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Abstract
Pain is a common and most debilitating symptom of head and neck cancers (HNC). The prevalence of pain in HNC is nearly 70%. There are no universally accepted classification or diagnostic criteria for HNC-related pain, and currently, HNC-related pain is classified based on the underlying pathophysiological mechanism, the location of the tumor, and the protagonist of pain. The clinical presentation of HNC-related pain varies and can be similar to primary pain disorders. The management of HNC-related pain primarily consists of pharmacotherapy. However, in some cases, interventions may be needed. This article will present a case study and review the epidemiology, diagnostic criteria and classification, clinical features, pathophysiology, and HNC-related pain management.
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Affiliation(s)
- Shehryar Nasir Khawaja
- Orofacial Pain Medicine, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centers, Lahore, Pakistan.
| | - Steven J Scrivani
- Department of Diagnostic Sciences, Craniofacial Pain Center, Tufts University, School of Dental Medicine, Boston, MA, USA
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Minard LV, Fisher J, Broadfield L, Walsh G, Sketris I. Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer. Front Pharmacol 2022; 13:836864. [PMID: 35401210 PMCID: PMC8987150 DOI: 10.3389/fphar.2022.836864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: To determine the factors associated with opioid analgesic prescriptions as measured by community pharmacy dispensations to all Nova Scotia (NS) patients with cancer at end-of-life from 2005 to 2009. Methods: The NS Cancer Registry and the NS Prescription Monitoring Program (NSPMP) were used to link Nova Scotians who had a cancer diagnosis and received a prescription for opioids in their last year of life (n = 6,186) from 2005 to 2009. The association of factors with opioid dispensations at end-of-life were determined (e.g., patient demographics, type of prescriber, type of cancer, and opioid type, formulation, and dose). Results: Almost 54% (n = 6,186) of the end-of-life study population with cancer (n = 11,498) was linked to the NSPMP and therefore dispensed opioids. Most prescriptions were written by general practitioners (89%) and were for strong opioids (81%). Immediate-release formulations were more common than modified-release formulations. Although the annual average parenteral morphine equivalents (MEQ) did not change during the study period, the number of opioid prescriptions per patient per year increased from 5.9 in 2006 to 7.0 in 2009 (p < 0.0001). Patients age 80 and over received the fewest prescriptions (mean 3.9/year) and the lowest opioid doses (17.0 MEQ) while patients aged 40–49 received the most prescriptions (mean 14.5/year) and the highest doses of opioid (80.2 MEQ). Conclusion: Our study examined opioid analgesic use at end-of-life in patients with cancer for a large real-world population and determined factors, trends and patterns associated with type and dose of opioid dispensed. We provide information regarding how general practitioners prescribe opioid therapy to patients at end-of-life. Our data suggest that at the time of this study, there may have been under-prescribing of opioids to patients with cancer at end-of-life. This information can be used to increase awareness among general practitioners, and to inform recommendations from professional regulatory bodies, to aid in managing pain for cancer patients at end-of-life. Future work could address how opioid prescribing has changed over time, and whether efforts to reduce opioid prescribing in response to the opioid crisis have affected patients with cancer at end-of-life in Nova Scotia.
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Affiliation(s)
- Laura V. Minard
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Judith Fisher
- Nova Scotia Department of Health and Wellness, Halifax, NS, Canada
| | | | - Gordon Walsh
- Nova Scotia Health Cancer Care Program, Halifax, NS, Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
- *Correspondence: Ingrid Sketris, mailto:
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Abstract
PURPOSE OF REVIEW An overview on breakthrough cancer pain (BTCP), including inherent limitations of the terminology, assessment, clinical presentation, and treatment options. RECENT FINDINGS The estimated prevalence of BTCP is dependent on the defined cutoffs for controlled background pain and the magnitude of the pain flare. In addition, pain flares outside the definition of BTCP are prevalent. In the 11th Revision of the International Classification of Diseases, the temporal characteristics of cancer pain are described as continuous background pain and intermittent episodic pain. BTCP should be assessed by validated methods, and the patient perspective should be included. The pain may be related to neoplastic destruction of bone, viscera, or nerve tissue and is characterized by rapid onset, high intensity, and short duration. Treatment directed towards painful metastases must be considered. Due to pharmacological properties mirroring the pain characteristics, transmucosal fentanyl formulations are important for the treatment of BTCP. Oral immediate release opioids can be used for slow-onset or predictable BTCP. For more difficult pain conditions, parenteral, or even intrathecal pain medication, may be indicated. SUMMARY All clinically relevant episodic pains must be adequately treated in accordance with the patient's preferences. Transmucosal fentanyl formulations are effective for BTCP.
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Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115991. [PMID: 34204871 PMCID: PMC8199778 DOI: 10.3390/ijerph18115991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND mobile applications (apps) facilitate cancer pain ecological momentary assessment (EMA) and provide more reliable data than retrospective monitoring. The aims of this study are (a) to describe the status of persons with cancer pain when assessed ecologically, (b) to analyze the utility of clinical alarms integrated into the app, and (c) to test the feasibility of implementing an app for daily oncological pain monitoring. METHODS in this feasibility study, 21 patients (mean age = 56.95 years, SD = 10.53, 81.0% men) responded to an app-based evaluation of physical status (baseline and breakthrough cancer pain (BTcP)) and mental health variables (fatigue, mood, and coping) daily during 30 days. RESULTS cancer pain characterization with the app was similar to data from the literature using retrospective assessments in terms of BTcP duration and perceived medication effectiveness. However, BTcP was less frequent when evaluated ecologically. Pain, fatigue, and mood were comparable in the morning and evening. Passive coping strategies were the most employed daily. Clinical alarms appear to be useful to detect and address adverse events. App implementation was feasible and acceptable. CONCLUSION apps reduce recall bias and facilitate a rapid response to adverse events in oncological care. Future efforts should be addressed to integrate EMA and ecological momentary interventions to facilitate pain self-management via apps.
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Kwok CYL, Chan DNS, So WKW. Effect of a theory-driven educational intervention on the level of knowledge, attitudes, and assessment practices regarding breakthrough cancer pain (BTCP) management among medical nurses in Hong Kong. Eur J Oncol Nurs 2021; 52:101945. [PMID: 33813183 DOI: 10.1016/j.ejon.2021.101945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the effect of an educational intervention intended to improve medical nurses' adherence to breakthrough cancer pain (BTCP) assessment practices and their level of knowledge, attitudes and perceived assessment practices regarding BTCP management. METHODS Nurses working in a regional hospital were recruited to this quasi-experimental study. The intervention group received a 3-h educational workshop and one session of individual clinical instruction, whilst the control group did not receive any intervention. Chart audits were performed to examine adherence to BTCP assessment practices as the primary outcome. A self-developed questionnaire was used to measure nurses' knowledge, attitudes and perceived assessment practices regarding BTCP management as the secondary outcomes. The chi-square or Fisher's exact test was used to compare the rate of adherence to BTCP assessment practices between groups. A generalised estimating equation was used to compare changes in knowledge, attitudes, and perceived assessment practices between groups over time. RESULTS One hundred and five nurses completed the study. The chart audits revealed a significantly higher rate of adherence to BTCP assessment practices in the intervention group after the intervention (p < .05). The intervention group exhibited significant positive changes in scores for knowledge (β = 25.49, p < .001), attitude (β = 0.98 to 2.81, p < .01), and their perceived assessment practices (β = 1.33 to 3.14, p < .002) when compared with the control group. CONCLUSIONS This theory-driven educational intervention significantly improved the medical nurses' adherence to BTCP assessment practices and their level of knowledge attitudes and perceived assessment practices regarding BTCP management.
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Affiliation(s)
- Carman Y L Kwok
- Haven of Hope Sister Annie Skau Holistic Centre, Hong Kong, SAR, China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Ng JY, Sharma AE. Guidelines for Cancer-Related Pain: A Systematic Review of Complementary and Alternative Medicine Recommendations. Pain Pract 2020; 21:454-467. [PMID: 33197300 DOI: 10.1111/papr.12964] [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: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Although up to 85% of patients with cancer use complementary and alternative medicine (CAM), they commonly do not disclose this information to their healthcare providers. Cancer-related pain (CRP) is one of the most common symptoms among those who may seek CAM. This study was conducted to identify the quantity and assess the quality of CAM recommendations across clinical practice guidelines (CPGs) for the treatment and/or management of CRP, as this has not been explored in the literature. METHODS A systematic review was conducted to identify cancer pain CPGs. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from 2009 to 2020. The Guideline International Network and the National Centre for Complementary and Integrative Health websites were also searched. Eligible CPGs on CRP in adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. RESULTS Of 771 unique search results, 13 mentioned CAM and 11 made CAM recommendations. Eligible CPGs were published in 2009 or later and focused on the treatment/management of CRP. Scaled domain percentages from highest to lowest ranged from (overall, CAM): 88.1%, 88.1% (for scope and purpose) to 21.0%, 8.5% (for applicability). Quality varied within and across CPGs. One CPG was recommended by both appraisers; 6 were recommended as "Yes" or "Yes with modifications." CONCLUSIONS The present study has identified and summarized a number of CPGs that clinicians may consult to understand what CAMs are recommended in the context of the treatment and/or management of CRP.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alisha E Sharma
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Trifilio S, Gordon L, Rubin H, Grosshans N, Mehta J. The non-steroidal anti-inflammatory drug salsalate provides safe and effective control of mucositis-unrelated pain during autologous and allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2020; 29:3643-3648. [PMID: 33179136 DOI: 10.1007/s00520-020-05664-x] [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: 02/25/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pain is a serious adverse event which frequently accompanies hematopoietic stem cell transplantation (HSCT). The safety and efficacy of NSAIDS during HSCT is currently unknown. Salsalate is a platelet-sparing NSAID with a favorable toxicity profile compared with other NSAIDS. We report the safety and efficacy of salsalate for different types of pain during SCT. METHODS We conducted a retrospective study of SCT recipients empirically treated with salsalate for > 48 h. Pain scores were assessed using the verbal rating scale for pain. A subset analysis of patients who received > 7 days of salsalate during periods of pancytopenia, mucositis, and other end-organ toxicities is included. RESULTS Sixty-four patients, 42 auto- and 22 allografts, were identified. Reason for use: vertebral-related pain (30%), musculoskeletal (30%), and cytokine inflammatory pain syndromes (24%). Median dose 1500 mg/day, number of treatment days = 5, started on day+5 post-HSCT. Pain resolved/improved to pain score < 4 in 76% and stable in 15%. Forty-four patients (28-auto and 16 allografts) received > 7-day salsalate. Median WBC and platelet nadir were < 0.1 and 10,000 cells/ml respectively. EFFICACY pain was improved or eradicated in 64% and stable in 32%. TOXICITY LFT elevation (n = 2), elevated serum creatinine (n = 2), and minor bleed (n = 5-nose, gums, and urine). Salsalate discontinuation (n = 6): ineffective (n = 1), the liver (n = 1), the kidney (n = 1), > 5 platelet transfusions (n = 1), and vomiting (n = 2). There was no treatment related mortality. Salsalate was well tolerated, safe, and beneficial for several different types of pain during HSCT.
