londen G, Rosenzweig M, Schenker Y. Patterns and Trends in Receipt of Opioids Among Patients Receiving Treatment for Cancer in a Large Health System. J Natl Compr Canc Netw 2022; 20:460-467.e1. [PMID: 35231900 PMCID: PMC10463265 DOI: 10.6004/jnccn.2021.7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Given limited evidence on opioid prescribing among patients receiving treatment for cancer during the ongoing opioid epidemic, our objective was to assess predictors of and trends in opioid receipt during cancer treatment, including how patterns differ by type of cancer. METHODS Using cancer registry data, we identified patients with a first lifetime primary diagnosis of breast, colorectal, or lung cancer from 2013 to 2017 who underwent treatment within a large cancer center network. Cancer registry data were linked to electronic health record information on opioid prescriptions. We examined predictors of and trends in receipt of any opioid prescription within 12 months of cancer diagnosis. RESULTS The percentage of patients receiving opioids varied by cancer type: breast cancer, 35% (1,996/5,649); colorectal, 37% (776/2,083); lung, 47% (1,259/2,654). In multivariable analysis, opioid use in the year before cancer diagnosis was the factor most strongly associated with receipt of opioids after cancer diagnosis, with 4.90 (95% CI, 4.10-5.86), 5.09 (95% CI, 3.88-6.69), and 3.31 (95% CI, 2.68-4.10) higher odds for breast, colorectal, and lung cancers, respectively. We did not observe a consistent decline in opioid prescribing over time, and trends differed by cancer type. CONCLUSIONS Our findings suggest that prescription of opioids to patients with cancer varies by cancer type and other factors. In particular, patients are more likely to receive opioids after cancer diagnosis if they were previously exposed before diagnosis, suggesting that pain among patients with cancer may commonly include non-cancer-related pain. Heterogeneity and complexity among patients with cancer must be accounted for in developing policies and guidelines aimed at addressing pain management while minimizing the risk of opioid misuse.
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Affiliation(s)
- Lindsay M. Sabik
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management
| | - Kirsten Y. Eom
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management
| | - Zhaojun Sun
- University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management
| | - Jessica S. Merlin
- University of Pittsburgh School of Medicine, Palliative Research Center (PaRC) and Section of Palliative Care and Medical Ethics, Division of General Internal Medicine
| | - Hailey W. Bulls
- University of Pittsburgh School of Medicine, Palliative Research Center (PaRC) and Section of Palliative Care and Medical Ethics, Division of General Internal Medicine
| | - Patience Moyo
- Brown University School of Public Health, Department of Health Services, Policy, and Practice
| | | | - G.J. van Londen
- University of Pittsburgh School of Medicine, Department of Medicine, Divisions of Hematology-Oncology and Geriatric Medicine
| | - Margaret Rosenzweig
- University of Pittsburgh School of Nursing, Department of Acute & Tertiary Care
| | - Yael Schenker
- University of Pittsburgh School of Medicine, Palliative Research Center (PaRC) and Section of Palliative Care and Medical Ethics, Division of General Internal Medicine
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12
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Bulls HW, Chu E, Goodin BR, Liebschutz JM, Wozniak A, Schenker Y, Merlin JS. Framework for opioid stigma in cancer pain. Pain 2022; 163:e182-e189. [PMID: 34010940 PMCID: PMC8589872 DOI: 10.1097/j.pain.0000000000002343] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
ABSTRACT Millions of patients with cancer pain are treated with prescription opioids each year. However, efforts to mitigate the ongoing opioid crisis result in unintended consequences with opioid pain management, including opioid stigma. Emerging research indicates that opioid stigma is problematic in patients with cancer, but few studies have examined contributors to and impacts of opioid stigma in this population. To guide future research in this area, we propose a conceptual framework-the opioid stigma framework (OSF)-with which to understand and improve opioid stigma in patients with cancer pain. Development of the OSF was guided by a literature review of stigma in health-related conditions, adaptation of the existing Health Stigma and Discrimination Framework, a topical review of challenges related to opioid cancer pain management, and author expertise in cancer, pain, and opioid prescribing. The proposed OSF highlights 5 domains: (1) contributors to opioid stigma, or factors that increase the likelihood that a patient will experience opioid stigma; (2) intersecting stigmas, or the convergence of multiple stigmatized identities within a patient; (3) stigma manifestations, or the ways opioid stigma is manifested in patients, clinicians, and the community; (4) proximal outcomes, or the immediate consequences of opioid stigma in patients; and (5) long-term impacts in patients. The OSF provides 2 main avenues to facilitate future research: (1) providing a framework to explore the mechanisms that underlie opioid stigma and its impact on cancer pain management and (2) supporting the development of targeted, tailored interventions to eliminate opioid stigma.
