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Li K, Zhang S, Sun W, Zhang Y, Yu M, Zhang G, Yu W. Survival Outcomes Associated With the Size of Opioid Prescriptions in the Management of Chronic Pain Related to Advanced Nasopharyngeal Carcinoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221145093. [PMID: 36482685 DOI: 10.1177/01455613221145093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE Patients with advanced nasopharyngeal carcinoma (ANC) often experience chronic pain. Opioids are generally recommended to treat tumor-related pain, but increased opioid use may lead to detrimental aftereffects, particularly with respect to tumor progression, resulting in reduced quality of life and increased risk of death. Our objective was to investigate whether the high size of opioid prescriptions is associated with poor overall survival (OS) in patients with ANC. METHODS A consecutive cohort of patients with newly diagnosed ANC who underwent high or low opioid prescription size treatment during 2012-2019 was retrospectively identified from our medical institutions. Survival was estimated with the Kaplan-Meier method with a log-rank test. Multivariate binary logistic regression was used to assess the association between opioid use and OS, adjusting for age, sex, body mass index (BMI), Eastern Collaborative Oncology Group performance status (ECOG PS), and ANC histology. The criterion to distinguish between the high opioid prescription size group [HD] and the low opioid prescription size group [LD] was 5 mg of oral morphine equivalents (OME) per 24 hours. RESULTS The cohort consisted of 244 consecutive patients (HD: n = 120, median age = 66 years [range, 40-81 years]; LD: n = 124, median age = 65 years [40-82 years]. Patients who underwent treatment with a high opioid prescription size had a worse median OS than those who underwent treatment with a low opioid prescription size (5.1 vs 6.6 months), and the high opioid prescription size was associated with a remarkable 48% higher risk of death than the low opioid prescription size (HR 1.48, 95% CI 1.11-1.98; P = .005). The cumulative dose of opioids greater than or equal to 500 mg of OME was associated with a higher risk of death, adjusted for age, sex, BMI, ECOG PS, and ANC histology. CONCLUSIONS In patients with newly diagnosed ANC experiencing palliative care, a high opioid prescription size may be associated with shorter OS than a low opioid prescription size.
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Affiliation(s)
- Kunhong Li
- Department of Anesthesiology, Wuhan Fourth Hospital, Wuhan, China
| | - Shi Zhang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Jiefang Road, Wuchang District, Wuhan, Hubei, China
| | - Wei Sun
- Department of Anesthesiology, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, Wuhan, China
| | - Yaodong Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Minji Yu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Guangwei Zhang
- Department of Otolaryngology, Wuhan Fourth Hospital, Wuhan, China
| | - Weiguang Yu
- Department of Orthopedics, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
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The other side of the coin: Positive view on the role of opioids in cancer. Eur J Pharmacol 2022; 923:174888. [PMID: 35367422 DOI: 10.1016/j.ejphar.2022.174888] [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: 12/18/2021] [Revised: 02/26/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
Abstract
Opioids have been used for medicinal purposes as an analgesic and recreational purposes as a euphorigenic throughout human history. Cancer patients are often treated with different doses of opioids concurrently with anti-cancer drugs for pain relief without exhibiting excessive adverse effects. The intersection of the biology of pain, opioid therapy, and disease progression represents the crux of the matters and is of potentially great importance in cancer care. For more than 20 years, multiple investigations have focused on the stimulatory effects of opioids on cancer cell growth, while in-depth studies on the inhibitory effects on cancer cell growth development have usually been neglected. This paper reviews the evidence regarding opioid therapies and their anti-cancer effects on various malignancies. Likewise, we have a glimpse into the molecular mechanisms necessary for pinpointing their positive or negative impacts on malignancies to raise awareness and stimulate more excellent dialogue regarding their carcinogenic/anticarcinogenic roles.
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Impact of CDC warning on co-prescribing of opioids and benzodiazepines in older allogeneic hematopoietic cell transplant recipients. Bone Marrow Transplant 2022; 57:1079-1085. [DOI: 10.1038/s41409-022-01654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 11/08/2022]
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Ramirez MF, Gorur A, Cata JP. Opioids and cancer prognosis: A summary of the clinical evidence. Neurosci Lett 2021; 746:135661. [PMID: 33482308 DOI: 10.1016/j.neulet.2021.135661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 12/20/2022]
Abstract
Pain is a common and devastating symptom among cancer patients. It can be caused by the cancer itself or by certain therapies like surgery, radiation or chemotherapy. Opioids are the first line of treatment for moderate to severe cancer-related pain. Opioids alone or in combination with non-opioid analgesics and adjuvant medications are important components for pain management during the perioperative period for cancer patients. Opioids act on the μ-opioid receptor (MOR), which is expressed in cancer cells and non-malignant cells of the tumor microenvironment. Retrospective studies suggest an association between the expression of MOR in cancers and shorter survival. In addition, recent evidence suggests that opium use and prescription opioids can influence clinical oncological outcomes. In this review, we will summarize the clinical evidence regarding the effect of opioid administration and survival in patients with cancer as well as the current evidence involving MOR expression and cancer progression.