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Affiliation(s)
- S Trifilio
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA.
| | - L Gordon
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA
| | - H Rubin
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA
| | - N Grosshans
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA
| | - J Mehta
- The Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 250 E. Superior St. Prentice Pavilion Rm 15-2125, Chicago, IL, 60611, USA
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Khawaja SN, Scrivani SJ. Utilization of neurolysis in management of refractory head and neck cancer-related pain in palliative patients: A retrospective review. J Oral Pathol Med 2020; 49:484-489. [PMID: 32531095 DOI: 10.1111/jop.13058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pain is a common symptom of head and neck cancers. In some instances, pain may not resolve with conventional modalities and become refractory. Chemical neurolysis is a technique that utilizes chemical neurolytic agents to temporarily denervate a targeted nerve and provide relief in pain-related symptoms. The aim of this investigation was to determine the effectiveness, safety, and predictors of chemical neurolysis procedures for management of refractory head and neck cancer-related pain. METHODS A retrospective chart review of patients who underwent chemical neurolysis procedure in the regions of head and neck for management of head and neck cancer-related pain was conducted between November 2017 and November 2018. All adult male and female patients who had undergone chemical neurolysis procedure in the head and neck region for management of refractory head and neck related pain, in Orofacial Pain Clinic, Shaukat Khanum Memorial Cancer Hospital and Research Center were included in the investigation. RESULTS Among 33 participants enrolled, 72.7% of participants experienced 75% or greater relief in pain at the 1-month follow-up. However, 9.1% reported experiencing an adverse effect following neurolysis. A statistically significant association was found between neurolysis effectiveness and chronicity of pain. CONCLUSIONS Chemical neurolysis can provide significant relief to patients with refractory head and neck cancer-related pain as an adjunctive therapy. However, it was found to be associated with mild risk of manageable adverse effects. Shorter chronicity of pain was found to be associated with successful outcome.
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Affiliation(s)
- Shehryar Nasir Khawaja
- Diplomate American Board of Orofacial Pain, Orofacial Pain Service, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Steven John Scrivani
- Craniofacial Pain Center, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA.,Pain Research, Education and Policy Program, Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA, USA
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Degu A, Kebede K. Drug-related problems and its associated factors among breast cancer patients at the University of Gondar Comprehensive Specialized Hospital, Ethiopia: A hospital-based retrospective cross-sectional study. J Oncol Pharm Pract 2020; 27:88-98. [PMID: 32252589 DOI: 10.1177/1078155220914710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths among women worldwide. If untreated and undetected at the early stage, it causes death by spreading to distant organs. Despite various studies suggesting the high prevalence of drug-related problems among cancer patients, there was a paucity of data regarding the problems among breast cancer patients in our setting. Hence, this study was aimed to assess the drug-related problems among patients with breast cancer at the Oncology Unit of the University of Gondar Comprehensive Specialized Hospital. METHODS A retrospective cross-sectional study was conducted at the Oncology Unit of the University of Gondar Comprehensive Specialized Hospital. The data were collected by retrospective reviewing medical records of 107 breast cancer patients. The data entry and analysis were done using SPSS version 20.0 statistical software. Descriptive statistics such as percent and frequency were used to summarize categorical variables of patients' characteristics. Univariable and multivariable binary logistic regression analyses were used to investigate the potential predictors of drug-related problems. A p-value of < 0.05 was considered statistically significant. RESULTS A total of 203 drug-related problems were identified from 76 breast cancer patients, translating to a prevalence of 71.03%. Among the drug-related problems identified, adverse drug reaction (48.6%), need for additional drug therapy (45.8%), and non-adherence (32.7%) were the most prevalent. In the multivariable analysis, breast cancer patients who had concurrent co-morbidities were almost three times (AOR = 2.97, p = 0.035) more likely to experience drug-related problems as compared to those patients without co-morbidity. Moreover, those patients who had been treated with neoadjuvant chemotherapeutic regimens were 0.34 times less likely (crude odd ratio = 0.34, p = 0.023) to have drug-related problems as compared to patients treated with adjuvant chemotherapy regimens. CONCLUSION The prevalence of drug-related problems was high in our setting. Adverse drug reactions, the need for additional drug therapy, and non-adherence were the most frequently occurring drug-related problems in the study setting. Neoadjuvant chemotherapy and the presence of co-morbidities were significant predictors of drug-related problems among breast cancer patients.
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Affiliation(s)
- Amsalu Degu
- School of Pharmacy and Health Sciences, United States International University-Africa, Nairobi, Kenya
| | - Kassu Kebede
- Department of Clinical Pharmacy, College of Medicine and Health Sciences, School of Pharmacy, University of Gondar, Gondar, Ethiopia
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Cuthbert CA, Xu Y, Kong S, Boyne DJ, Hemmelgarn BR, Cheung WY. Patient-level factors associated with chronic opioid use in cancer: a population-based cohort study. Support Care Cancer 2020; 28:4201-4209. [PMID: 31900614 DOI: 10.1007/s00520-019-05224-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/28/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE Concerns around chronic opioid use (COU), misuse, and harms have led to increased scrutiny of opioid prescribing in oncology. There is lack of research examining patient-level factors associated with COU. Our aim was to examine patient-level factors associated with COU in newly diagnosed cancer patients. METHODS Population-based retrospective cohort study using administrative health data of patients in Alberta, Canada, diagnosed between February 2016 and October 2017. Adult cancer patients who completed a symptom survey within ± 60 days of diagnosis were included. Patients were divided into two groups: COU (defined as continuous opioid prescriptions for at least 90 days post-diagnosis) and non-chronic opioid use (NCOU). Logistic regression was used to evaluate factors associated with COU. RESULTS We included 694 patients (mean age 65 years; 51% female). Most had breast (20%), colorectal (13%), and lung (33%) cancers. Of the 14% with COU, 79% were opioid naïve at diagnosis. Those in the COU group were more often diagnosed with advanced cancer (66% versus 40%), had lung cancer (47%), and were opioid tolerant (> 90 days of continuous opioids within one-year pre-diagnosis). A total of 64% of COU versus 27% of NCOU had moderate to severe pain at diagnosis (p < 0.001). Irrespective of treatment type or stage, those with moderate to severe pain, were opioid tolerant at diagnosis, or had multiple prescribers were at greater risk for COU. CONCLUSIONS Specific patient groups were at increased risk of COU and should be the focus of adaptive prescribing approaches to ensure that opioid use is appropriate.
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Affiliation(s)
- Colleen A Cuthbert
- Faculty of Nursing, University of Calgary, PF 2294, 2500 University Drive N.W, Calgary, AB, T2N 1N4, Canada.
| | - Yuan Xu
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Shiying Kong
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Devon J Boyne
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Brenda R Hemmelgarn
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Winson Y Cheung
- Alberta Health Services Cancer Control, Calgary, Alberta, Canada.,Cumming School of Medicine, Department of Oncology, University of Calgary, Calgary, Canada
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Kan E, Mustafa S, Chong WW, Premakumar CM, Mohamed Shah N. Relationship Between Adherence to Opioid Analgesics and Pain Beliefs Among Patients with Cancer Pain at Tertiary Care Hospitals in Malaysia. Patient Prefer Adherence 2020; 14:1411-1419. [PMID: 32848370 PMCID: PMC7429214 DOI: 10.2147/ppa.s255289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/20/2020] [Indexed: 12/18/2022] Open
Abstract
CONTEXT Pain is a common and distressing symptom among cancer patients. Opioid analgesics are the mainstay of cancer pain management, and adequate adherence plays an important role in achieving good pain control. PURPOSE To determine the level of adherence to opioid analgesics in patients with cancer pain and to identify factors that may influence the adherence. PATIENT AND METHODS This was a cross-sectional study conducted from March to June 2018 at two tertiary care hospitals in Malaysia. Study instruments consisted of a set of validated questionnaires; the Medication Compliance Questionnaire, Brief Pain Inventory and Pain Opioid Analgesic Beliefs─Cancer scale. RESULTS A total of 134 patients participated in this study. The patients' adherence scores ranged from 52-100%. Factors with a moderate, statistically significant negative correlation with adherence were negative effect beliefs (rs= -0.53, p<0.001), pain endurance beliefs (rs = -0.49, p<0.001) and the use of aqueous morphine (rs = -0.26, p=0.002). A multiple linear regression model on these predictors resulted in a final model which accounted for 47.0% of the total variance in adherence (R2 = 0.47, F (7, 126) = 15.75, p<0.001). After controlling for other variables, negative effect beliefs were the strongest contributor to the model (β = -0.39, p<0.001) and uniquely explained 12.3% of the total variance. CONCLUSION The overall adherence to opioid analgesics among Malaysian patients with cancer pain was good. Negative effects beliefs regarding cancer pain and opioids strongly predicted adherence.