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Affiliation(s)
- Hailey W. Bulls
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edward Chu
- Department of Medicine & Molecular Pharmacology, Albert
Einsten Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research
on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Antoinette Wozniak
- Division of Hematology/Oncology, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Chinese Version of the Psychological Inflexibility in Pain Scale for Cancer Patients Reporting Chronic Pain. Cancer Nurs 2021; 44:180-189. [PMID: 31651462 PMCID: PMC8061340 DOI: 10.1097/ncc.0000000000000772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Cancer-related chronic pain is reported by many patients during treatment. There are very few Chinese tools for measuring psychological inflexibility caused by cancer pain, particularly with regard to psychological processes that might influence pain severity and function disorder during cancer treatment. Objective To culturally adapt the Psychological Inflexibility in Pain Scale (PIPS) to Chinese cancer patients experiencing chronic pain, including the determination of psychometric properties of the translated PIPS. Methods This cross-sectional study included 2 phases: (1) translation and cultural adaptation and (2) determination of psychometric properties of the translated PIPS. In total, 389 cancer patients with several types of cancer experiencing chronic pain enrolled from May to September 2018 at a tertiary cancer hospital in Yuelu District of Hunan Province, China. Results The Chinese PIPS version was semantically equivalent to the original. It had a 2-factor structure with satisfactory content validity (content validity index = 0.78–1.00), convergent and discriminant validity (composite reliability and average variance extracted at 0.41–0.89, P < .001), criterion-related validity (r = 0.54 and 0.41, P < .001), Cronbach’s α coefficients (α = .87), and test-retest reliability (0.9 ≤ r ≤ 0.98). Conclusions The Chinese PIPS version has been culturally adapted and has strong psychometric properties. The scale is a psychometrically sound assessment of psychological inflexibility that can be used for future studies of pain and pain management for cancer patients. Implications for Practice The study provides a vital tool for the psychological management of cancer patients with chronic pain.
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14
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Huang D, Chervoneva I, Babinsky L, Hurwitz MD. Application of Forcing Functions to Electronic Health Records Is Associated With Improved Pain Control for Patients Undergoing Radiation Therapy for Bone Metastases. Am J Med Qual 2020; 35:479-485. [DOI: 10.1177/1062860619900791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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15
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Presley CJ, Canavan M, Wang SY, Feder SL, Kapo J, Saphire ML, Sheinfeld E, Kent EE, Davidoff AJ. Severe functional limitation due to pain & emotional distress and subsequent receipt of prescription medications among older adults with cancer. J Geriatr Oncol 2020; 11:960-968. [PMID: 32169548 DOI: 10.1016/j.jgo.2020.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Certain cancer types and subsequent treatment can cause or worsen pain and emotional distress, leading to functional limitation, particularly among a growing population of older adults with cancer. METHODS We constructed a national sample of older adult Medicare beneficiaries with cancer using the 2007-2012 Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D enrollment and prescription claims data. MHOS survey responses described functional limitations due to pain and emotional distress. Using multivariable logistic regression, we estimated the association between participant characteristics and patient-reported functional limitation due to pain and emotional distress and subsequent prescription medication use. RESULTS Among 9105 older adults with cancer, aged 66-102 years (y), 68.6% reported moderate to severe functional limitation due to pain, and 48.3% reported moderate to severe functional limitation due to emotional distress. Nearly 10% reported severe functional limitation due to co-occurring symptoms of pain and emotional distress. Significant predictors of severe functional limitation due to co-occurring symptoms included age ≥ 80y (ref: 66-69y, adjusted relative risk (aRR): 1.74; 95% confidence interval (CI) 1.39-2.18, p < .001), stage IV disease at diagnosis (ref: stage I, aRR: 2.08; CI 1.52-2.86, p < .001), and lung cancer (ref: breast cancer, aRR: 1.84; CI 1.30-2.61, p < .001). Among 892 participants reporting co-occurring symptoms, 32.5% received neither pain nor emotional distress prescription medication. CONCLUSIONS Functional limitation due to pain and emotional distress persist among older adults with cancer, particularly octogenarians. Efforts to identify and target unmet supportive care needs to maintain functional independence are needed.