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Affiliation(s)
- Maria F Ramirez
- Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - A Gorur
- Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
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From Tramadol to Methadone: Opioids in the Treatment of Pain and Dyspnea in Pediatric Palliative Care. Clin J Pain 2020; 35:501-508. [PMID: 30985399 DOI: 10.1097/ajp.0000000000000704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND More than 15,000 children die annually in the United States due to an underlying life-limiting disease and the majority of those children experience distressing symptoms, which are not adequately relieved, such as pain and dyspnea. Multimodal analgesia, that is multiple agents, interventions, rehabilitation, psychological modalities, and integrative (nonpharmacologic) therapies, act synergistically for more effective pediatric pain and symptom control with fewer side effects than a single analgesic or modality. However, opioids, such as morphine, fentanyl, hydromorphone, oxycodone, and methadone (in the United Kingdom: diamorphine) remain the mainstay medication to effectively treat pain and dyspnea in children with serious illness. METHODS This article reviews commonly used opioids in Pediatric Palliative Care, which a special emphasis on 2 potentially particularly effective multimechanistic opioids: tramadol and methadone. RESULTS Methadone, due to its multimechanistic action profile, is possibly among the most effective and most underutilized opioid analgesics in children with severe unrelieved pain at end of life. However, methadone should not be prescribed by those unfamiliar with its use: Its effects should be closely monitored for several days, particularly when it is first started and after any dose changes. CONCLUSIONS Tramadol appears to play a key role in treating episodes of inconsolability in children with progressive neurologic, metabolic, or chromosomally based condition with impairment of the central nervous system. However, the recent 2017 United States Food and Drug Administration (FDA) warning against pediatric use of tramadol does not seem to be based on clinical evidence, and therefore puts children at risk for unrelieved pain or increased respiratory depression.
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Kawaguchi J, Hamatani Y, Hirayama A, Nishimura K, Nakai E, Nakamura E, Miyata M, Kawano Y, Takada Y, Anchi Y, Funabashi S, Kuroda K, Azechi M, Takahama H, Anzai T, Yasuda S, Kitaoka H, Izumi C. Experience of morphine therapy for refractory dyspnea as palliative care in advanced heart failure patients. J Cardiol 2020; 75:682-688. [PMID: 32061472 DOI: 10.1016/j.jjcc.2019.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/05/2019] [Accepted: 12/21/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND In the field of palliative care, morphine is known to be effective for alleviating dyspnea in cancer patients. However, little is known regarding the safety and efficacy of morphine therapy for refractory dyspnea as palliative care in advanced heart failure (HF) patients. METHODS We retrospectively reviewed consecutive advanced HF patients who were referred to the Palliative Care Team at our institution and administered morphine for refractory dyspnea during hospitalization between September 2013 and December 2018. We investigated the details of morphine usage, vital signs, an 11-point quantitative symptom scale, and adverse events at baseline, 24 h, and 72 h after the start of treatment. RESULTS Morphine was administered for refractory dyspnea in 43 advanced HF patients [mean age: 73.5 years, male: 28 (65%), New York Heart Association functional class IV: 43 (100%), median left ventricular ejection fraction: 25%, median B-type natriuretic peptide level: 927 pg/ml, concurrent intravenous inotrope: 33 (77%)]. Median initial dose of morphine was 5 mg/day in both oral and intravenous administration and median duration of administration was 5 days. Significant decreases in an 11-point quantitative symptom scale [7 (5, 9) vs. 2 (1, 6); p < 0.01, (data available in 8 patients)] and respiratory rate (22.2 ± 6.1 vs. 19.7 ± 5.2 breaths per minute; p < 0.01) were observed 24 h after the start of morphine administration. Meanwhile, oxygen saturation, blood pressure, and heart rate were not significantly altered after treatment (NS). Common adverse events were delirium (18%) and constipation (8%); however, no lethal adverse event definitely related to morphine therapy occurred during treatment. CONCLUSIONS This single-center retrospective study revealed the clinical practice of morphine therapy and suggested that morphine therapy might be feasible for refractory dyspnea as palliative care in advanced HF patients.