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Affiliation(s)
- Elaine Kan
- Pharmacy Department, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Mustafa
- Pharmacy Department, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Correspondence: Noraida Mohamed Shah Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur50300, MalaysiaTel +60 3 9289 8038 Email
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Şenel B, Öztürk AA. New approaches to tumor therapy with siRNA-decorated and chitosan-modified PLGA nanoparticles. Drug Dev Ind Pharm 2019; 45:1835-1848. [DOI: 10.1080/03639045.2019.1665061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Behiye Şenel
- Department of Pharmaceutical Biotechnology, Anadolu University, Eskisehir, Turkey
| | - A. Alper Öztürk
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Anadolu University, Eskisehir, Turkey
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Fernando GVMC, Wanigabadu LU, Vidanagama B, Samaranayaka TSP, Jeewandara JMKC. "Adjunctive Effects of a Short Session of Music on Pain, Low-mood and Anxiety Modulation among Cancer Patients" - A Randomized Crossover Clinical Trial. Indian J Palliat Care 2019; 25:367-373. [PMID: 31413450 PMCID: PMC6659521 DOI: 10.4103/ijpc.ijpc_22_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Pain, a distressing symptom frequently suffered by cancer patients, is inherently associated with anxiety and depression yet often not alleviated with pharmacotherapy alone. This study was aimed at assessing the effect of an instrumental classical music listening session as an adjunct to the ongoing therapies, on pain, anxiety, and mood modulation in cancer patients. MATERIALS AND METHODS A randomized crossover open clinical trial was designed involving adult resident patients suffering pain at a tertiary cancer care institution. The same group of patients (n = 24) were monitored for selected outcomes without (day 1) and then with administration of music (day 2). The primary (subjective) outcomes such as pain, anxiety, and mood levels measured on visual analog scale and surrogate (objective) parameters such as pulse rate, systolic blood pressure, diastolic blood pressure, respiratory rate, and pupillary size monitored were compared utilizing paired-sample t-test. RESULTS Statistically significant improvements were noted in all three subjective parameters; pain and anxiety were significantly diminished until the 4th h (P = 0.007 and P = 0.0022, respectively), while low mood remained alleviated until the 12th h reading point (P = 0.007). Statistically significant reductions were present in surrogate end points such as pupillary size (P = 0.003 up to 12 h) and respiratory rate (P = 0.01 up to 8 h). Declines noted in the heart rate, and blood pressure readings were statistically insignificant. None suffered deterioration of their existing well-being. CONCLUSIONS Hence, we conclude that culturally familiar instrumental classical music demonstrates a significant effect in alleviating pain, anxiety, and low mood as an adjunct to on-going therapies in cancer patients.
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Affiliation(s)
- Gunasekara Vidana Mestrige Chamath Fernando
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Sri Lanka
| | | | - Buddhika Vidanagama
- Department of Anaesthesiology, National Cancer Institute, Maharagama, Sri Lanka
| | - Terancy Shyamale Perera Samaranayaka
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Sri Lanka
| | - Jeewandara Mudiyanselage Kamal Chandima Jeewandara
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Sri Lanka
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A clinical approach to the management of cancer-related pain in emergency situations. Support Care Cancer 2019; 27:3147-3157. [PMID: 31076900 DOI: 10.1007/s00520-019-04830-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Most cancer patients experience many pain episodes depending on disruptive elements, leading them to the emergency room. The objective of the article is to describe common pitfalls that need to be avoided, as well as opportunities to be seized for repositioning patients back on their care pathway. METHODS Critical reflection based on literature analysis and clinical practice. RESULTS Most forms of cancer are now chronic, evolving diseases, and patients are treated with high-technology targeted therapies with iatrogenic effects. Moreover, the multimorphic nature of cancer-related pain requires dynamic, interdisciplinary assessments addressing its etiology, its pathophysiology, its dimensions (sensory-discriminatory, cognitive, emotional, and behavioral), and the patient's perception of it, in order to propose the most adapted therapies. However, for most patients, cancer pain remains underestimated, poorly assessed, and under-treated. In this context, the key steps in emergency cancer pain management are as follows: • Quick relief of uncontrolled cancer pain: after eliminating potential medical or surgical emergencies revealed by pain, a brief questioning will make the use of carefully titrated morphine in most situations possible. • Assessment and re-assessment of the pain and the patient, screening specific elements, to better understand the situation and its consequences. • Identification of disruptive elements leading to uncontrolled pain, with an interdisciplinary confrontation to find a mid to long-term approach, involving the appropriate pharmaceutical and/or non-pharmaceutical strategies, possibly including interventions. CONCLUSIONS Pain emergencies should be part of the cancer care pathway and, through supportive care, provide an opportunity to help cancer patients both maintain their physical, psychological, and social balance and anticipate further painful episodes.
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Development of a cancer pain self-management resource to address patient, provider, and health system barriers to care. Palliat Support Care 2019; 17:472-478. [PMID: 31010454 DOI: 10.1017/s1478951518000792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as "catalysts" for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system. METHOD The project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource. RESULT Findings suggested that an optimal self-management resource should encourage pain reporting, build patients' sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support. SIGNIFICANCE OF RESULTS Self-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.
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16
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Goodwin J, Das B. Acute Lymphoblastic Leukemia Presenting Solely as Low Back Pain. Clin Pract Cases Emerg Med 2019; 3:59-61. [PMID: 30775667 PMCID: PMC6366376 DOI: 10.5811/cpcem.2019.1.40699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/22/2018] [Accepted: 01/01/2019] [Indexed: 11/11/2022] Open
Abstract
A 23-year-old man with acute lymphoblastic leukemia presented to the emergency department without any history of constitutional symptoms (fatigue, anorexia, or weight loss), dyspnea, bruising, or bleeding. Presentation of acute leukemia solely as musculoskeletal pathology is common in pediatric populations but rare among adult patients. Recognizing this presentation of acute leukemia in adult patients could help prevent delayed diagnoses.
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Affiliation(s)
- Joshua Goodwin
- Dalhousie University, Department of Emergency Medicine, Halifax, Nova Scotia
| | - Bijon Das
- Dalhousie University, Department of Emergency Medicine, Halifax, Nova Scotia
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Valenta S, Spirig R, Miaskowski C, Zaugg K, Spichiger E. Testing a pain self-management intervention by exploring reduction of analgesics' side effects in cancer outpatients and the involvement of family caregivers: a study protocol (PEINCA-FAM). BMC Nurs 2018; 17:54. [PMID: 30559603 PMCID: PMC6292053 DOI: 10.1186/s12912-018-0323-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/19/2018] [Indexed: 12/13/2022] Open
Abstract
Background Pain is one of cancer patients’ most frequent and distressing symptoms; however, analgesics’ side effects often increase symptom burden. Further, with the home rapidly becoming the primary cancer care setting, family caregivers (FCs) commonly play central roles in patients’ pain self-management, but with little or no preparation. One US-tested intervention, the PRO-SELF© Plus Pain Control Program (PCP), designed to support cancer outpatients and their FCs in pain self-management, is currently being tested in the Swiss multi-centre PEINCA study. The current PEINCA-FAM study is a sub-study of PEINCA. The aims of PEINCA-FAM are: a) to test the efficacy of the adapted German PRO-SELF © Plus PCP to reduce side effects of analgesics; b) to enhance patients’/FCs’ knowledge regarding cancer pain; and c) to explore FCs’ involvement in patients’ pain self-management. Methods This mixed methods project combines a multi-centre randomized controlled clinical trial with qualitative data collection techniques and includes 210 patients recruited from three oncology outpatient clinics. FCs involved in patients’ pain self-management are also invited to participate. After baseline evaluation, eligible participants are randomized to a 6-week intervention group and a control group. Both groups complete a daily pain and symptom diary. Intervention group patients/FCs receive the weekly psychoeducational PRO-SELF© Plus PCP interventions; control group patients receive usual care. After completing the six-week study procedures, a subsample of 7–10 patients/FCs per group and hospital (N = 42–60) will be interviewed regarding their pain management experiences. Data collection will take place from April 2016 until December 2018. An intent-to-treat analysis and generalized linear mixed models will be applied. Qualitative data will be analysed by using interpretive description. Quantitative and qualitative results will be combined within a mixed method matrix. Discussion In clinical practice, specially trained oncology nurses in outpatient clinics could apply the intervention to reduce side effects and to enhance patients’/FCs’ self-efficacy and pain management knowledge. Trial registration The PEINCA study is registered in the Clinical Trials.gov site (code: NCT02713919, 08 March 2016).
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Affiliation(s)
- Sabine Valenta
- 1Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.,2Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Rebecca Spirig
- 1Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.,3Department of Nursing Science, University of Witten/ Herdecke, Witten, Germany
| | - Christine Miaskowski
- 4School of Nursing, University of California San Francisco (UCSF), San Francisco, USA
| | - Kathrin Zaugg
- 5Department of Radiation Oncology, Stadtspital Triemli, Zurich, Switzerland.,6Department of Radiation Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Elisabeth Spichiger
- 1Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.,7Head Office of Nursing and Allied Health Professionals, Inselspital, University Hospital Bern, Bern, Switzerland
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18
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Could Perioperative Opioid Use Increase the Risk of Cancer Progression and Metastases? Int Anesthesiol Clin 2018; 54:e1-e16. [PMID: 27602710 DOI: 10.1097/aia.0000000000000112] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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19
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Shinohara A, Andoh T, Saiki I, Kuraishi Y. Analgesic effects of systemic fentanyl on cancer pain are mediated by not only central but also peripheral opioid receptors in mice. Eur J Pharmacol 2018; 833:275-282. [DOI: 10.1016/j.ejphar.2018.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
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20
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Kim K, Lee S. Intradermal Acupuncture Along with Analgesics for Pain Control in Advanced Cancer Cases: A Pilot, Randomized, Patient-Assessor-Blinded, Controlled Trial. Integr Cancer Ther 2018; 17:1137-1143. [PMID: 30009652 PMCID: PMC6247560 DOI: 10.1177/1534735418786797] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: Ninety percent of patients with advanced cancer have
moderate to severe pain, and up to 70% of patients with cancer pain do not
receive adequate pain relief. This randomized controlled clinical trial was
designed to determine the feasibility and evaluate the effects and safety of
intradermal acupuncture (IA) in patients who were being administered analgesics
for cancer pain. Methods: Advanced cancer patients experiencing
pain were randomly assigned to IA or sham IA treatment for 3 weeks (15 patients
for each group), wherein the CV12, bilateral ST25, LI4, LR3, PC06, and Ashi
points were selected and stimulated. Follow-up evaluations were conducted 3
weeks after the end of treatments. The grade and dosage of analgesics for cancer
pain, pain intensity, quality of life, and safety were assessed.