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Affiliation(s)
- Carolyn J Presley
- The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, B424 Starling Loving Hall, 320 W. 10th Avenue, Columbus, OH 43214, USA.
| | - Maureen Canavan
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA; Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Shelli L Feder
- National Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Jennifer Kapo
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA
| | - Maureen L Saphire
- The Ohio State University Wexner Medical Center/The James Cancer Hospital, 410 W 10th Avenue, Columbus, OH 43210, USA
| | - Ella Sheinfeld
- Yale Fox Fellowship, 333 Cedar Street, New Haven, CT 06510, USA
| | - Erin E Kent
- National Cancer Institute, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA; Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
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16
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The Patient with Difficult Cancer Pain. Cancers (Basel) 2019; 11:cancers11040565. [PMID: 31010249 PMCID: PMC6521083 DOI: 10.3390/cancers11040565] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/17/2022] Open
Abstract
Most patients with cancer pain can be managed with relatively simple methods using oral analgesics at relatively low doses, even for prolonged periods of time. However, in some clinical conditions pain may be more difficult to manage. Various factors can interfere with a desirable and favorable analgesic response. Data from several studies assessing factors of negative pain prognosis have indicated that neuropathic pain, incident pain, psychological distress, opioid addiction, and baseline pain intensity were associated with more difficult pain control. In this narrative review, the main factors that make the therapeutic response to opioids difficult are examined.
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17
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Mercadante S, Adile C, Ferrera P, Cortegiani A, Casuccio A. Symptom hyper-expression in advanced cancer patients with anxiety and depression admitted to an acute supportive/palliative care unit. Support Care Cancer 2019; 27:3081-3088. [PMID: 30607679 DOI: 10.1007/s00520-018-4624-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to compare symptom expression in advanced cancer patients with depression and anxiety and in patients with no such symptoms. METHODS Secondary analysis of a previous study assessing the role of an acute palliative supportive care unit (APSCU) in a comprehensive cancer center. Patients completed the Edmonton Symptom Assessment System (ESAS) at admission (T0) and 7 days after or at discharge (T7). RESULTS Three hundred-fourteen consecutive cancer patients admitted to the APSCU were surveyed. Eighty-six and 66 patients improved their level of depression and anxiety, respectively (passing from ≥ 4 to 0-3, from T0 to T7), after that palliative care intervention resulted in a significant improvement of the other symptoms. Changes were statistically significant for both symptoms (P < 0.0005). Patients admitted for uncontrolled pain were more likely to be anxious, while patients admitted for other symptoms or end-of-life care were more likely to be depressed. The presence of anxiety and depression (≥ 4/10 on ESAS) was significantly associated with a higher level of symptom expression at admission and at T7 (P < 0.0005). In patients presenting both psychological symptoms, symptom expression was significantly more relevant in comparison with patients not reporting moderate-severe psychological symptoms. Pain and depression were independently associated with anxiety at T0. Variables independently associated with depression at T0 were drowsiness, appetite, and anxiety. CONCLUSIONS Psychological symptoms of ESAS concur to hyper-express some symptoms and make symptom control more difficult. A clear association between anxiety and depression exists.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief and Palliative/Supportive Care, Via san Lorenzo 312, 90145, Palermo, Italy. .,Department of Supportive Care & Rehabilitation, MD Anderson, Houston, TX, USA.