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Affiliation(s)
- Juri Kawaguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Atsushi Hirayama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Eri Nakai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Cardiology, Department of Medicine II, Kansai Medical University, Osaka, Japan
| | - Emi Nakamura
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Michi Miyata
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yukie Kawano
- Department of Nursing, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuko Takada
- Department of Nursing, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuta Anchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Sayaka Funabashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kensuke Kuroda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Michiyo Azechi
- Department of Psychiatry, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
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Zheng J, He J, Wang W, Zhou H, Cai S, Zhu L, Qian X, Wang J, Lu Z, Huang C. The impact of pain and opioids use on survival in cancer patients: Results from a population-based cohort study and a meta-analysis. Medicine (Baltimore) 2020; 99:e19306. [PMID: 32118751 PMCID: PMC7478583 DOI: 10.1097/md.0000000000019306] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The study aimed to explore whether cancer-related pain and opioids use are associated with the survival of cancer patients, and perform a cohort study and a meta-analysis to quantify the magnitude of any association.A retrospective cohort study was performed to analyze the impact of pain level, and opioids use on cancer-specific survival (CSS) in advanced cancer patients. Patients and relevant medical records were selected from the registry of the Radiation and chemotherapy division of Ningbo First Hospital between June 2013 and October 2017. Hazard ratios (HRs) and 95% confidential intervals (CIs) for CSS by opioids use were calculated by univariate and multivariate Cox regression analyses. The systematic review included relevant studies published before October 2018. The combined HRs and 95% CIs for overall survival (OS) and progression-free survival (PFS) were calculated using random-effect models.A total of consecutive 203 cancer patients were included in the cohort study. Kaplan-Meier curves indicate a negative association between CSS and cancer-related pain or opioids requirement, but less evidence of an association with the dose of opioids use. Multivariate models revealed that the pain level and opioids requirement were associated with shorter CSS, after adjusting for significant covariates. The results of the meta-analysis indicated that postoperative opioids use had a poor effect on PFS, and opioids use for cancer-related pain was associated with poor OS in cancer patients, while intraoperative opioids use was not associated with cancer survival.We concluded that cancer-related pain and opioids requirements are associated with poor survival in advanced cancer patients, and postoperative opioids use and opioids use for cancer-related pain may have an adverse effect on the survival of cancer patients.
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Affiliation(s)
- Jungang Zheng
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Jing He
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | | | - Haidong Zhou
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Saihong Cai
- Department of Radiotherapy and Chemotherapy, Ningbo First Hospital, Ningbo
| | - Linhai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinger Qian
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Jun Wang
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Zihui Lu
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
| | - Changshun Huang
- Department of Anesthesiology, Ningbo First Hospital, Ningbo, Zhejiang
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Murakami M. Opioids for Relief of Dyspnea Immediately Before Death in Patients With Noncancer Disease: A Case Series Study. Am J Hosp Palliat Care 2019; 36:734-739. [DOI: 10.1177/1049909119832816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Dyspnea is commonly found in most conditions among patients with progressive noncancer disease. Objective: To clarify the effectiveness and safety of opioid administration for the treatment of dyspnea immediately before death in patients with noncancer disease. Methods: A retrospective case-series study involving 13 consecutive terminally ill patients who were near death and diagnosed with noncancer disease, and had refractory dyspnea and received opioid therapy, was performed. The authors investigated the route of administration, period, dosage of opioids, intensity of dyspnea—scored according to the Japanese version of the Support Team Assessment Schedule—and clinical course from a review of medical records. Results: The mean age of the patients was 86.5 ± 7.6years (range: 72-98years). The primary causes of dyspnea that led to opioid administration were heart failure (n = 10) and respiratory failure (n = 3). Oxycodone was used in one patient who experienced a complication of chronic renal failure; morphine was used in the other 12 patients. The route of opioid administration was continuous infusions in 11 patients, suppository in one, and oral administration in one. The final dose of oral morphine equivalents was 20.1 ± 8.1 mg/d (range: 5-36 mg [median: 18 mg]). All patients improved in symptom score after opioid administration. The score was significantly decreased from 3.2 ± 0.7 at the beginning of opioid administration to 1.2 ± 0.6 at final estimation ( P < .001). No severe adverse events occurred. Conclusions: Low-dose opioid administration in patients with terminally ill noncancer improved dyspnea and occurred no severe adverse events.