Results: Twenty-seven patients (90%) completed 6-week trial,
and no serious adverse events were associated with either IA or sham IA
procedures except the transient side effect such as fatigue. Nine patients in
the IA group (64.3%) and 5 in the sham IA group (38.5%) responded to the 3-week
intervention. These patients were mostly in the nonopioid and the weak opioid
levels of the World Health Organization analgesic ladder. Self-reported pain
declined by −1.54 ± 1.45 and −1.15 ± 1.57 in the IA and sham IA groups,
respectively, with improved quality of life reported. Conclusions:
IA treatment appears feasible and safe for advanced cancer patients. It might
reduce analgesic usage in the early World Health Organization analgesic ladder
stage cancer patient, though it could not show significant outcome differences
due to design limitation of sham IA.
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Affiliation(s)
- Kyungsuk Kim
- 1 Department of Medical Consilience, Graduate school, Dankook University, Yongin-si, Republic of Korea
| | - Sanghun Lee
- 1 Department of Medical Consilience, Graduate school, Dankook University, Yongin-si, Republic of Korea
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21
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von Moos R, Body JJ, Rider A, de Courcy J, Bhowmik D, Gatta F, Hechmati G, Qian Y. Bone-targeted agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in real-world practice in six European countries. J Bone Oncol 2018; 11:1-9. [PMID: 29892519 PMCID: PMC5993954 DOI: 10.1016/j.jbo.2017.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Bone metastases (BMs) are common in patients with breast cancer and can lead to skeletal-related events (SREs), which are associated with increased pain and reduced quality of life (QoL). Bone-targeted agents (BTAs), like zoledronic acid and denosumab, reduce the incidence of SREs and delay progression of bone pain. MATERIALS AND METHODS We evaluated the management of BMs and pain in six European countries (Belgium, France, Germany, Italy, Spain, and UK) using the Adelphi Breast Cancer Disease Specific Programme, which included a physician survey and patient-reported outcomes (PROs) to assess the impact of BMs on pain and QoL. RESULTS 301 physicians completed patient record forms for 2984 patients with advanced breast cancer; 1408 with BMs and 1136 with metastases at sites other than bone (non-BMs). Most patients with BMs (88%) received a BTA, with 81% receiving treatment during 3 months following BM diagnosis. For those who did not receive a BTA, the main reasons given were: very recent BM diagnosis, perceived low risk of bone complications, and short life expectancy. Most patients with BMs (68%) were experiencing bone pain and, of these, 97% were taking analgesics (including 28% receiving strong opioids). Despite this, moderate to severe pain was reported in 20% of patients who were experiencing pain. PROs were assessed in 766 patients with advanced breast cancer (392 with BMs, 374 with non-BMs). Overall, patients with BMs reported worse pain and QoL outcomes than those with non-BMs, those not receiving a BTA reported worse pain. CONCLUSION Despite the large proportion of patients receiving BTAs in this study, some patients with BMs are still not receiving early treatment to prevent SREs or to manage pain. Improving physicians' understanding of the role of BTAs and the importance of early treatment following BM diagnosis has the potential to improve patient care.
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Key Words
- BMs, bone metastases
- BPI, Brief Pain Inventory
- BTA, bone-targeted agent
- Bone metastases
- Bone pain
- Bone-targeted agents
- CI, confidence interval
- DSP, Disease Specific Programme
- EQ-5D, 5-dimension (3-level) EuroQol questionnaire
- ER, estrogen receptor
- FACT-B, Functional Assessment of Cancer Therapy – Breast questionnaire
- HER2, human epidermal growth factor receptor 2
- ONJ, osteonecrosis of the jaw
- PRF, Patient Record Form
- PRO, patient-reported outcome
- PSCF, Patient Self-Completion Form
- QoL, quality of life
- SRE, Skeletal-related event
- ZA, zoledronic acid
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Affiliation(s)
- Roger von Moos
- Kantonsspital Graubünden, Loëstrasse 170, CH-7000 Chur, Switzerland
| | | | | | | | | | | | | | - Yi Qian
- Amgen Inc., Thousand Oaks, CA, USA
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22
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Dubé CE, Mack DS, Hunnicutt JN, Lapane KL. Cognitive Impairment and Pain Among Nursing Home Residents With Cancer. J Pain Symptom Manage 2018; 55:1509-1518. [PMID: 29496536 PMCID: PMC5951760 DOI: 10.1016/j.jpainsymman.2018.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 11/15/2022]
Abstract
CONTEXT The prevalence of pain and its management has been shown to be inversely associated with greater levels of cognitive impairment. OBJECTIVES To evaluate whether the documentation and management of pain varies by level of cognitive impairment among nursing home residents with cancer. METHODS Using a cross-sectional study, we identified all newly admitted U.S. nursing home residents with a cancer diagnosis in 2011-2012 (n = 367,462). Minimum Data Set 3.0 admission assessment was used to evaluate pain/pain management in the past five days and cognitive impairment (assessed via the Brief Interview for Mental Status or the Cognitive Performance Scale for 91.6% and 8.4%, respectively). Adjusted prevalence ratios with 95% CI were estimated from robust Poisson regression models. RESULTS For those with staff-assessed pain, pain prevalence was 55.5% with no/mild cognitive impairment and 50.5% in those severely impaired. Pain was common in those able to self-report (67.9% no/mild, 55.9% moderate, and 41.8% severe cognitive impairment). Greater cognitive impairment was associated with reduced prevalence of any pain (adjusted prevalence ratio severe vs. no/mild cognitive impairment; self-assessed pain 0.77; 95% CI 0.76-0.78; staff-assessed pain 0.96; 95% CI 0.93-0.99). Pharmacologic pain management was less prevalent in those with severe cognitive impairment (59.4% vs. 74.9% in those with no/mild cognitive impairment). CONCLUSION In nursing home residents with cancer, pain was less frequently documented in those with severe cognitive impairment, which may lead to less frequent use of treatments for pain. Techniques to improve documentation and treatment of pain in nursing home residents with cognitive impairment are needed.
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Affiliation(s)
- Catherine E Dubé
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
| | - Deborah S Mack
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jacob N Hunnicutt
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Health-Related Quality of Life of Patients with HPV-Related Cancers in Indonesia. Value Health Reg Issues 2018; 15:63-69. [DOI: 10.1016/j.vhri.2017.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/27/2017] [Accepted: 07/27/2017] [Indexed: 12/13/2022]
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McDowell GC, Winchell J. Role of primary care physicians in intrathecal pain management: a narrative review of the literature. Postgrad Med 2018. [PMID: 29542370 DOI: 10.1080/00325481.2018.1448207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The majority of patients seeking medical care for chronic pain consult a primary care physician (PCP). Because systemic opioids are commonly prescribed to patients with chronic pain, PCPs are attempting to balance the competing priorities of providing adequate pain relief while reducing risks for opioid misuse and overdose. It is important for PCPs to be aware of pain management strategies other than systemic opioid dose escalation when patients with chronic pain fail to respond to conservative therapies and to initiate a multimodal treatment plan. METHODS The Medline database and evidence-based treatment guidelines were searched to identify publications on intrathecal (IT) therapy for the management of chronic pain. Selection of publications relevant to PCPs was based on the authors' clinical and research expertise. RESULTS IT administration delivers analgesic medication directly into the cerebrospinal fluid, avoiding first-pass effect and bypassing the blood-brain barrier, thereby requiring lower medication doses. Morphine, a µ-opioid receptor agonist, and ziconotide, a non-opioid, selective N-type calcium channel blocker, are the only analgesics approved by the US Food and Drug Administration to treat chronic refractory pain by the IT route. Patients who are potential candidates for IT therapy may benefit from evaluation by an interventional pain physician. PCPs can play an important role in patient selection and referral for IT therapy and provide ongoing collaborative care for patients receiving IT therapy, including monitoring for efficacy and adverse events and facilitating communication with the treating specialist. CONCLUSIONS Collaboration between PCPs and pain specialists may improve outcomes of and patient satisfaction with IT therapy and other interventional treatments.
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25
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Ferioli M, Zauli G, Martelli AM, Vitale M, McCubrey JA, Ultimo S, Capitani S, Neri LM. Impact of physical exercise in cancer survivors during and after antineoplastic treatments. Oncotarget 2018; 9:14005-14034. [PMID: 29568412 PMCID: PMC5862633 DOI: 10.18632/oncotarget.24456] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/23/2018] [Indexed: 12/12/2022] Open
Abstract
Cancer patients experience symptoms and adverse effects of treatments that may last even after the end of treatments. Exercise is a safe, non-pharmacological and cost-effective therapy that can provide several health benefits in cancer patient and survivors, reducing cancer symptoms and cancer treatment side effects. The purpose of this review is to describe how the physical exercise is capable to reduce cancer symptoms and cancer treatment side effects. We realized a pragmatic classification of symptoms, dividing them into physical, psychological and psycho-physical aspects. For each symptom we discuss causes, therapies, we analyse the effects of physical exercise and we summarize the most effective type of exercise to reduce the symptoms. This review also points out what are the difficulties that patients and survivors face during the practice of physical activity and provides some solutions to overcome these barriers. Related to each specific cancer, it emerges that type, frequency and intensity of physical exercise could be prescribed and supervised as a therapeutic program, like it occurs for the type, dose and duration of a drug treatment.
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Affiliation(s)
- Martina Ferioli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giorgio Zauli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alberto M Martelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Vitale
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- CoreLab, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - James A McCubrey
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Simona Ultimo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Silvano Capitani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Luca M Neri
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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26
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A nationwide study of the extent and factors associated with fentanyl use in Australia. Res Social Adm Pharm 2018; 14:303-308. [DOI: 10.1016/j.sapharm.2017.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 11/18/2022]
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27
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SEOM clinical guideline for treatment of cancer pain (2017). Clin Transl Oncol 2017; 20:97-107. [PMID: 29127593 PMCID: PMC5785609 DOI: 10.1007/s12094-017-1791-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/23/2022]
Abstract
Pain is a highly prevalent symptom in patients with cancer. Despite therapeutic advances and well-accepted treatment guidelines, a percentage of patients with pain are under-treated.