| | - Claudio Adile
- Main Regional Center for Pain Relief and Palliative/Supportive Care, Via san Lorenzo 312, 90145, Palermo, Italy
| | - Patrizia Ferrera
- Main Regional Center for Pain Relief and Palliative/Supportive Care, Via san Lorenzo 312, 90145, Palermo, Italy
| | - Andrea Cortegiani
- Department of Biopathology, Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico "P, Giaccone", University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother Child Care, University of Palermo, Palermo, Italy
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18
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Fainsinger RL, Nekolaichuk C, Muller V. Assessing and Classifying Cancer Pain: Can We Develop An Internationally Accepted Common Language? J Palliat Care 2018. [DOI: 10.1177/082585971403000406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robin L. Fainsinger
- Covenant Health Palliative Institute, 416 St. Marguerite Health Services Centre, 1090 Youville Drive West, Edmonton, Alberta, Canada T6L 0A3; and Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada; and Covenant Health Palliative Institute, Edmonton, Alberta, Canada; Covenant Health Palliative Institute, Edmonton, Alberta, Canada
| | - Viki Muller
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada; and Covenant Health Palliative Institute, Edmonton, Alberta, Canada; Covenant Health Palliative Institute, Edmonton, Alberta, Canada
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19
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Fallon M, Walker J, Colvin L, Rodriguez A, Murray G, Sharpe M. Pain Management in Cancer Center Inpatients: A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach-The Edinburgh Pain Assessment and Management Tool. J Clin Oncol 2018; 36:1284-1290. [PMID: 29543567 PMCID: PMC5929219 DOI: 10.1200/jco.2017.76.1825] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC. The primary outcome was change in the percentage of study participants in each center with a clinically significant (≥ 2 point) improvement in worst pain (using the Brief Pain Inventory Short Form) from admission to 3 to 5 days after admission. Secondary outcomes included quality of analgesic prescribing and opioid-related adverse effects. Results Ten centers were randomly assigned to EPAT, and nine were assigned to UC. We enrolled 1,921 patients and obtained outcome data from 93% (n = 1,795). Participants (mean age, 60 years; 49% women) had a variety of cancer types. For centers randomly assigned to EPAT, the percentage of participants with a clinically significant improvement in worst pain increased from 47.7% to 54.1%, and for those randomly assigned to continue UC, this percentage decreased from 50.6% to 46.4%. The absolute difference was 10.7% (95% CI, 0.2% to 21.1%; P = .046) and it increased to 15.4% (95% CI, 5.8% to 25.0%; P = .004) when two centers that failed to implement EPAT were excluded. EPAT centers had greater improvements in prescribing practice and in the Brief Pain Inventory Short Form pain subscale score. Other pain and distress outcomes and opioid adverse effects did not differ between EPAT and UC. Conclusion A systematic integrated approach improves pain outcomes for inpatients in cancer centers without increasing opioid adverse effects.
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Affiliation(s)
- Marie Fallon
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Jane Walker
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Lesley Colvin
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Aryelly Rodriguez
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Gordon Murray
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Michael Sharpe
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - for the Edinburgh Pain Assessment and Management Tool Study Group
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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20
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Lawlor PG, Lawlor NA, Reis-Pina P. The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1467211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Peter G Lawlor
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Niamh A Lawlor
- Ottawa Hospital Cancer Program, The Ottawa Hospital (NAL), Ottawa, Canada
| | - Paulo Reis-Pina
- Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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21
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Paice JA. Cancer pain management and the opioid crisis in America: How to preserve hard-earned gains in improving the quality of cancer pain management. Cancer 2018; 124:2491-2497. [PMID: 29499072 DOI: 10.1002/cncr.31303] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 11/10/2022]
Abstract
Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief. Oncologists and other professionals treating those with cancer pain will require new knowledge and tools to provide safe and effective pain control while preventing additional cases of substance use disorders (SUDs), helping patients in recovery to maintain sobriety, and guiding those not yet in recovery to seek treatment. How do these 2 serious epidemics intersect and affect oncology practice? First, oncology professionals will need to adopt practices to prevent SUDs by assessing risk and providing safe pain care. Second, oncology practices are likely to see an increased number of patients with a current or past SUD, including opioid misuse. Few guidelines exist for the direct management of pain when opioids may be indicated in these individuals. Third, modified prescribing practices along with the education of patients and families are warranted to prevent the exposure of these medications to unintended persons. Finally, advocacy on behalf of those with cancer pain is imperative to avoid losing access to essential therapies, including opioids, for those who might benefit. Cancer 2018;124:2491-7. © 2018 American Cancer Society.