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Affiliation(s)
- Maki Murakami
- Department of Palliative Care, The Salvation Army Kiyose Hospital, Tokyo, Japan
- Department of Palliative Care, National Hospital Organization Shinshu Ueda Medical Center, Nagano, Japan
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Delivering Pediatric Palliative Care: From Denial, Palliphobia, Pallilalia to Palliactive. CHILDREN-BASEL 2018; 5:children5090120. [PMID: 30200370 PMCID: PMC6162556 DOI: 10.3390/children5090120] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022]
Abstract
Among the over 21 million children with life-limiting conditions worldwide that would benefit annually from a pediatric palliative care (PPC) approach, more than eight million would need specialized PPC services. In the United States alone, more than 42,000 children die every year, half of them infants younger than one year. Advanced interdisciplinary pediatric palliative care for children with serious illnesses is now an expected standard of pediatric medicine. Unfortunately, in many institutions there remain significant barriers to achieving optimal care related to lack of formal education, reimbursement issues, the emotional impact of caring for a dying child, and most importantly, the lack of interdisciplinary PPC teams with sufficient staffing and funding. Data reveals the majority of distressing symptoms in children with serious illness (such as pain, dyspnea and nausea/vomiting) were not addressed during their end-of-life period, and when treated, therapy was commonly ineffective. Whenever possible, treatment should focus on continued efforts to control the underlying illness. At the same time, children and their families should have access to interdisciplinary care aimed at promoting optimal physical, psychological and spiritual wellbeing. Persistent myths and misconceptions have led to inadequate symptom control in children with life-limiting diseases. Pediatric Palliative Care advocates the provision of comfort care, pain, and symptom management concurrently with disease-directed treatments. Families no longer have to opt for one over the other. They can pursue both, and include integrative care to maximize the child's quality of life. Since most of the sickest children with serious illness are being taken care of in a hospital, every children's hospital is now expected to offer an interdisciplinary palliative care service as the standard of care. This article addresses common myths and misconceptions which may pose clinical obstacles to effective PPC delivery and discusses the four typical stages of pediatric palliative care program implementation.
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Coyne P, Mulvenon C, Paice JA. American Society for Pain Management Nursing and Hospice and Palliative Nurses Association Position Statement: Pain Management at the End of Life. Pain Manag Nurs 2018; 19:3-7. [DOI: 10.1016/j.pmn.2017.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 11/25/2022]
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Golčić M, Dobrila-Dintinjana R, Golčić G, Čubranić A. The Impact of Combined Use of Opioids, Antipsychotics, and Anxiolytics on Survival in the Hospice Setting. J Pain Symptom Manage 2018; 55:22-30. [PMID: 28803083 DOI: 10.1016/j.jpainsymman.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Opioids and sedatives are the cornerstone of symptom management in the end-of-life patients, but undertreatment is a common problem. Although several studies explored the individual effect of opioids, anxiolytics, and antipsychotics on survival, not much is known regarding their combined use. As these drugs share similar and potentially fatal side effects, primarily respiratory depression which occurs more often during night-hours, it is crucial to explore whether their interaction poses a danger for fragile hospice patients. OBJECTIVES To analyze the relationship of a combination of opioids, anxiolytics, and antipsychotics on survival and the change of night-time death percentage. METHODS A retrospective study of 765 consecutive patients admitted to hospice in Croatia over the period of four years (2013-2017). The main outcome was the total length of survival of hospice patients regarding different drug combination, along with night-time death percentage. RESULTS Different combinations of opioids, anxiolytics, and antipsychotics were associated with longer survival in hospice compared with patients using no such drugs. When we included different parameters which affected overall survival into a multivariate analysis, only the patients who had the combination of both opioids, anxiolytics, and antipsychotics in their regular therapy were associated with longer survival in hospice (11 vs. five days, hazard ratio 0.54, P < 0.001). No combination of opioids, anxiolytics, and antipsychotics significantly changed the night-time death percentage. CONCLUSION This research supports the safety of opioids, anxiolytics, and antipsychotics in the hospice setting when used both individually as well as in combination.
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Affiliation(s)
- Marin Golčić
- Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Rijeka, Croatia.
