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Cherny NI, Ziff-Werman B. Ethical considerations in the relief of cancer pain. Support Care Cancer 2023; 31:414. [PMID: 37351702 DOI: 10.1007/s00520-023-07868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The management of pain for patients with cancer and cancer survivors is a critical clinical task that involves a multitude of ethical issues at almost every phase of the cancer experience. This review is divided into three sections: In the first, we address rights and duties in the relief of pain from the perspective of patients, clinicians, health care institutions and organizations, and public policy. This section includes a detailed description of issues and duties in relation to opioid misuse and addiction. In the second section, we discuss the ethical consideration of therapeutic planning. The final section addresses ethical considerations in the management of pain at the end of life including a detailed discussion regarding ethical issues relating to the use of palliative sedation as a clinical intervention of last resort.
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Yoshida M, Iwasaki K, Miyashita M, Saeki T, Morioka Y, Hiroi S, Shimizu E. Opioid prescriptions at the point of surgery, bone metastasis, or death among patients with breast cancer in Japanese acute care hospitals: a claims-based, retrospective, longitudinal study. Support Care Cancer 2023; 31:369. [PMID: 37266722 DOI: 10.1007/s00520-023-07805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Breast cancer is the most common cancer among Japanese women and often yields a better prognosis than other cancers. However, few studies have been conducted on pain control using opioids in Japan. In this study, we aimed to examine actual opioid use among breast cancer patients. METHODS Breast cancer patients were defined as female patients with a first breast cancer diagnosis during the observational period in an acute care hospital database (April 2008 - February 2020). We examined the percentage of patients prescribed opioids, the opioid amount per patient, and the opioid dosage per day around surgery, bone metastasis diagnosis, or death. RESULTS Overall, 217,722 breast cancer patients were identified. The percentage of patients prescribed opioids and the average amount of opioids per patient were highest in the month of surgery, 78% and 27 morphine milligram equivalents (MMEs), respectively. The average opioid dosage increased with time after surgery from 19 to 28 MMEs. Around bone metastasis, the percentage of patients prescribed opioids and the average opioid amount per patient peaked one month after the diagnosis, 31% and 371 MMEs, respectively. The average opioid dosage gradually increased from 22 to 35 MMEs in succeeding days after a bone metastasis diagnosis. The percentage of patients prescribed opioids and the average opioid amount per patient increased as the month of death approached. CONCLUSION We investigated opioid prescription trends around clinical events in breast cancer patients on a large scale in Japan. These results may be useful to control cancer pain among breast cancer patients.
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Affiliation(s)
| | - Kosuke Iwasaki
- Social Cooperation Program of IT Healthcare, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- Milliman, Inc., Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Shinzo Hiroi
- Medical Affairs, Shionogi & Co., Ltd., Tokyo, Japan
- Social Cooperation Program of IT Healthcare, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Eiko Shimizu