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Affiliation(s)
- Judith A Paice
- Cancer Pain Program, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Patients with advanced cancer and depression report a significantly higher symptom burden than non-depressed patients. Palliat Support Care 2018; 17:143-149. [DOI: 10.1017/s1478951517001183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveClinical observations indicate that patients with advanced cancer and depression report higher symptom burden than nondepressed patients. This is rarely examined empirically. Study aim was to investigate the association between self-reported depression disorder (DD) and symptoms in patients with advanced cancer controlled for prognostic factors.MethodThe sample included 935 patients, mean age 62, 52% males, from an international multicentre observational study (European Palliative Care Research Collaborative – Computerised Symptom Assessment and Classification of Pain, Depression and Physical Function). DD was assessed by the Patient Health Questionnaire-9 and scored with Diagnostic and Statistical Manual of Mental Disorder-5 algorithm for major depressive disorder, excluding somatic symptoms. Symptom burden was assessed by summing scores on somatic Edmonton Symptom Assessment Scale (ESAS) symptoms, excluding depression, anxiety, and well-being. Item-by-item scores and symptom burden of those with and without DD were compared using nonparametric Mann-Whitney U tests. The relative importance of sociodemographic, medical, and prognostic factors and DD in predicting symptom burden was assessed by hierarchical, multiple regression analyses.ResultPatients with DD reported significantly higher scores on ESAS items and a twofold higher symptom burden compared with those without. Factors associated with higher symptom burden were as follows. Diagnosis: lung (β = 0.15, p < 0.001) or breast cancer (β = 0.08, p < 0.05); poorer prognosis: high C-reactive protein (β = 0.08, p < 0.05), lower Karnofsky Performance Status (β = −0.14, p < 0.001), and greater weight loss (β = −0.15, p < 0.001); taking opioids (β = 0.11, p < 0.01); and having DD (β = 0.23, p < 0.001). The full model explained 18% of the variance in symptom burden. DD explained 4.4% over and above that explained by all the other variables.Significance of resultsDepression in patients with advanced cancer is associated with higher symptom burden. These results encourage improved routines for identifying and treating those suffering from depression.
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Walker J, Wanat M, Fielding J, Martin P, Petit A, Burke K, Sharpe M. Screening Medical Patients for Depression: Lessons From a National Program in Cancer Clinics. PSYCHOSOMATICS 2017; 58:274-280. [PMID: 28336194 DOI: 10.1016/j.psym.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Screening has been recommended to improve the identification of depression in medical patients. There is, therefore, a need for useful practical information on how to successfully implement large-scale depression screening in medical clinics. OBJECTIVE To describe the practical lessons learned from our experience of implementing a large-scale depression screening program in cancer clinics throughout Scotland, UK. METHOD Reflective review based on the experience of the screening team and records of the iterative development of the program. FINDINGS Systematic screening for depression in patients with medical illnesses can be delivered in clinics as long as the program is well designed. Design issues include ensuring the engagement of staff and patients, implementing efficient 2-stage screening processes and effectively managing workflow and quality assurance. DISCUSSION Screening has the potential to offer a solution to the well-documented problem of missed depression and other psychiatric diagnoses, thereby improving patient care if closely linked to treatment provision.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Marta Wanat
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Josephine Fielding
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Paul Martin
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ariane Petit
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Katy Burke
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Michael Sharpe
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
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Morikawa M, Shirai Y, Ochiai R, Miyagawa K. Barriers to the Collaboration Between Hematologists and Palliative Care Teams on Relapse or Refractory Leukemia and Malignant Lymphoma Patients’ Care. Am J Hosp Palliat Care 2016; 33:977-984. [DOI: 10.1177/1049909115611081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Palliative care service (PCS) has been shown to be utilized less in patients with leukemia and malignant lymphoma than in those with solid tumors. Previous studies have suggested hematologists’ limited awareness of PCS as one of the reason for low PCS referral in hematology. However, little is known about such an awareness and potential barriers to collaboration between hematologists and PCS. Aim: The present study aimed to assess ematologists and palliative care specialists’ perception about the roles of the hospital-based palliative care team (HPCT) and the barriers to collaboration between hematologists and palliative care teams on relapse or refractory leukemia and malignant lymphoma patients’ care Materials and Methods: A qualitative study was conducted using semistructured interviews with hematologists and palliative care specialists recruited from a hospital that provides hematology and palliative care by the HPCT. Data were evaluated via content analysis. Results: The study included 11 hematologists and 10 palliative care specialists. Our results revealed that they shared many common perceptions about the roles and expectations of the HPCT. Additionally, 7 categories of barriers to collaboration were identified, including not feeling the need to refer, the difficulty in referral timing, the lack of aggressive approach, the negative image of the HPCT, the need for hematologic malignancy-oriented management, the lack of communication, and others. Conclusion: We have identified hematologists’ and palliative care specialists’ perceptions of the HPCT’s roles and the barriers to their collaboration. A better understanding of such barriers may lead to effective collaboration between hematologists and the HPCT.