| | | | - Goran Golčić
- Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Aleksandar Čubranić
- Department of Gastroenterology, Clinical Hospital Center Rijeka, Rijeka, Croatia
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van Hoorn R, Tummers M, Booth A, Gerhardus A, Rehfuess E, Hind D, Bossuyt PM, Welch V, Debray TPA, Underwood M, Cuijpers P, Kraemer H, van der Wilt GJ, Kievit W. The development of CHAMP: a checklist for the appraisal of moderators and predictors. BMC Med Res Methodol 2017; 17:173. [PMID: 29268721 PMCID: PMC5740883 DOI: 10.1186/s12874-017-0451-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/05/2017] [Indexed: 12/14/2022] Open
Abstract
Background Personalized healthcare relies on the identification of factors explaining why individuals respond differently to the same intervention. Analyses identifying such factors, so called predictors and moderators, have their own set of assumptions and limitations which, when violated, can result in misleading claims, and incorrect actions. The aim of this study was to develop a checklist for critically appraising the results of predictor and moderator analyses by combining recommendations from published guidelines and experts in the field. Methods Candidate criteria for the checklist were retrieved through systematic searches of the literature. These criteria were evaluated for appropriateness using a Delphi procedure. Two Delphi rounds yielded a pilot checklist, which was tested on a set of papers included in a systematic review on reinforced home-based palliative care. The results of the pilot informed a third Delphi round, which served to finalize the checklist. Results Forty-nine appraisal criteria were identified in the literature. Feedback was obtained from fourteen experts from (bio)statistics, epidemiology and other associated fields elicited via three Delphi rounds. Additional feedback from other researchers was collected in a pilot test. The final version of our checklist included seventeen criteria, covering the design (e.g. a priori plausibility), analysis (e.g. use of interaction tests) and results (e.g. complete reporting) of moderator and predictor analysis, together with the transferability of the results (e.g. clinical importance). There are criteria both for individual papers and for bodies of evidence. Conclusions The proposed checklist can be used for critical appraisal of reported moderator and predictor effects, as assessed in randomized or non-randomized studies using individual participant or aggregate data. This checklist is accompanied by a user’s guide to facilitate implementation. Its future use across a wide variety of research domains and study types will provide insights about its usability and feasibility. Electronic supplementary material The online version of this article (10.1186/s12874-017-0451-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ralph van Hoorn
- Radboud Institute for Health Sciences, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525, EZ, The Netherlands.
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525, EZ, The Netherlands
| | - Andrew Booth
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield Regent Court, Sheffield, UK
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute for Public Health and Nursing Research, University of Bremen and Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology; Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield Regent Court, Sheffield, UK
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University; Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Helena Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Wietkse Kievit
- Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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Sathornviriyapong A, Nagaviroj K, Anothaisintawee T. The association between different opioid doses and the survival of advanced cancer patients receiving palliative care. BMC Palliat Care 2016; 15:95. [PMID: 27871265 PMCID: PMC5117570 DOI: 10.1186/s12904-016-0169-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022] Open
Abstract
Background Concerns that opioids may hasten death can be a cause of the physicians’ reluctance to prescribe opioids, leading to inadequate symptom palliation. Our aim was to find if there was an association between different opioid doses and the survival of the cancer patients that participated in our palliative care program. Methods A retrospective study was conducted at Ramathibodi Hospital, Bangkok between January 2013 and December 2015. All of the cancer patients that were referred to palliative care teams by their primary physicians were included in the study. The study data included the patients’ demographics, disease status, comorbidities, functional status, type of services, cancer treatments, date of consultation, and the date of the patient’s death or last follow-up. The information concerning opioid use was collected by reviewing the medical records and this was converted to an oral morphine equivalent (OME), following a standard ratio. The time-varying covariate in the Cox regression analysis was applied in order to determine the association between different doses of opioids and patient survival. Results A total of 317 cancer patients were included in the study. The median (IQR) of the OME among our patients was 6.43 mg/day (0.53, 27.36). The univariate Cox regression analysis did not show any association between different opioid doses (OME ≤ 30 mg/day and > 30 mg/day) and the patients’ survival (p = 0.52). The PPS levels (p < 0.01), palliative care clinic visits (HR 0.32, 95%CI 0.24–0.43), home visits (HR 0.75, 95%CI 0.57–0.99), chemotherapy (HR 0.32, 95%CI 0.22–0.46), and radiotherapy (HR 0.53, 95%CI 0.36–0.78) were identified as factors that increased the probability of survival. Conclusions Our study has demonstrated that different opioid doses in advanced cancer patients are not associated with shortened survival period.
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Affiliation(s)
- Anon Sathornviriyapong
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Street, Rajthevi, Bangkok, 10400, Thailand
| | - Kittiphon Nagaviroj
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Street, Rajthevi, Bangkok, 10400, Thailand.