- Social Cooperation Program of IT Healthcare, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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Simões IMDO, Barrile SR, Gimenes C, Bortolli TTD, Conti MHD, Martinelli B. Alterações musculoesquelética, cardiorrespiratória, antropométrica e sensorial após cirurgia de câncer de mama. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.356016.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: O câncer de mama é a segunda neoplasia maligna mais encontrada entre as mulheres, sendo a intervenção cirúrgica um dos tratamentos preconizados, o que pode acarretar sequelas físicas e sensoriais importantes. Objetivo: Analisar as funções musculoes-queléticas, cardiorrespiratórias, antropométricas e sensoriais de mulheres submetidas ao procedimento cirúrgico para neoplasia mamária. Métodos: Estudo observacional e transversal com mulheres que realizaram procedimento cirúrgico para ressecção de neoplasia mamária assistidas no interior paulista, Jaú/SP. Foram realizadas três avaliações: pré-cirurgia (AV1), um dia (AV2) e 15 dias após a cirurgia (AV3). Foram coletadas informações sociodemográficas e ginecológicas e realizadas avaliações antropométrica, cardiovascular, sensibilidade dérmica, amplitude de movimento (ADM) dos membros superiores, saturação periférica de oxigênio (SpO2), força muscular inspiratória (PImax), pico de fluxo expiratório (PFE) e mobilidade toracoabdominal. Os dados foram avaliados pelo teste estatístico ANOVA de medidas repetidas e Wilcoxon com correção de Bonferroni (p < 0,05). Resultados: Dezoito mulheres, de 57,44 ± 9,35 anos, tiveram o lado esquerdo mais acometido (61,1%) e a linfonodectomia foi realizada em 50% dos casos. Houve diferenças nas variáveis pressão arterial sistólica e diastólica, PFE e SpO2, índice de amplitude axilar (AV1>AV2), PImax (AV3>AV2), perimetria (AV2>AV3), ADM em todos os eixos de movimento do ombro e em flexão de punho (AV2<AV1) e alteração de sensibilidade próxima à cicatriz (AV3>AV2 e AV1). Conclusão: A cirurgia para exerese de neoplasia mamária acarretou alterações principalmente hemodinâmicas e respiratórias, sobremaneira no primeiro dia após a cirurgia, retornando aos valores basais aproxi-madamente 15 dias após o procedimento.
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Affiliation(s)
| | | | - Camila Gimenes
- Centro Universitário Sagrado Coração (UNISAGRADO), Brazil
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Simões IMDO, Barrile SR, Gimenes C, Bortolli TTD, Conti MHD, Martinelli B. Musculoskeletal, cardiorespiratory, anthropometric and sensorial changes following breast cancer surgery. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.356016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Breast cancer is the second most common malignant neoplasm in women. Surgical intervention is one of the recommended treatments, which can lead to significant physical and sensorial sequelae. Objective: To analyze the musculoskeletal, cardiorespiratory, anthropometric and sensorial functions of women who underwent breast cancer surgery. Methods: An observational, cross-sectional study with women who underwent surgical resection of breast tumors at Amaral Carvalho, a reference hospital in the countryside of the São Paulo State, Jaú/SP, Brazil. Three assessments were obtained: pre-surgery (Ass1), one day after the surgery (Ass2) and 15 days after surgery (Ass3). Sociodemographic and gynecological data were collected, and anthropometric, cardiovascular, dermal sensitivity, range of motion (ROM) of the upper limbs, peripheral oxygen saturation (SpO2), inspiratory muscle strength (PImax), peak expiratory flow (PEF) and thoraco-abdominal mobility assessments were performed. Data were evaluated by repeated measures ANOVA and Wilcoxon statistical test with a Bonferroni correction (p < 0.05). Results: Eighteen women, with a mean age of 57.44 ± 9.35 years, mainly with the left side affected (61.1%) and lymphadenectomy performed in 50% of the cases. Differences were found in systolic and diastolic blood pressure, PEF and SpO2, axillary ROM index (Ass1>Ass2), PImax (Ass3>Ass2), perimetry (Ass2>Ass3), ROM in all axes of shoulder motion and wrist flexion (Ass2<Ass1), and sensitivity alteration close to the surgical wound (Ass3>Ass2 and Ass1). Conclusion: The surgery for breast cancer excision resulted in hemodynamic and respiratory changes, especially on the first day after the procedure, returning to baseline values approximately 15 days later.