Currently, it has been recognized that several barriers in pain management still exist and, in addition, there are new challenges surrounding complex subtypes of pain, such as breakthrough and neuropathic pain, requiring further reviews and recommendations. This is an update of the guide our society previously published and represents the continued commitment of SEOM to move forward and improve supportive care of cancer patients.
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Abstract
Opioid analgesia is a mainstay of the treatment of cancer pain. Treatment of pain in patients with cancer with an ongoing substance abuse disorder can be difficult. We report the ethical challenges of treating a patient with cancer with a concomitant substance abuse disorder in an outpatient palliative care setting. We present an analysis of ethical considerations for the palliative care physician and strategies to aid in the successful treatment of such patients. We argue that there are select patients with cancer for whom exclusion from treatment with opioid therapy is warranted if their health is endangered by prescription of these medications.
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Affiliation(s)
- Leanne K. Jackson
- Michael E. DeBakey Veterans Affairs Medical Center; Baylor College of Medicine, Houston, TX
| | - Syed N. Imam
- Michael E. DeBakey Veterans Affairs Medical Center; Baylor College of Medicine, Houston, TX
| | - Ursula K. Braun
- Michael E. DeBakey Veterans Affairs Medical Center; Baylor College of Medicine, Houston, TX
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29
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Reis-Pina P, Lawlor PG, Barbosa A. Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic. J Pain Res 2017; 10:2097-2107. [PMID: 28919809 PMCID: PMC5587145 DOI: 10.2147/jpr.s139715] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Several guidelines have advocated the need for adequate cancer-related pain (CRP) management. The pain management index (PMI) has been proposed as an auditable measure of the appropriateness for analgesic therapy. Objectives To determine the adequacy of CRP management based on the PMI status and its patient-related predictors at the point of referral to a pain clinic (PC). Methods Consecutive patients referred to a PC had standardized initial assessments and status documentation on the Brief Pain Inventory (BPI) ratings; pain mechanism, using a neuropathic pain diagnostic questionnaire (the Douleur Neuropathique 4 tool); episodic pain; oral morphine equivalent daily dose; the Hospital Anxiety Depression Scale and the Emotion Thermometer scores; and cancer diagnosis, metastases, treatment, and pain duration. Predictors of “negative PMI status” [PMI(−)] were examined in logistic regression models. Variables with p<0.25 in an initial bivariable analysis were entered into a multivariable model. Results Of 371 participants, 95 (25.6%) had PMI(−), suggesting undertreatment of CRP. Both female sex and higher scores on the BPI’s “interference with general activity” more strongly predicted PMI(−). Patients who received either radiotherapy or one or more adjuvant analgesics prior to the initial consultation at the PC, those who had neuropathic pain, those who had a greater need for emotional help, and those with higher BPI’s “relief ” scores were all less likely to be PMI(−). Conclusion The potential burden of patient and family distress associated with suboptimal CRP management in one in four patients should generate major public health concern and prompt appropriate educational and health policy measures to address the deficit.
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Affiliation(s)
- Paulo Reis-Pina
- Palliative Care Unit, Casa de Saúde da Idanha, Sintra.,Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Peter G Lawlor
- Ottawa Hospital Research Institute.,Bruyère Research Institute, Bruyère Continuing Care.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - António Barbosa
- Department of Psychiatry, North Lisbon Hospital Centre, Lisbon.,Centre of Bioethics and Palliative Care Studies Division, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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30
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Shen WC, Chen JS, Shao YY, Lee KD, Chiou TJ, Sung YC, Rau KM, Yen CJ, Liao YM, Liu TC, Wu MF, Lee MY, Yu MS, Hwang WL, Lai PY, Chang CS, Chou WC, Hsieh RK. Impact of Undertreatment of Cancer Pain With Analgesic Drugs on Patient Outcomes: A Nationwide Survey of Outpatient Cancer Patient Care in Taiwan. J Pain Symptom Manage 2017; 54:55-65.e1. [PMID: 28479410 DOI: 10.1016/j.jpainsymman.2017.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/10/2017] [Accepted: 02/20/2017] [Indexed: 11/21/2022]
Abstract
CONTEXT Undertreatment of cancer pain among outpatient cancer patients needs to be addressed to enhance care and improve patients' quality of life (QoL). OBJECTIVES This prospective, cross-sectional, patient-focused study aimed to explore the prevalence of pain and undertreatment of cancer pain in outpatients in Taiwan. METHODS A total of 2652 non-selected outpatients with cancer and aged 20 years or older from 16 medical centers across Taiwan were included in this survey. All patients completed a questionnaire based on the Brief Pain Inventory. Pain management index (PMI) was used to evaluate the adequacy of pain management. Possible clinical variables of patients with positive PMI were examined by univariate and multivariate logistic regressions. RESULTS A total of 1659 (62.6%) outpatients had experienced some degree of pain; among these, 32.4% had negative PMI. Patients with a negative PMI score had significantly poor outcomes of QoL and a significantly higher tendency toward dissatisfaction with pain control by the physician and with the prescribed analgesic drugs. Female gender, primary tumor from breast, non-cancer-related cause of pain, and hospital locations from north Taiwan were independent variables that predicated patients with undertreatment of cancer pain. Most importantly, a forward trend of undertreatment of pain among patients who presented with lower prevalent rate of pain was observed. CONCLUSION One-third of Taiwanese outpatients experienced pain because of undertreatment. Awareness of the prevalence of undertreatment of cancer pain and identification of the vulnerable subjects may assist in enhancing patient care and improving patient's QoL.
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Affiliation(s)
- Wen-Chi Shen
- Division of Hematology-Oncology, Department of Internal Medicine, Linkuo Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Linkuo Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yun Shao
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Der Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tzeon-Jye Chiou
- Division of Hematology-Oncology, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Yung-Chuan Sung
- Division of Hematology-Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Kun-Ming Rau
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chia-Jui Yen
- Division of Hematology-Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yu-Min Liao
- Division of Hematology-Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Ta-Chih Liu
- Division of Hematology-Oncology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Ming-Fang Wu
- Division of Hematology-Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Yang Lee
- Division of Hematology-Oncology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Ming-Sun Yu
- Division of Hematology-Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Li Hwang
- Division of Hematology-Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pang-Yu Lai
- Division of Hematology-Oncology, E-DA Hospital, Kaohsiung, Taiwan
| | - Cheng-Shyong Chang
- Division of Hematology-Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Department of Internal Medicine, Linkuo Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Ruey-Kuen Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
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Dureja GP, Iyer RN, Das G, Ahdal J, Narang P. Evidence and consensus recommendations for the pharmacological management of pain in India. J Pain Res 2017; 10:709-736. [PMID: 28435313 PMCID: PMC5386610 DOI: 10.2147/jpr.s128655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events - particularly with opioids and surgical methods of analgesia - are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case-control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making.
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Affiliation(s)
| | - Rajagopalan N Iyer
- Department of Orthopaedics, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka
| | - Gautam Das
- Daradia Pain Clinic, Kolkata, West Bengal
| | - Jaishid Ahdal
- Department of Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd, Mumbai, Maharashtra, India
| | - Prashant Narang
- Department of Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd, Mumbai, Maharashtra, India
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Beatty L, Binnion C, Kemp E, Koczwara B. A qualitative exploration of barriers and facilitatorsto adherence to an online self-help intervention for cancer-related distress. Support Care Cancer 2017; 25:2539-2548. [PMID: 28299458 DOI: 10.1007/s00520-017-3663-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/06/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study qualitatively explored barriers and facilitators of adherence to an online psychological intervention for cancer-related distress. METHODS Semi-structured interviews were conducted with 13 adults with cancer, randomised to receive either a 6-week intervention (n = 8) or attention control (n = 5) as part of a larger RCT. Transcripts were coded for themes and subthemes, and recruitment ceased when saturation of themes occurred. RESULTS Adherence overall was high: six participants completed all six modules, three completed five modules, two completed four modules, one completed one module, and one did not access the program. The total numbers of barriers (n = 19) and facilitators (n = 17) identified were equivalent and were categorised into five overarching themes: illness factors, psychological factors, personal factors, intervention factors and computer factors. However, the prevalence with which themes were discussed differed: illness factors (specifically cancer treatment side effects) were the main reported barrier to adherence; intervention factors (email reminders, program satisfaction, ease of use, program content) were the most common facilitators. CONCLUSION While some factors were cited as both facilitating and barring adherence, and therefore reflective of personal preferences and circumstances, a number of recommendations were derived regarding (i) the best timing for online interventions and (ii) the need for multi-platform programs.
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Affiliation(s)
- Lisa Beatty
- School of Psychology, Flinders University, Adelaide, Australia.
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia.
| | - Claire Binnion
- School of Psychology, Flinders University, Adelaide, Australia
| | - Emma Kemp
- School of Psychology, Flinders University, Adelaide, Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
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Jokinen V, Lilius T, Laitila J, Niemi M, Kambur O, Kalso E, Rauhala P. Do Diuretics have Antinociceptive Actions: Studies of Spironolactone, Eplerenone, Furosemide and Chlorothiazide, Individually and with Oxycodone and Morphine. Basic Clin Pharmacol Toxicol 2016; 120:38-45. [PMID: 27312359 DOI: 10.1111/bcpt.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/14/2016] [Indexed: 11/29/2022]
Abstract
Spironolactone, eplerenone, chlorothiazide and furosemide are diuretics that have been suggested to have antinociceptive properties, for example via mineralocorticoid receptor antagonism. In co-administration, diuretics might enhance the antinociceptive effect of opioids via pharmacodynamic and pharmacokinetic mechanisms. Effects of spironolactone (100 mg/kg, i.p.), eplerenone (100 mg/kg, i.p.), chlorothiazide (50 mg/kg, i.p.) and furosemide (100 mg/kg, i.p.) were studied on acute oxycodone (0.75 mg/kg, s.c.)- and morphine (3 mg/kg, s.c.)-induced antinociception using tail-flick and hot plate tests in male Sprague Dawley rats. The diuretics were administered 30 min. before the opioids, and behavioural tests were performed 30 and 90 min. after the opioids. Concentrations of oxycodone, morphine and their major metabolites in plasma and brain were quantified by mass spectrometry. In the hot plate test at 30 and 90 min., spironolactone significantly enhanced the antinociceptive effect (% of maximum possible effect) of oxycodone from 10% to 78% and from 0% to 50%, respectively, and that of morphine from 12% to 73% and from 4% to 83%, respectively. The brain oxycodone and morphine concentrations were significantly increased at 30 min. (oxycodone, 46%) and at 90 min. (morphine, 190%). We did not detect any independent antinociceptive effects with the diuretics. Eplerenone and chlorothiazide did not enhance the antinociceptive effect of either opioid. The results suggest that spironolactone enhances the antinociceptive effect of both oxycodone and morphine by increasing their concentrations in the central nervous system.