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Street, Rajthevi, Bangkok, 10400, Thailand
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Sato K, Yokoi H, Tsuneto S. Shock Index and Decreased Level of Consciousness as Terminal Cancer Patients' Survival Time Predictors: A Retrospective Cohort Study. J Pain Symptom Manage 2016; 51:220-31.e2. [PMID: 26598038 DOI: 10.1016/j.jpainsymman.2015.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/21/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
Abstract
CONTEXT Predicting prognosis using noninvasive and objective tools may facilitate end-of-life decisions for terminal cancer patients, their families, and other health care professionals. OBJECTIVES To investigate if the shock index (SI), along with decreased level of consciousness (DLOC), is a reliable tool for predicting short-term survival time in terminal cancer patients. METHODS A two-part retrospective cohort study was performed on 670 consecutive adult hospice patients. Part 1 of the study was performed to investigate the reliability of SI and DLOC on admission and to make a simple tool for predicting survival time. Part 2 of the study was to validate the tool's reproducibility and analyze the correlation between SI, DLOC, and survival time. RESULTS In Part 1, multivariate Cox proportional hazards analyses for all study patients revealed that SI ≥ 1.0 in patients with DLOC was a significant risk factor of death (hazard ratio 3.08; 95% CI 1.72-5.53; P = 0.000). Generalized additive models confirmed that DLOC patients with SI = 1.0 had 9.58 days of mean survival time (MST). Receiver operating characteristic curve analyses of SI in patients with DLOC revealed that a survival time of less than three days was most reliably predicted. In Part 2, an increase in SI statistically decreased survival time. The upper 95% CIs of the calculated mean survival time for DLOC patients with SI ≥ 1.0 were less than one week. Bootstrap analyses revealed that the 95% CIs of the predicted survival time were 4.54-6.18 days in DLOC patients with SI = 1.0. CONCLUSION An SI ≥ 1.0 along with DLOC is a highly reliable tool for predicting short-term survival time in terminal cancer patients.
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Affiliation(s)
- Ko Sato
- Division of Palliative Medicine, Ise Municipal General Hospital, Ise, Japan.
| | - Hideto Yokoi
- Department of Medical Informatics, Kagawa University Hospital, Kagawa University, Miki, Japan
| | - Satoru Tsuneto
- Palliative Care Center, Department of Palliative Medicine, Kyoto University Hospital, Kyoto University, Kyoto, Japan
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Bidet G, Daoust L, Duval M, Ducruet T, Toledano B, Humbert N, Gauvin F. An Order Protocol for Respiratory Distress/Acute Pain Crisis in Pediatric Palliative Care Patients: Medical and Nursing Staff Perceptions. J Palliat Med 2016; 19:306-13. [PMID: 26788836 DOI: 10.1089/jpm.2015.0100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND An order protocol for distress (OPD), including respiratory distress and acute pain crisis, has been established for pediatric palliative care patients at Sainte-Justine Hospital (SJH). After discussion with the patient/his or her family, the OPD is prescribed by the attending physician whenever judged appropriate. The OPD can then be initiated by the bedside nurse when necessary; the physician is notified after the first dose is administered. OBJECTIVES The study objectives were to evaluate the perceptions and experience of the medical/nursing staff towards the use of the OPD. METHODS A survey was distributed to all physicians/nurses working on wards with pediatric palliative care patients. Answers to the survey were anonymous, done on a voluntary basis, and after consent of the participant. RESULTS Surveys (258/548) were answered corresponding to a response rate of 47%. According to the respondents, the most important motivations in using the OPD were the desire to relieve patient's distress and the speed of relief of distress by the OPD; the most important obstacles were going against the patient's/his or her family's wishes and fear of hastening death. The respondents reported that the OPD was frequently (56%) or always (36%) effective in relieving the patient's distress. The respondents felt sometimes (16%), frequently (34%), or always (41%) comfortable in giving the OPD. They thought the OPD could never (12%), rarely (32%), sometimes (46%), frequently (8%), or always (1%) hasten death. Physicians were less favorable than nurses with the autonomy of bedside nurses to initiate the OPD before notifying the physician (p = 0.04). Overall, 95% of respondents considered that they would use the OPD in the future. CONCLUSIONS Data from this survey shows that respondents are in favor of using the OPD at SJH and find it effective. Further training as well as support for health care professionals are mandatory in such palliative care settings.
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Affiliation(s)
- Gwenaëlle Bidet
- 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Lysanne Daoust
- 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Michel Duval
- 2 Hemato-Oncology Service, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Thierry Ducruet
- 3 Applied Clinical Research Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Baruch Toledano
- 4 Pediatric Critical Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - Nago Humbert
- 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
| | - France Gauvin
- 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada
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Is regular systemic opioid analgesia associated with shorter survival in adult patients with cancer? A systematic literature review. Pain 2015. [DOI: 10.1097/j.pain.0000000000000306] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Chiang JK, Kao YH. Prediction of Patient Survival by Change in Daily Opioid Dosage in Advanced Cancer Patients: A Prospective Hospital-based Epidemiologic Study. Jpn J Clin Oncol 2014; 44:1189-97. [DOI: 10.1093/jjco/hyu153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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A systematic review of the influence of opioids on advanced cancer patient survival. Curr Opin Support Palliat Care 2014; 7:424-30. [PMID: 24145680 DOI: 10.1097/spc.0b013e328365763a] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Many health professionals still believe that opioids shorten the lifespan of patients. This situation implies that the ethical doctrine of double effect is often invoked to justify their use in extreme circumstances. The objective of this study is to revise the evidence existing in the recently published literature regarding the effect on patient survival of opioid used to control disease symptoms. RECENT FINDINGS A review of the scientific literature regarding the effects of opioids on symptom control and survival does not provide any evidence that there is an association between these two variables. SUMMARY The studies revised have not shown that the use of opioids for symptom control in advanced disease stages or in the last days of life has any effect on patient survival. Similarly, survival was not influenced by either the use of higher or lower doses of opioids, or by the practice of administering a double dose at night.