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Affiliation(s)
| | | | - Camila Gimenes
- Centro Universitário Sagrado Coração (UNISAGRADO), Brazil
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Khemiri S, Ben Thabet J, Ben Kridis W, Maalej M, Khanfir A, Frikha M. Psychoaffective repercussions of pain in cancer patients. Cancer Radiother 2019; 23:188-193. [PMID: 31097369 DOI: 10.1016/j.canrad.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Pain often induces in cancer patient emotional disorders such as anxiety, depression and alteration of quality of life. The purpose of our work was to assess the impact of the intensity of pain and those characteristics on anxiety, depression state and quality of life of cancer patients. MATERIAL AND METHODS This is an analytical cross-sectional study including 106 cancer patients with pain. We evaluated four parameters: pain intensity by visual analogue scale, the presence of anxiety and of depression using the Hospital Anxiety and Depressive Scale, and the alteration of quality of life by 36-item Short-Form Health Survey. RESULTS Patients' average age was 55 years old. The sex ratio was 0.79. Pain intensity was low in 16%, moderate in 49.1% and intense in 34.9% of patients. The prevalence of anxiety and depression was 49.1% and 54% of patients, respectively. The independent factors correlated to the occurrence of anxiety were: pain intensity, bone localization, continuous progression, chronicity of pain, advanced stage, hospitalization at day hospital, the partial or no response to analgesic treatment. The independent factors correlated to the onset of depression were: intensity of pain, advanced stage of the disease, bone localization, step 2 or 3 of analgesic, and partial or no response to analgesic treatment. CONCLUSION The prevalence of anxiety and depression in our patients was slightly higher than those reported in the literature. The main factors correlated with the onset of depression and anxiety were: severe pain, bone location, and advanced stage of the disease.
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Affiliation(s)
- S Khemiri
- Department of oncology, Habib-Bourguiba hospital, Sfax, Tunisia
| | - J Ben Thabet
- Department of psychiatry, Hédi-Chaker hospital, Sfax, Tunisia
| | - W Ben Kridis
- Department of oncology, Habib-Bourguiba hospital, Sfax, Tunisia.
| | - M Maalej
- Department of psychiatry, Hédi-Chaker hospital, Sfax, Tunisia
| | - A Khanfir
- Department of oncology, Habib-Bourguiba hospital, Sfax, Tunisia
| | - M Frikha
- Department of oncology, Habib-Bourguiba hospital, Sfax, Tunisia
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Cancer Pain Management and Pain Interference with Daily Functioning among Cancer Patients in Gondar University Hospital. Pain Res Manag 2017; 2017:5698640. [PMID: 28694715 PMCID: PMC5485331 DOI: 10.1155/2017/5698640] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/15/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
Cancer is an increasing public health burden for Ethiopia. Pain is among the most common symptoms in patients with cancer. Hence, we aimed to assess cancer pain prevalence, cancer pain interference, and adequacy of cancer pain treatment in the oncology ward of an Ethiopian teaching hospital. Of 83 patients, total of 76 (91.6%) cancer patients experienced pain with varying degree of severity, and 7 (8.4%) patients experienced severe pain. Of the 76 cancer patients with pain, 68 (89.2%) experienced pain interference with their daily activities. Fifty-four (65%) patients were receiving inadequate cancer pain treatment with negative Pain Management Index. Therefore, it is vital to anticipate and assess pain of the cancer patients as routine clinical practice, to optimize analgesic therapy, and to identify and overcome barriers to adequate pain management.
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Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy. Pain 2016; 156:967-979. [PMID: 25719616 DOI: 10.1097/j.pain.0000000000000142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (e.g., rrence of surgery), other predictors (e.g., symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC.