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Affiliation(s)
- Viljami Jokinen
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuomas Lilius
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jouko Laitila
- Department of Clinical Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mikko Niemi
- Department of Clinical Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Oleg Kambur
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eija Kalso
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Rauhala
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Kashyap S. Retroperitoneal Endodermal Sinus Tumor Patient with Palliative Care Needs. Indian J Palliat Care 2016; 22:97-100. [PMID: 26962288 PMCID: PMC4768458 DOI: 10.4103/0973-1075.173955] [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: 11/26/2022] Open
Abstract
This article is a case reflection of a personal encounter on the palliative care treatment required after the removal of a complicated case of a primary extra-gonadal retro-peritoneal endodermal sinus tumor (yolk sac tumor). This reflection is from the perspective of a recently graduated MD student who spent one month with an Indian pain management and palliative care team at the Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), New Delhi
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Affiliation(s)
- Surbhi Kashyap
- Windsor University School of Medicine, St. Kitts, West Indies
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35
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Pergolizzi JV, Zampogna G, Taylor R, Gonima E, Posada J, Raffa RB. A Guide for Pain Management in Low and Middle Income Communities. Managing the Risk of Opioid Abuse in Patients with Cancer Pain. Front Pharmacol 2016; 7:42. [PMID: 26973529 PMCID: PMC4771925 DOI: 10.3389/fphar.2016.00042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
Most patients who present with cancer have advanced disease and often suffer moderate to severe pain. Opioid therapy can be safe and effective for use in cancer patients with pain, but there are rightful concerns about inappropriate opioid use even in the cancer population. Since cancer patients live longer than ever before in history (and survivors may have long exposure times to opioid therapy), opioid misuse among cancer patients is an important topic worthy of deeper investigation. Cancer patients with pain must be evaluated for risk factors for potential opioid misuse and aberrant drug-taking behaviors assessed. A variety of validated screening tools should be used. Of particular importance is the fact that pain in cancer patients changes frequently, whether it is related to their underlying disease (progression or remission), pain related to treatment (such as painful chemotherapy-induced peripheral neuropathy), and concomitant pain unrelated to cancer (such as osteoarthritis, headache, or back pain). Fortunately, clinicians can use universal precautions to help reduce the risk of opioid misuse while still assuring that cancer patients get the pain therapy they need. Another important new “tool” in this regard is the emergence of abuse-deterrent opioid formulations.
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Affiliation(s)
- Joseph V Pergolizzi
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore, MD, USA; Department of Anesthesiology, Georgetown University School of MedicineWashington, DC, USA; Department of Pharmacology, Temple University School of MedicinePhiladelphia, PA, USA
| | | | | | - Edmundo Gonima
- Anesthesiologist, Pain and Palliative Care, Pain Specialist in Hospital Militar Bogota, Colombia
| | - Jose Posada
- Psychiatry, Colombian National Board of Narcotics Bogota, Colombia
| | - Robert B Raffa
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy Philadelphia, PA, USA
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Cherny NI. ESMO gave me a chance to help make a difference: a personal reflection on the occasion of receiving the 2015 ESMO Award. ESMO Open 2016; 1:e000061. [PMID: 27843614 PMCID: PMC5070249 DOI: 10.1136/esmoopen-2016-000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022] Open
Abstract
On the occasion of receiving the ESMO 2015, Prof Nathan Cherny reflects on the potential of the individual clinician to address issues of consequence on a wider scale through the auspices of a professional medical society. He describes his 20 year relationship with ESMO illustrating the potential of harnessing the power of ESMO to influence care, professional behaviours and distributional justice in the provision of care. He urges oncologists to be inspired by the credos that he was nurtured on emphasising professional and personal integrity and the audacity to push boundaries.
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Affiliation(s)
- Nathan I Cherny
- Department of Medical Oncology , Shaare Zedek Medical Center , Jerusalem , Israel
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Rastogi P, Naseem S, Varma N, Varma S. Nucleophosmin mutation in de-novo acute myeloid leukemia. Asia Pac J Clin Oncol 2015; 12:77-85. [PMID: 26669619 DOI: 10.1111/ajco.12442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 06/22/2015] [Accepted: 10/11/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Acute myeloid leukemia (AML) with mutated nucleophosmin gene (NPM1) has distinctive clinical, hematological and molecular features, and is included as a provisional entity in 2008 World Health Organization classification. In this study, we analyzed the frequency and features of AML with mutated NPM1 in Indian patients. METHODS One-hundred consecutive patients of de-novo AML were evaluated for NPM1 mutation and their features were compared with unmutated NPM1 patients. RESULTS AML with mutated NPM1 was seen in 21% cases. There was female preponderance with median age of 51 years. Distinguishing Features in mutated group were less bleeding manifestations and bone pains; more lymphadenopathy; higher median total leukocyte and platelet count; less frequency of pancytopenia and more preserved megakaryocytes. Morphologically, cup-shaped nuclei in peripheral blood blasts correlated with NPM1 mutation (p <0.01), but not bone marrow blasts. Among the French-American-British subtypes, NPM1 mutation was seen in M1, M4 and M2 subtypes but not in M0 and M3. Immunophenotypically, there was statistically significant negativity for CD34, strong association with monocytic markers (especially CD11c), CD123 was seen at higher frequency and higher mean fluorescence intensity (MFI) values for CD33 were observed in mutated cases. CONCLUSIONS Important findings in this study that have not been highlighted in detail in previous studies in NPM1-mutated cases include less bleeding manifestations and bone pains, lower frequency of pancytopenia and more preserved magakaryocytes, higher CD123 expression and higher MFI values for CD33. Presence of blasts with cup-shaped nuclei correlated with NPM1 mutation.
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Affiliation(s)
| | | | | | - Subhash Varma
- Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Wang CH, Lee SYC. Undertreatment of caner pain. ACTA ACUST UNITED AC 2015; 53:58-61. [PMID: 26063333 DOI: 10.1016/j.aat.2015.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022]
Abstract
Pain is a burdensome symptom that can commonly exist chronically along the cancer trajectory. Uncontrolled pain will impact on cancer patients' quality of life, even further negatively affect cancer survivors' employment. Based on systemic reviews of studies for past 10 years, the paper reported that although there is enormous advancement on the knowledge of cancer pain and pain management, studies still documented undertreatment of cancer pain globally. Additionally, pain distress a significant portion of cancer survivors. The pain in cancer survivors distinct from the pain related with cancer, instead emphasize on pain related with cancer treatment, such as neuropathic pain, muscular syndrome. Evidence-based pain management with common pain problems in cancer survivors is lacking. Further studies are needed to understand the pain in cancer survivors and to develop effective strategies in helping cancer survivors to manage their pain.
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Affiliation(s)
- Cheng-Hsu Wang
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Shiu-Yu C Lee
- Chang Gung Memorial Hospital, Clinic of Internal Medicine, Division of Hematology-Oncology, Department of Internal Medicine, Keelung, Taiwan
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Leppert W. Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:2215-31. [PMID: 25931815 PMCID: PMC4404965 DOI: 10.2147/dddt.s32684] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Opioid-induced bowel dysfunction (OIBD) comprises gastrointestinal (GI) symptoms, including dry mouth, nausea, vomiting, gastric stasis, bloating, abdominal pain, and opioid-induced constipation, which significantly impair patients’ quality of life and may lead to undertreatment of pain. Traditional laxatives are often prescribed for OIBD symptoms, although they display limited efficacy and exert adverse effects. Other strategies include prokinetics and change of opioids or their administration route. However, these approaches do not address underlying causes of OIBD associated with opioid effects on mostly peripheral opioid receptors located in the GI tract. Targeted management of OIBD comprises purely peripherally acting opioid receptor antagonists and a combination of opioid receptor agonist and antagonist. Methylnaltrexone induces laxation in 50%–60% of patients with advanced diseases and OIBD who do not respond to traditional oral laxatives without inducing opioid withdrawal symptoms with similar response (45%–50%) after an oral administration of naloxegol. A combination of prolonged-release oxycodone with prolonged-release naloxone (OXN) in one tablet (a ratio of 2:1) provides analgesia with limited negative effect on the bowel function, as oxycodone displays high oral bioavailability and naloxone demonstrates local antagonist effect on opioid receptors in the GI tract and is totally inactivated in the liver. OXN in daily doses of up to 80 mg/40 mg provides equally effective analgesia with improved bowel function compared to oxycodone administered alone in patients with chronic non-malignant and cancer-related pain. OIBD is a common complication of long-term opioid therapy and may lead to quality of life deterioration and undertreatment of pain. Thus, a complex assessment and management that addresses underlying causes and patomechanisms of OIBD is recommended. Newer strategies comprise methylnaltrexone or OXN administration in the management of OIBD, and OXN may be also considered as a preventive measure of OIBD development in patients who require opioid administration.