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Gupte KP, Wu W. Impact of anticholinergic load of medications on the length of stay of cancer patients in hospice care. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:192-8. [PMID: 24954119 DOI: 10.1111/ijpp.12132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 05/13/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES An important goal of hospice care is to relieve pain and suffering of terminal cancer patients. Anticholinergic medications are effective in the symptom palliation among terminal cancer patients. However, use of these medications has been associated with increased risk of side effects, which might lead to premature mortality. Short lengths of stay in hospice care leave patients with a higher level of unmet needs. The study was conducted to examine the effect of increasing anticholinergic load on the length of stay of cancer patients in hospice care in the USA. METHODS The National Home and Hospice Care Survey 2007 was used as the data source. The Cox proportional hazards model was used to investigate the risk of death among users of moderate and high anticholinergic load compared with users of low anticholinergic load in presence of other prognostic factors. KEY FINDINGS Cancer patients on a moderate anticholinergic load had a 12.7% lower hazard of death (P = 0.0244), while those on a high anticholinergic load had a 15.6% lower hazard of death (P = 0.0071) as compared with those patients on a low anticholinergic load. Among other prognostic factors, non-elderly age group, male gender, white race, metropolitan hospice agency, non-profit hospice agency, severe activities of daily living dependency and cognitive impairment were significantly associated with a higher probability of death. CONCLUSIONS These results provide no evidence for increasing anticholinergic load increasing mortality in cancer patients using hospice care. Thus, high anticholinergic load might have conferred a protective effect on the patients because of better symptom control.
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Affiliation(s)
- Komal P Gupte
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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American Society for Pain Management Nursing Position Statement: Pain Management at the End of Life. Pain Manag Nurs 2013; 14:172-5. [DOI: 10.1016/j.pmn.2013.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bailey FA, Williams BR, Goode PS, Woodby LL, Redden DT, Johnson TM, Taylor JW, Burgio KL. Opioid pain medication orders and administration in the last days of life. J Pain Symptom Manage 2012; 44:681-91. [PMID: 22765968 DOI: 10.1016/j.jpainsymman.2011.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 11/16/2011] [Accepted: 11/29/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Most patients with serious and life-limiting illness experience pain at some point in the illness trajectory. OBJECTIVES To describe baseline pain management practices for imminently dying patients in Veterans Administration Medical Centers (VAMCs) and examine factors associated with these processes, including presence of opioid orders at the time of death and medication administration in the last seven days, 48 hours, and 24 hours of life. METHODS Data on orders and administration of opioid pain medication at the end of life were abstracted from the medical records of veterans who died in six VAMC hospitals in 2005. RESULTS Of 1068 patient records, 686 (64.2%) had an active order for an opioid medication at the time of death. Of these, 69.8% of patients had received the medication at some time within the last seven days of life, 61.2% within the last 48 hours, and 47.0% within the last 24 hours. In multivariable models, presence of an order for opioid pain medication at the time of death and administration within the last 24 hours were both significantly associated with having a Do Not Resuscitate (DNR) order (P < 0.0001/0.0002), terminal condition (P < 0.0001/< 0.0001), family presence (P < 0.0001/0.0023), location of death (P = 0.003/0.0005), and having pain noted in the care plan (P = 0.0073/0.0007). CONCLUSION Findings indicate a need for improving availability of opioids for end-of-life care in the inpatient setting. Modifiable factors, such as family presence and goals-of-care discussions, suggest potential targets for intervention to improve recognition of the dying process and proactive planning for pain control.
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Affiliation(s)
- F Amos Bailey
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL, USA
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Blinderman CD. Do surrogates have a right to refuse pain medications for incompetent patients? J Pain Symptom Manage 2012; 43:299-305. [PMID: 22248789 DOI: 10.1016/j.jpainsymman.2011.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 08/26/2011] [Accepted: 09/09/2011] [Indexed: 10/14/2022]
Abstract
The relief of pain is widely considered to be a basic human right. Physicians are expected to make every attempt to relieve pain and suffering, especially in patients who do not have capacity. This article presents a case in which the family of a woman with severe somatic pain from metastatic breast cancer requests that pain medications be reduced and, at times, held. The ethical issues associated with surrogate decision making and the refusal of medical treatments are reviewed. The obligation to treat pain remains paramount despite family objections.