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Affiliation(s)
- Miharu Morikawa
- The Jikei University Hospital, Tokyo, Japan
- Certified Nurse Specialist Course in Cancer Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Shirai
- School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Asoka Vihara Hospital, Kyoto, Japan
| | - Ryota Ochiai
- School of Medicine Nursing Course, Yokohama City University, Yokohama, Japan
| | - Kiyoshi Miyagawa
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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25
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van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage 2016; 51:1070-1090.e9. [PMID: 27112310 DOI: 10.1016/j.jpainsymman.2015.12.340] [Citation(s) in RCA: 956] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/10/2015] [Accepted: 12/23/2015] [Indexed: 12/17/2022]
Abstract
CONTEXT Cancer pain has a severe impact on quality of life and is associated with numerous psychosocial responses. Recent studies suggest that treatment of cancer pain has improved during the last decade. OBJECTIVES The aim of this review was to examine the present status of pain prevalence and pain severity in patients with cancer. METHODS A systematic search of the literature published between September 2005 and January 2014 was performed using the databases PubMed, Medline, Embase, CINAHL, and Cochrane. Articles in English or Dutch that reported on the prevalence of cancer pain in an adult population were included. Titles and abstracts were screened by two authors independently, after which full texts were evaluated and assessed on methodological quality. Study details and pain characteristics were extracted from the articles with adequate study quality. Prevalence rates were pooled with meta-analysis; meta-regression was performed to explore determinants of pain prevalence. RESULTS Of 4117 titles, 122 studies were selected for the meta-analyses on pain (117 studies, n = 63,533) and pain severity (52 studies, n = 32,261). Pain prevalence rates were 39.3% after curative treatment; 55.0% during anticancer treatment; and 66.4% in advanced, metastatic, or terminal disease. Moderate to severe pain (numerical rating scale score ≥5) was reported by 38.0% of all patients. CONCLUSION Despite increased attention on assessment and management, pain continues to be a prevalent symptom in patients with cancer. In the upcoming decade, we need to overcome barriers toward effective pain treatment and develop and implement interventions to optimally manage pain in patients with cancer.
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Affiliation(s)
- Marieke H J van den Beuken-van Everdingen
- Center of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Anesthesiology and Pain Management, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Laura M J Hochstenbach
- School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Health Services Research, Maastricht University (UM), Maastricht, The Netherlands
| | - Elbert A J Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; School of Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Medical Oncology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Daisy J A Janssen
- Center of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Research and Education, Center of Expertise for Chronic Organ Failure, CIRO+, Horn, The Netherlands
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26
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Porta-Sales J, Nabal-Vicuna M, Vallano A, Espinosa J, Planas-Domingo J, Verger-Fransoy E, Julià-Torras J, Serna J, Pascual-López A, Rodríguez D, Grimau I, Morlans G, Sala-Rovira C, Calsina-Berna A, Borras-Andrés JM, Gomez-Batiste X. Have We Improved Pain Control in Cancer Patients? A Multicenter Study of Ambulatory and Hospitalized Cancer Patients. J Palliat Med 2015. [DOI: 10.1089/jpm.2015.29002.jps] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Josep Porta-Sales
- Palliative Care Service, Catalan Institute of Oncology, Barcelona, Spain
| | - Maria Nabal-Vicuna
- Palliative Care Department, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Antonio Vallano
- Clinical Pharmacology Department, University Hospital Bellvitge, Spain
| | | | | | | | | | - Judith Serna
- Palliative Care Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Pascual-López
- Palliative Care Department, University Hospital de la Sta. Creu i St. Pau, Barcelona, Spain
| | - Dulce Rodríguez
- Palliative Care Department, University Hospital St. Joan, Reus, Spain
| | - Isidre Grimau
- Palliative Care Department, Parc Taulí Health Coorporation, Sabadell, Spain
| | - Germà Morlans
- Palliative Care Department, Hospital Asil de Granollers, Granollers, Spain
| | - Carme Sala-Rovira
- Palliative Care Department, Terrassa Health Consortium, Terrassa, Spain
| | | | | | - Xavier Gomez-Batiste
- WHO Collaborating Centre for Public Health Palliative Care Programmes, Barcelona, Spain
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Dhingra L, Chen J, Chu A. Epidemiology of Cancer and Noncancer Pain in Chinese American Oncology Outpatients. J Pain Symptom Manage 2015; 49:e7-8. [PMID: 25891667 DOI: 10.1016/j.jpainsymman.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Alice Chu
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA
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28
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Shao YJ, Ji K, Hao JL, Cheng XJ, Guan BQ, Liu WS, Wang K. Nonpain Symptom Prevalence and Intensity of Inpatients With Moderate to Severe Cancer Pain in China. Am J Hosp Palliat Care 2014; 33:448-55. [PMID: 25550408 DOI: 10.1177/1049909114565109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To identify prevalence and severity of nonpain symptoms and to clarify possible influences on each nonpain symptom. Methods: The study used a descriptive survey design. Chinese version of the Edmonton Symptom Assessment System was used. Patients’ demographic and pain characteristics were collected. Results: The most common symptoms reported were loss of appetite (94.3%) followed by insomnia (93.3%), and tiredness (91.6%). Prevalence rates of nonpain symptom were all above 70% except “thinking clearly.” Prevalence and severity of nonpain symptoms varied by gender, age, primary cancer, and pain characteristics, especially intensity, number of breakthrough pain episodes per day, and number of pain sites. Conclusions: Most inpatients with cancer pain experienced concurrent nonpain symptoms. Comprehensive symptom assessment and intervention managing multiple symptoms are essential for these inpatients.