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Affiliation(s)
- Wojciech Leppert
- Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Lovell M, Luckett T, Boyle F, Stubbs J, Phillips J, Davidson PM, Olver I, von Dincklage J, Agar M. Adaptation of international guidelines on assessment and management of cancer pain for the Australian context. Asia Pac J Clin Oncol 2015; 11:170-7. [DOI: 10.1111/ajco.12352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Lovell
- Greenwich Hospital; HammondCare; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
| | - Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney (UTS); Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales (UNSW); Sydney New South Wales Australia
| | - Frances Boyle
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- Patricia Ritchie Centre for Cancer Care and Research; Mater Hospital; Sydney New South Wales Australia
| | | | - Jane Phillips
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney (UTS); Sydney New South Wales Australia
| | - Patricia Mary Davidson
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- Centre for Cardiovascular and Chronic Care; Faculty of Health; University of Technology Sydney (UTS); Sydney New South Wales Australia
- School of Nursing; Johns Hopkins University; Baltimore Maryland USA
| | - Ian Olver
- Cancer Council Australia; Sydney New South Wales Australia
| | | | - Meera Agar
- Greenwich Hospital; HammondCare; Sydney New South Wales Australia
- Improving Palliative Care through Clinical Trials (ImPaCCT); Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales (UNSW); Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Sydney New South Wales Australia
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Torresan MM, Garrino L, Borraccino A, Macchi G, De Luca A, Dimonte V. Adherence to treatment in patient with severe cancer pain: A qualitative enquiry through illness narratives. Eur J Oncol Nurs 2015; 19:397-404. [PMID: 25691299 DOI: 10.1016/j.ejon.2015.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/09/2015] [Accepted: 01/15/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Pain is a common symptom in cancer patients and often the most tangible sign of disease they and their families perceive. Despite currently available treatments, cancer pain frequently remains underrated and undertreated because of lack of adherence to the prescribed drug regimen. With this study we sought to identify elements that could facilitate pain management by exploring through narrative interviews the lived experiences of patients with severe chronic cancer pain in relation to their adherence to pain therapy. METHOD A purposive sample of 18 cancer patients, treated at the Centre for Oncology and Haematology (COES), City Hospital for Health and Science, Turin, were interviewed. The interview contents were analysed using a qualitative phenomenological methodology as described by Giorgi. RESULTS Three themes emerged from analysis of the interview transcripts: the significance of pain in subjective experience; the experience of being a patient pursuing a care pathway and the importance attributed to pain therapy. Factors facilitating adherence included the perception of the physical and psychological benefits of having and following a pain medications plan, subjective self-efficacy in pain control, and trust in the healthcare team. Barriers to adherence were negative attitudes toward opioid analgesic therapy, debilitating drug side effects, and denial of pain as a tangible sign of disease. CONCLUSION Probing into the significance of the pain experience and its treatment through these narrative interviews revealed several core constituents of adherence. Healthcare providers can use this better understanding to build a trusting relationship with patients and foster adherence to treatment throughout the care pathway.
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Affiliation(s)
- Maria Marina Torresan
- Pain Management and Palliative Care Unit, City Hospital Health and Science of the City of Turin, Corso Dogliotti 14, 10126 Torino, Italy
| | - Lorenza Garrino
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126 Torino (TO), Italy
| | - Alberto Borraccino
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126 Torino (TO), Italy.
| | - Giorgia Macchi
- Pain Management and Palliative Care Unit, City Hospital Health and Science of the City of Turin, Corso Dogliotti 14, 10126 Torino, Italy
| | - Anna De Luca
- Pain Management and Palliative Care Unit, City Hospital Health and Science of the City of Turin, Corso Dogliotti 14, 10126 Torino, Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126 Torino (TO), Italy
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Palliative thoracic radiotherapy for patients with advanced non-small cell lung cancer and poor performance status. Lung Cancer 2015; 87:130-5. [DOI: 10.1016/j.lungcan.2014.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 11/18/2014] [Accepted: 11/24/2014] [Indexed: 11/15/2022]
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Argoff CE, Kopecky EA. Patients with chronic pain and dysphagia (CPD): unmet medical needs and pharmacologic treatment options. Curr Med Res Opin 2014; 30:2543-59. [PMID: 25244248 DOI: 10.1185/03007995.2014.967388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND For properly selected patients experiencing chronic pain, extended-release opioid formulations may represent an appropriate pain management choice. For the many adults, elderly, and children who have medical conditions that make swallowing solid, oral-dose formulations difficult (dysphagia) or painful (odynophagia), this option may be limited. The combination of chronic pain with dysphagia (CPD) presents a challenge to physicians and patients alike when oral opioid analgesia is needed to control pain, but patients are unable to swallow solid, oral dosage forms. METHODS A Medline search was performed (1990 to 2013) using the search terms swallowing difficulties, dysphagia, odynophagia, adults, pediatrics, elderly, chronic pain, pain, and opioids. The following websites were searched: American Dysphagia Network, Dysphagia Research Society, World Health Organization, American Pain Society, International Association for the Study of Pain, American Academy of Pain Medicine, and American Society of Interventional Pain Physicians. Chronic pain guidelines from the following professional organizations were searched: American Pain Society, National Comprehensive Cancer Network, American Society of Interventional Pain Physicians, British Geriatric Society, European Society of Medical Oncology, World Health Organization, and the European Association for Palliative Care. FINDINGS There is an unmet medical need for greater recognition of dysphagia, awareness of potential problems with medication administration in these patients, recognition of alternative drug formulations that are available for use in CPD, and an appreciation that there are new, solid, oral-dose, opioid formulations in development that can mitigate these issues associated with swallowing difficulty while still providing practical, effective analgesia. Current pharmacologic treatments have limitations; new, prospective opioid formulations in clinical development may offer physicians and patients with CPD effective treatment options while mitigating accidental exposure and abuse liability. CONCLUSIONS The number of patients with CPD may be larger than is currently anticipated by healthcare providers. Physicians should proactively include a discussion of dysphagia as part of the patient examination. CPD is an unmet medical need. There are novel opioid formulations in clinical development that address the limitations of current opioid treatments. This manuscript reviews the problems associated with dysphagia on medication administration and adherence, currently available treatment options, and opioid analgesic formulations currently in clinical development.
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Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 2014; 32:4149-54. [PMID: 25403222 DOI: 10.1200/jco.2014.56.0383] [Citation(s) in RCA: 335] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pain is a frequent symptom in patients with cancer, with substantial impact. Despite the availability of opioids and updated guidelines from reliable leading societies, undertreatment is still frequent. METHODS We updated a systematic review published in 2008, which showed that according to the Pain Management Index (PMI), 43.4% of patients with cancer were undertreated. This review included observational and experimental studies reporting negative PMI scores for adults with cancer and pain published from 2007 to 2013 and retrieved through MEDLINE, Embase, and Google Scholar. To detect any temporal trend and identify potential determinants of undertreatment, we compared articles published before and after 2007 with univariable, multivariable, and sensitivity analyses. RESULTS In the new set of 20 articles published from 2007 to 2013, there was a decrease in undertreatment of approximately 25% (from 43.4 to 31.8%). In the whole sample, the proportion of undertreated patients fell from 2007 to 2013, and an association was confirmed between negative PMI score, economic level, and nonspecific setting for cancer pain. Sensitivity analysis confirmed the robustness of results. CONCLUSION Analysis of 46 articles published from 1994 to 2013 using the PMI to assess the adequacy of analgesic therapy suggests the quality of pharmacologic pain management has improved. However, approximately one third of patients still do not receive pain medication proportional to their pain intensity.
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Affiliation(s)
- Maria Teresa Greco
- Maria Teresa Greco, University of Milan; Maria Teresa Greco, Anna Roberto, and Oscar Corli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto di Ricerche Farmacologiche "Mario Negri," Milan; Silvia Deandrea, European Commission, Joint Research Centre, Ispra; Elena Bandieri, Azienda Unita Sanitaria Locale di Modena, Modena; and Silvio Cavuto and Giovanni Apolone, IRCCS, Arcispedale "S. Maria Nuova," Reggio Emilia, Italy.
| | - Anna Roberto
- Maria Teresa Greco, University of Milan; Maria Teresa Greco, Anna Roberto, and Oscar Corli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto di Ricerche Farmacologiche "Mario Negri," Milan; Silvia Deandrea, European Commission, Joint Research Centre, Ispra; Elena Bandieri, Azienda Unita Sanitaria Locale di Modena, Modena; and Silvio Cavuto and Giovanni Apolone, IRCCS, Arcispedale "S. Maria Nuova," Reggio Emilia, Italy
| | - Oscar Corli
- Maria Teresa Greco, University of Milan; Maria Teresa Greco, Anna Roberto, and Oscar Corli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto di Ricerche Farmacologiche "Mario Negri," Milan; Silvia Deandrea, European Commission, Joint Research Centre, Ispra; Elena Bandieri, Azienda Unita Sanitaria Locale di Modena, Modena; and Silvio Cavuto and Giovanni Apolone, IRCCS, Arcispedale "S. Maria Nuova," Reggio Emilia, Italy
| | - Silvia Deandrea
- Maria Teresa Greco, University of Milan; Maria Teresa Greco, Anna Roberto, and Oscar Corli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto di Ricerche Farmacologiche "Mario Negri," Milan; Silvia Deandrea, European Commission, Joint Research Centre, Ispra; Elena Bandieri, Azienda Unita Sanitaria Locale di Modena, Modena; and Silvio Cavuto and Giovanni Apolone, IRCCS, Arcispedale "S. Maria Nuova," Reggio Emilia, Italy
| | - Elena Bandieri
- Maria Teresa Greco, University of Milan; Maria Teresa Greco, Anna Roberto, and Oscar Corli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto di Ricerche Farmacologiche "Mario Negri," Milan; Silvia Deandrea, European Commission, Joint Research Centre, Ispra; Elena Bandieri, Azienda Unita Sanitaria Locale di Modena, Modena; and Silvio Cavuto and Giovanni Apolone, IRCCS, Arcispedale "S. Maria Nuova," Reggio Emilia, Italy
| | - Silvio Cavuto
- Maria Teresa Greco, University of Milan; Maria Teresa Greco, Anna Roberto, and Oscar Corli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto di Ricerche Farmacologiche "Mario Negri," Milan; Silvia Deandrea, European Commission, Joint Research Centre, Ispra; Elena Bandieri, Azienda Unita Sanitaria Locale di Modena, Modena; and Silvio Cavuto and Giovanni Apolone, IRCCS, Arcispedale "S. Maria Nuova," Reggio Emilia, Italy
| | - Giovanni Apolone
- Maria Teresa Greco, University of Milan; Maria Teresa Greco, Anna Roberto, and Oscar Corli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto di Ricerche Farmacologiche "Mario Negri," Milan; Silvia Deandrea, European Commission, Joint Research Centre, Ispra; Elena Bandieri, Azienda Unita Sanitaria Locale di Modena, Modena; and Silvio Cavuto and Giovanni Apolone, IRCCS, Arcispedale "S. Maria Nuova," Reggio Emilia, Italy
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Natoli S, Lazzari M, Dauri M. Open questions in the treatment of cancer pain: time for a strong evidence-based approach? Expert Opin Pharmacother 2014; 16:1-4. [PMID: 25387541 DOI: 10.1517/14656566.2015.980724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pain affects patients with cancer at any stage of their disease. Yet, it is not adequately treated in a significant percentage of cases. In 1986, the WHO proposed a three-step approach for the treatment of pain in cancer patients (from nonopioids to weak opioids to strong opioids, according to pain intensity) following the recommendations of an international group of experts. The application of the WHO strategy demonstrated that a clear and simple approach is of educational value and ensured worldwide dissemination. However, there is little evidence that the WHO approach is the best, and there are still several points to debate on the treatment of cancer pain.