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Affiliation(s)
- Craig D Blinderman
- Division of Palliative Medicine, Department of Anesthesiology, Columbia University Medical Center, New York, New York 10032, USA.
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Casey C, Chen LM, Rabow MW. Symptom management in gynecologic malignancies. Expert Rev Anticancer Ther 2012; 11:1077-89. [PMID: 21806331 DOI: 10.1586/era.11.83] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients with gynecologic cancer experience significant symptom burden throughout their disease course and treatment, which negatively impacts their quality of life. The most common symptoms in gynecologic cancer include pain, fatigue, depression and anxiety. Palliative care, including symptom management, focuses on the prevention and relief of suffering and improvement in quality of life, irrespective of prognosis. In a comprehensive cancer care model, palliative care, including symptom management, is offered concurrently with anticancer therapies throughout the disease course, not just at the end of life and not only once curative attempts have been abandoned. Good symptom management begins with routine symptom assessment and use of a standardized screening tool can help identify patients with high symptom burden. Literature regarding epidemiology, assessment and management of pain, fatigue, nausea/vomiting, lymphedema, ascites, depression, anxiety and sexual dysfunction in gynecologic oncology patients will be reviewed in this article.
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Affiliation(s)
- Carolyn Casey
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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Kumar SP. Reporting characteristics of cancer pain: a systematic review and quantitative analysis of research publications in palliative care journals. Indian J Palliat Care 2011; 17:57-66. [PMID: 21633623 PMCID: PMC3098545 DOI: 10.4103/0973-1075.78451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: A common disorder requiring symptom palliation in palliative and end-of-life care is cancer. Cancer pain is recognized as a global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and its reporting characteristics in the palliative care journal literature. Materials and Methods: Search conducted in MEDLINE and CINAHL sought to locate all studies published in 19 palliative/ hospice/ supportive/ end-of-life care journals from 2009 to 2010. The journals included were: American Journal of Hospice and Palliative Care, BMC Palliative Care, Current Opinion in Supportive and Palliative Care, End of Life Care Journal, European Journal of Palliative Care, Hospice Management Advisor, Indian Journal of Palliative Care, International Journal of Palliative Nursing, Internet Journal of Pain Symptom Control and Palliative Care, Journal of Pain and Palliative Care Pharmacotherapy, Journal of Palliative Care, Journal of Palliative Medicine, Journal of Social Work in End-of-life and Palliative Care, Journal of Supportive Oncology, Palliative Medicine, Palliative and Supportive Care, and Supportive Care in Cancer. Journal contents were searched to identify studies that included cancer pain in abstract. Results: During the years 2009 and 2010, of the selected 1,569 articles published in the journals reviewed, only 5.86% (92 articles) were on cancer pain. Conclusion: While researchers in the field of palliative care have studied cancer pain, the total percentage for studies is still a low 5.86%. To move the field of palliative care forward so that appropriate guidelines for cancer pain management can be developed, it is critical that more research be reported upon which to base cancer pain therapy in an evidence-based palliative care model.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College (Manipal University), Mangalore, India
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Csikós Á, Nagy L, Busa C, Kállai J. [Important aspects of end-of-life care. Survey of patients visiting the primary care office]. Orv Hetil 2011; 152:1082-90; quiz 1091-2. [PMID: 21676675 DOI: 10.1556/oh.2011.29139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Death and dying are still taboo topics in Hungary. The care of the dying, the adequate relief of their symptoms and the psychosocial support of both patients and their caregivers are not yet well addressed. AIMS Authors obtained information about the feelings and thoughts of patients on death and dying, and about their expectations for end-of-life care. METHODS Mailed questionnaire was send to a convenience sample of 29 adult primary care offices where a total of 845 unselected patients completed the questionnaire. RESULTS More than two thirds (69%) of respondents would like to receive end of life care in their home. Only 19% of respondents would prefer to die in a hospital. Respondents' greatest fear was to lose their autonomy (55%). The second most noted concern was fear from pain (38%). According to 93% of the participants, truth telling is very important in the event of terminal illness. CONCLUSIONS Hungarian patients prefer to receive end of life care in their home. Our data support the need for improvement in three primary areas, physician communication skills, pain and symptom management, and expansion of home hospice care.
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Affiliation(s)
- Ágnes Csikós
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Családorvostani Intézet, Pécs, Akác u. 1. 7632
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