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Yeh CH, Chien LC, Chiang YC, Ren D, Suen LKP. Auricular point acupressure as an adjunct analgesic treatment for cancer patients: a feasibility study. Pain Manag Nurs 2014; 16:285-93. [PMID: 25439120 DOI: 10.1016/j.pmn.2014.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 11/25/2022]
Abstract
This study aimed (1) to examine the feasibility of an auricular point acupressure (APA) research protocol in terms of recruitment and for the assessment and management of pain and (2) to examine the potential APA analgesic effects for cancer patients. This study was a repeated-measures one-group design. Participants were recruited from the cancer center follow-up clinic affiliated with a large university hospital in the northeastern United States. Participants included 50 patients aged 55-87 years with a diagnosis of cancer. Participants received 7 days of APA treatment for their pain. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point on each ear. The study recruitment and retention rates were 92% and 91%, respectively. Importantly, the study found preliminary evidence for the analgesic effects of APA for cancer pain management. For example, by the end of the 7-day study, APA reduced pain intensity more than 55% for "worst pain" and about 57% for "average pain" and "pain intensity." Moreover, the use of pain medication was reduced during the APA treatment (e.g., 78% of patients [n = 39] took less pain medication than before the treatment). APA appears to be highly acceptable to patients with cancer-related pain. However, without a placebo control, we cannot draw conclusive evidence for the analgesic effect of APA for cancer patients. A sham group must be added to future studies to differentiate the true effects of APA from the possible psychological effects of the APA treatment.
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Affiliation(s)
- Chao Hsing Yeh
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lung-Chang Chien
- Division of Biostatistics, University of Texas School of Public Health at San Antonio Regional Campus, San Antonio, Texas; Research to Advance Community Health Center, University of Texas Health Science Center at San Antonio Regional Campus, San Antonio, Texas
| | - Yi Chien Chiang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuen, Taiwan.
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lorna Kwai-Ping Suen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Shinde S, Gordon P, Sharma P, Gross J, Davis MP. Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements? Support Care Cancer 2014; 23:695-703. [PMID: 25168780 DOI: 10.1007/s00520-014-2415-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 08/18/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing. METHODS In this retrospective observational study, patients admitted to the inpatient palliative care unit over a 3-month period with a diagnosis of cancer on opioid therapy were selected. Data pertaining to demographics, diagnosis, oral morphine dose equivalent of the opioid at the time of discharge, adjuvant analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and pain scores as reported by nurses and physicians were collected. RESULTS Seventy-seven patients were eligible over a 3-month period, out of which 65 (84 %) were taking an adjuvant medication. The most commonly prescribed adjuvant was gabapentin (70 %). Fifty-seven percent were taking more than one adjuvant. There were more women in the group receiving adjuvants (57 vs. 17%, p = 0.010). Those without adjuvants compared with those on adjuvants did not have worse pain scores on discharge as reported by physicians (0.8 ± 0.8 vs. 1.0 ± 0.7, p = 0.58) or nurses (2.0 ± 2.7 vs. 2.1 ± 2.6, p = 0.86). There was no difference in morphine equivalent doses of the opioid in both groups (median (min, max); 112 (58, 504) vs. 200 (30, 5,040)) at the time of discharge; 75-80 % of patients had improvement in pain scores as measured by a two-point reduction in numerical rating scale (NRS). DISCUSSION This study shows that adjuvant medications are commonly used for treating pain in patients with cancer. More than half of study population were on two adjuvants or an adjuvant plus NSAID along with an opioid. We did not demonstrate any benefit in terms of improved pain scores or opioid doses with adjuvants, but this could reflect confounding variables and physician choice. Larger prospective studies are needed to define the opioid-sparing effects of adjuvants. CONCLUSION Adjuvant agents are used in over 80 % of those treated for cancer pain.
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Affiliation(s)
- Shivani Shinde
- The Harry R Horvitz Center for Palliative Medicine, Division of Solid Tumor, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, R35, Cleveland, OH, 44195, USA
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Overcash J, Hanes D, Birkhimer D, Askew T. Pain intensity and pain management of hospitalized patients with cancer: an opportunity for improvement. Clin J Oncol Nurs 2013; 17:365-8. [PMID: 23899973 DOI: 10.1188/13.cjon.365-368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
About 73% of patients diagnosed with cancer report poor pain management. The purpose of this study was to evaluate pain intensity and the extent to which pain was controlled, and based on the findings, to pose options for improving pain management for hospitalized patients with cancer.
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Affiliation(s)
- Janine Overcash
- College of Nursing, The Ohio State University Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, USA.
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