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Affiliation(s)
- Silvia Natoli
- University of Rome Tor Vergata, Department of Clinical Science and Translational Medicine Policlinico di Tor Vergata, Viale Oxford 81,00133 , Rome , Italy
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Morton T, Kostenbader K, Montgomery J, Devarakonda K, Barrett T, Webster L. Comparison of subjective effects of extended-release versus immediate-release oxycodone/acetaminophen tablets in healthy nondependent recreational users of prescription opioids: a randomized trial. Postgrad Med 2014; 126:20-32. [PMID: 25141240 DOI: 10.3810/pgm.2014.07.2780] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Prescription opioids have substantial abuse potential. This study compared the positive subjective drug effects of a newly developed extended-release (ER) oxycodone (OC)/acetaminophen (acetyl-para-aminophenol [APAP]) formulation with those of immediate-release (IR) OC/APAP. METHODS This randomized, double-blind, active- and placebo-controlled, 7-way crossover study enrolled healthy volunteers who were recreational prescription opioid users. The protocol was approved by an institutional review board and all participants provided written informed consent. Participants received single doses of intact ER and IR OC/APAP 15/650 mg, intact ER and IR OC/APAP 30/1300 mg, crushed ER and IR OC/APAP 30/1300 mg, and placebo. Peak subjective effects (Emax), time to Emax, and area under the drug-effect curves for drug liking, drug high, and good drug effects were measured using visual analogue scales. Least squares means with 95% confidence interval were compared using analysis of variance. RESULTS Among completers (N = 55), intact ER OC/APAP produced delayed and lower peak effects versus IR OC/APAP. Comparing intact tablets, the drug liking Emax (least squares means [95% confidence interval]) was significantly lower for OC/APAP 30/1300 mg (76.4 [72.8 to 80.0]) than for IR OC/APAP 30/1300 mg (85.6 [81.9 to 89.2]; difference, -9.2 [-13.1 to -5.2]; P < 0.001). Similar results were observed for intact ER and IR OC/APAP (15 mg/650 mg). Crushing ER OC/APAP 30/1300 mg further delayed these effects compared with the same dose of crushed IR OC/APAP and intact ER OC/APAP. CONCLUSIONS Extended-release OC/APAP produced lower subjective drug effects than IR OC/APAP. Crushing ER OC/APAP further delayed onset of subjective effects compared with intact ER OC/APAP. The ER OC/APAP may be less attractive for abuse than IR OC/APAP. CLINICAL TRIAL REGISTRATION This phase 1 study conducted in the United States was not registered.
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Affiliation(s)
- Terri Morton
- Senior Principal Pharmacokinetic Scientist, PRA Healthsciences, Salt Lake City, UT
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Mearis M, Shega JW, Knoebel RW. Does adherence to National Comprehensive Cancer Network guidelines improve pain-related outcomes? An evaluation of inpatient cancer pain management at an academic medical center. J Pain Symptom Manage 2014; 48:451-8. [PMID: 24439844 DOI: 10.1016/j.jpainsymman.2013.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 09/10/2013] [Accepted: 09/15/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT Evidence-based guidelines are in place for the management of cancer-related pain, yet adherence remains problematic throughout health systems because of efficacy and safety concerns. OBJECTIVES To evaluate adherence to the National Comprehensive Cancer Network (NCCN) guidelines on pain management among cancer inpatients and assess whether adherence is associated with pain control. METHODS A retrospective chart review of patients admitted to the hematology/oncology service at an academic medical center between April 1, 2011 and September 30, 2011 was conducted, and patients were allocated into groups based on adherence to NCCN guidelines. Pain control and safety outcomes were compared between adherence groups for the first 24 hours of hospital admission. Multivariate analyses were performed to identify predictors of regimens nonadherent to guidelines and predictors of inadequate achievement of analgesia. RESULTS Among a random sample of 193 inpatients, 109 met the inclusion criteria of which 70 were guideline adherent and 39 nonadherent. A total of 63% of the patients initiated on NCCN adherent guidelines obtained analgesia at 24 hours compared with 41% in the nonadherent group (P=0.028). Average pain scores across the 24-hour period were lower in the adherent compared with the nonadherent group (3.5 vs. 4.4, respectively, P<0.001). Naloxone use, respiratory depression, and hypoxia did not significantly vary between adherence groups. Chronic home opioid exposure was significantly associated with nonadherent therapy (vs. adherent; odds ratio=3.04, confidence interval=1.28-7.18, P=0.01) and achievement of analgesia at 24 hours (vs. not; odds ratio=0.30, confidence interval=0.12-0.73, P<0.01). CONCLUSION Adherence to NCCN guidelines remains insufficient, with nonadherence being associated with inadequate analgesia. Opioid-tolerant patients remain at higher risk for guideline nonadherence and inadequate analgesia. Quality improvement initiatives should target opioid-tolerant patients.
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Affiliation(s)
- Michael Mearis
- Department of Pharmacy, Advocate Condell Medical Center, Libertyville, Illinois, USA.
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Risk factors for cisplatin-induced nephrotoxicity and potential of magnesium supplementation for renal protection. PLoS One 2014; 9:e101902. [PMID: 25020203 PMCID: PMC4096506 DOI: 10.1371/journal.pone.0101902] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/12/2014] [Indexed: 11/19/2022] Open
Abstract
Background Nephrotoxicity remains a problem for patients who receive cisplatin chemotherapy. We retrospectively evaluated potential risk factors for cisplatin-induced nephrotoxicity as well as the potential impact of intravenous magnesium supplementation on such toxicity. Patients and Methods We reviewed clinical data for 401 patients who underwent chemotherapy including a high dose (≥60 mg/m2) of cisplatin in the first-line setting. Nephrotoxicity was defined as an increase in the serum creatinine concentration of at least grade 2 during the first course of cisplatin chemotherapy, as assessed on the basis of National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. The severity of nephrotoxicity was evaluated on the basis of the mean change in the serum creatinine level. Magnesium was administered intravenously to 67 patients (17%). Results Cisplatin-induced nephrotoxicity was observed in 127 patients (32%). Multivariable analysis revealed that an Eastern Cooperative Oncology Group performance status of 2 (risk ratio, 1.876; P = 0.004) and the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) (risk ratio, 1.357; P = 0.047) were significantly associated with an increased risk for cisplatin nephrotoxicity, whereas intravenous magnesium supplementation was associated with a significantly reduced risk for such toxicity (risk ratio, 0.175; P = 0.0004). The development of hypomagnesemia during cisplatin treatment was significantly associated with a greater increase in serum creatinine level (P = 0.0025). Magnesium supplementation therapy was also associated with a significantly reduced severity of renal toxicity (P = 0.012). Conclusions A relatively poor performance status and the regular use of NSAIDs were significantly associated with cisplatin-induced nephrotoxicity, although the latter association was marginal. Our findings also suggest that the ability of magnesium supplementation to protect against the renal toxicity of cisplatin warrants further investigation in a prospective trial.
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Cheon S, Zhang X, Lee IS, Cho SH, Chae Y, Lee H. Pharmacopuncture for cancer care: a systematic review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:804746. [PMID: 24899911 PMCID: PMC4036607 DOI: 10.1155/2014/804746] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022]
Abstract
Background. Pharmacopuncture, injection to acupoints with pharmacological medication or herbal medicine, is a new acupuncture therapy widely available in Korea and China for cancer-related symptoms. However, the evidence is yet to be clear. Objective. To determine pharmacopuncture's effectiveness on cancer-related symptoms. Methods. Eleven databases were searched for randomized controlled trials of pharmacopuncture in cancer patients. The Cochrane risk of bias (ROB) assessment tool was used for quality assessment. Results. Twenty-two studies involving 2,459 patients were included. Five trials of chemotherapy-induced nausea and vomiting (CINV) underwent meta-analysis. Pharmacopuncture significantly relieved severity of CINV compared with control group (3 trials, risk ratio (RR) 1.28, 95% confidence interval (CI) = 1.14-1.44). The frequency of CINV was also significantly reduced with pharmacopuncture (2 trials, RR 2.47, 95% CI = 2.12-2.89). Seventeen trials studied various symptoms, and in most studies, pharmacopuncture significantly relieved pain, ileus, hiccup, fever, and gastrointestinal symptoms and improved quality of life in various cancer patients. ROB was generally high. Conclusion. It may be suggested with caution that pharmacopuncture may help various symptom relief in cancer patients, but it is hard to draw a firm conclusion due to clinical heterogeneity and high ROB of the included studies, hence warranting further investigation.
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Affiliation(s)
- Soyeon Cheon
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Xiuyu Zhang
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - In-Seon Lee
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Seung-Hun Cho
- Hospital of Korean Medicine, Kyung Hee University Medical Center, Kyung Hee Dae-ro 23, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Younbyoung Chae
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Hyangsook Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul 130-701, Republic of Korea
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