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Affiliation(s)
- Yue-Juan Shao
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Kai Ji
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Jian-Lei Hao
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Xian-Jiang Cheng
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Bing-Qing Guan
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Wei-Shuai Liu
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Kun Wang
- Department of Pain Relief, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
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Walker J, Hansen CH, Martin P, Symeonides S, Ramessur R, Murray G, Sharpe M. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry 2014; 1:343-50. [PMID: 26360998 DOI: 10.1016/s2215-0366(14)70313-x] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Major depression is an important complication of cancer. However, reliable data are lacking for the prevalence of depression in patients with cancer in different primary sites, the association of depression with demographic and clinical variables within cancer groupings, and the proportion of depressed patients with cancer receiving potentially effective treatment for depression. We investigated these questions with data from a large representative clinical sample. METHODS We analysed data from patients with breast, lung, colorectal, genitourinary, or gynaecological cancer who had participated in routine screening for depression in cancer clinics in Scotland, UK between May 12, 2008, and Aug 24, 2011. Depression screening was done in two stages (first, Hospital Anxiety and Depression Scale; then, major depression section of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition). Data for depression status were linked with demographic and clinical data obtained from the Scottish National Cancer Registry. FINDINGS We analysed data for 21 151 patients. The prevalence of major depression was highest in patients with lung cancer (13·1%, 95% CI 11·9-14·2%), followed by gynaecological cancer (10·9%, 9·8-12·1), breast cancer (9·3%, 8·7-10·0), colorectal cancer (7·0%, 6·1-8·0), and genitourinary cancer (5·6%, 4·5-6·7). Within these cancer groupings, a diagnosis of major depression was more likely in patients who were younger, had worse social deprivation scores, and, for lung cancer and colorectal cancer, female patients. 1130 (73%) of 1538 patients with depression and complete patient-reported treatment data were not receiving potentially effective treatment. INTERPRETATION Major depression is common in patients attending cancer clinics and most goes untreated. A pressing need exists to improve the management of major depression for patients attending specialist cancer services. FUNDING Cancer Research UK and Chief Scientist Office of the Scottish Government.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
| | - Christian Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Martin
- Psychological Medicine Research, University of Edinburgh Department of Psychiatry, Edinburgh, UK
| | - Stefan Symeonides
- University of Edinburgh Cancer Research UK Centre, Western General Hospital, Edinburgh, UK
| | - Ravi Ramessur
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Gordon Murray
- University of Edinburgh Centre for Population Health Sciences, Edinburgh, UK
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
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Sharpe M, Walker J, Holm Hansen C, Martin P, Symeonides S, Gourley C, Wall L, Weller D, Murray G. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet 2014; 384:1099-108. [PMID: 25175478 DOI: 10.1016/s0140-6736(14)61231-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care. METHODS SMaRT Oncology-2 is a parallel-group, multicentre, randomised controlled effectiveness trial. We enrolled outpatients with major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with cancer intervention or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. Depression care for people with cancer is a manualised, multicomponent collaborative care treatment that is delivered systematically by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. Outcome data were collected up until 48 weeks. The primary outcome was treatment response (≥50% reduction in Symptom Checklist Depression Scale [SCL-20] score, range 0-4) at 24 weeks. Trial statisticians and data collection staff were masked to treatment allocation, but participants could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN40568538. FINDINGS 500 participants were enrolled between May 12, 2008, and May 13, 2011; 253 were randomly allocated to depression care for people with cancer and 247 to usual care. 143 (62%) of 231 participants in the depression care for people with cancer group and 40 (17%) of 231 in the usual care group responded to treatment: absolute difference 45% (95% CI 37-53), adjusted odds ratio 8·5 (95% CI 5·5-13·4), p<0·0001. Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05). During the study, 34 cancer-related deaths occurred (19 in the depression care for people with cancer group, 15 in the usual care group), one patient in the depression care for people with cancer group was admitted to a psychiatric ward, and one patient in this group attempted suicide. None of these events were judged to be related to the trial treatments or procedures. INTERPRETATION Our findings suggest that depression care for people with cancer is an effective treatment for major depression in patients with cancer. It offers a model for the treatment of depression comorbid with other medical conditions. FUNDING Cancer Research UK and Chief Scientist Office of the Scottish Government.
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Affiliation(s)
- Michael Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
| | - Jane Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Christian Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Martin
- Psychological Medicine Research, University of Edinburgh Department of Psychiatry, Edinburgh, UK
| | - Stefan Symeonides
- University of Edinburgh Cancer Research UK Centre, Western General Hospital, Edinburgh, UK
| | - Charlie Gourley
- University of Edinburgh Cancer Research UK Centre, Western General Hospital, Edinburgh, UK
| | - Lucy Wall
- University of Edinburgh Cancer Research UK Centre, Western General Hospital, Edinburgh, UK
| | - David Weller
- University of Edinburgh Centre for Population Health Sciences, Teviot Place, Edinburgh, UK
| | - Gordon Murray
- University of Edinburgh Centre for Population Health Sciences, Teviot Place, Edinburgh, UK
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Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. J Clin Oncol 2014; 32:1703-11. [PMID: 24799497 PMCID: PMC4031190 DOI: 10.1200/jco.2013.54.4825] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain.
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Affiliation(s)
- Karen L Syrjala
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC.
| | - Mark P Jensen
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - M Elena Mendoza
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Jean C Yi
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Hannah M Fisher
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Francis J Keefe
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
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32
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A cross-sectional study on prevalence of pain and breakthrough pain among an unselected group of outpatients in a tertiary cancer clinic. Support Care Cancer 2014; 22:1965-71. [DOI: 10.1007/s00520-014-2178-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
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Nekolaichuk CL, Fainsinger RL, Aass N, Hjermstad MJ, Knudsen AK, Klepstad P, Currow DC, Kaasa, for the European Palliative S. The Edmonton Classification System for Cancer Pain: Comparison of Pain Classification Features and Pain Intensity Across Diverse Palliative Care Settings in Eight Countries. J Palliat Med 2013; 16:516-23. [DOI: 10.1089/jpm.2012.0390] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cheryl L. Nekolaichuk
- Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robin L. Fainsinger
- Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nina Aass
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Marianne J. Hjermstad
- Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Pål Klepstad
- European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olav University Hospital, Trondheim, Norway
| | | | - Stein Kaasa, for the European Palliative
- European Palliative Care Research Centre (PRC), Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olav University Hospital, Trondheim, Norway
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Zimmermann C, Yuen D, Mischitelle A, Minden MD, Brandwein JM, Schimmer A, Gagliese L, Lo C, Rydall A, Rodin G. Symptom burden and supportive care in patients with acute leukemia. Leuk Res 2013; 37:731-6. [PMID: 23490030 DOI: 10.1016/j.leukres.2013.02.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/05/2013] [Accepted: 02/09/2013] [Indexed: 12/25/2022]
Abstract
We examined the symptoms and referral rates to specialized palliative care and psychosocial oncology services of patients with acute leukemia. The Memorial Symptom Assessment Scale (MSAS) was completed by 249 adult patients with acute leukemia. Patients reported a median of 9 physical and 2 psychological symptoms, and those with intense lack of energy, difficulty sleeping and pain were more likely to report intense worrying/sadness (P<0.001). No patients with moderate-severe pain were referred for specialized symptom control and only 13% of those with severe worrying/sadness were referred to psychiatry/psychology within one month of the assessment. Patients in this population have a substantial symptom burden; further research is needed to determine the benefit of early referral to specialized supportive care services.
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Affiliation(s)
- Camilla Zimmermann
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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