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Simão D, Barata PC, Alves M, Papoila AL, Oliveira S, Lawlor P. Symptom Clusters in Patients With Advanced Cancer: A Prospective Longitudinal Cohort Study to Examine Their Stability and Prognostic Significance. Oncologist 2024; 29:e152-e163. [PMID: 37536276 PMCID: PMC10769798 DOI: 10.1093/oncolo/oyad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/23/2023] [Indexed: 08/05/2023] Open
Abstract
This study's purpose was to assess symptom cluster (SC) stability during disease progression and determine their strength of association with survival in patients with advanced cancer . Consecutively eligible patients with advanced cancer not receiving cancer-specific treatment and referred to a Tertiary Palliative Care Clinic were enrolled in a prospective cohort study. At first consultation (D0) and in subsequent consultations at day 15 (D15) and day 30 (D30), patients rated 9 symptoms through the Edmonton Symptom Assessment System scale (0-10) and 10 others using a Likert scale (1-5). Principal components factor analysis with varimax rotation was used to determine SCs at each consultation. Of 318 patients with advanced cancer, 301 met eligibility criteria with a median age of 69 years (range 37-94). Three SCs were identified: neuro-psycho-metabolic (NPM), gastrointestinal, and sleep impairment, with some variations in their constitution over time. Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter median survival was observed continuously for NPM cluster (D0 23 vs. 58 days, P < .001; D15 41 vs. 104 days, P=.004; D30 46 vs. 114 days, P = .002), although the presence of 2 or more SCs on D0 and D15 also had prognostic significance (D0: 21 vs. 45 days, P = .005; D30: 50 vs. 96 days, P = .040). In a multivariable model, NPM cluster (D0 hazard ratio estimate: HR 1.64; 95%CI, 1.17-2.31; P = .005; D15 HR: 2.51; 95%CI, 1.25-5.05; P = .009; D30 HR: 3.9; 95%CI, 1.54-9.86; P = .004) and hospitalization (D0 HR: 2.27; 95%CI, 1.47-3.51; P < .001; D15 HR: 2.43; 95%CI, 1.18-5.01; P = .016; D30 HR: 3.41; 95%CI, 1.35-8.62; P = .009) were independently and significantly associated with worse survival. Three clinically relevant SCs were identified, and their constitution had small variations, maintaining a stable set of nuclear symptoms through disease progression. Presence of the NPM cluster and hospitalization maintained their prognostic value over time.
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Affiliation(s)
- Diana Simão
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro C Barata
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Division of Solid Tumor Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Marta Alves
- Epidemiology and Statistics Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana L Papoila
- Epidemiology and Statistics Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sónia Oliveira
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Peter Lawlor
- Bruyere Continuing Care, Division of Palliative Care, Department of Medicine, Bruyere and Ottawa Hospital Research Institutes, University of Ottawa, Ottawa, Canada
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Zhang J, Chan DNS, Liu X, Cai Y, Chen J, Xie M. Effects of self-management interventions for cancer patients with pain: A systematic review of randomised controlled trials. J Clin Nurs 2023; 32:5652-5667. [PMID: 36929168 DOI: 10.1111/jocn.16669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 03/18/2023]
Abstract
AIMS To evaluate the effects of self-management interventions targeting individuals with cancer-related pain on pain intensity, self-efficacy, quality of life (QoL), pain medication adherence, and pain-related knowledge and provide recommendations for the content and format of self-management interventions based on the existing evidence. DESIGN A systematic review of randomised controlled trials (RCTs) and narrative synthesis. DATA SOURCES A search of six electronic databases, including Medline, PsycINFO, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. REVIEW METHODS This systematic review followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published from January 2011 to March 2022 in English were retrieved. The Cochrane Risk of Bias Tool was used to assess quality. Data were summarised using narrative synthesis. RESULTS This systematic review included six RCTs involving 748 patients with cancer-related pain. The results support the effectiveness of the intervention on QoL and pain-related knowledge. Mixed results were observed in the effectiveness on pain intensity, self-efficacy and medication adherence. Overall, the quality of the evidence was low. The content of self-management interventions varied across studies but with similar formats (face-to-face coaching and telephone follow-up). CONCLUSION The existing evidence supports the effectiveness of self-management interventions on pain-related knowledge and QoL. Further high-quality RCTs are needed to determine the most effective interventions. RELEVANCE TO CLINICAL PRACTICE Self-management is recommended to improve cancer patients' pain awareness, self-management behaviour and adaptability. Components for self-management of cancer pain, including patient attitude and knowledge assessment, nurse coaching and counselling, reinforcement during follow-up period, and provision of supplementary materials on pain management and medication adherence, could be covered in the intervention. In the future, it is worthwhile exploring an effective intervention using Internet-based information technology, for example WeChat, to aid the delivery of self-management intervention. NO PATIENT OR PUBLIC CONTRIBUTION This systematic review does not necessarily involve patients or public members in this work.
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Affiliation(s)
- Junfeng Zhang
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Xingling Liu
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
| | - Yingying Cai
- Department of Nursing, Jieyang People's Hospital, Jieyang, People's Republic of China
| | - Jiawen Chen
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, People's Republic of China
| | - Minjuan Xie
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People's Republic of China
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Characteristics and prevalence of orofacial pain as an initial symptom of oral and oropharyngeal cancer and its impact on the patient's functionality and quality of life. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:457-464. [DOI: 10.1016/j.oooo.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
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Sine H, Achbani A, Filali K. The Effect of Hypnosis on the Intensity of Pain and Anxiety in Cancer Patients: A Systematic Review of Controlled Experimental Trials. Cancer Invest 2021; 40:235-253. [PMID: 34698595 DOI: 10.1080/07357907.2021.1998520] [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: 10/20/2022]
Abstract
BACKGROUND Pain is a common symptom in cancer patients. Hypnosis is considered one of the most recognized non-pharmacological techniques in pain management. In oncology, this technique can be used as a complementary treatment to reduce the level of pain and anxiety. The objective of this study is to systematically review and evaluate controlled clinical trials (CCTs) examining the effect of hypnosis on the intensity of pain, and anxiety in cancer patients. METHODS A systematic review was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA). The Cochrane systematic review database, the abstract databases, Scopus, PubMed, Google Scholar, and Cochrane Library have been systematically reviewed from 2005 to 2018. RESULTS Eleven CCT with a total of 1182 participants met the inclusion criteria and were included in this review. The participants were mainly women (n = 968). Their average age alternates between 48 and 58 years. Perceived pain was measured primarily by visual analog scale (VAS)/numerical pain rating scale (NPRS), which showed that anxiety was measured by Hospital Anxiety and Depression scale (HADS). Hypnosis-related anxiety and pain decreased significantly with respect to usual treatment. CONCLUSIONS Evidence suggests promising results of hypnosis on the management of pain, and anxiety levels in the vast majority of cancer patients. Therefore, because of the exploratory design and high risk of bias, the effectiveness of hypnosis or hypnotherapy in reducing pain and anxiety levels remains unclear. There is a need for more rigorous randomized controlled trials (RCTs).
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Affiliation(s)
- Hayat Sine
- Clinical Epidemiology and Medico-Surgical Sciences, Faculty of Medicine and Pharmacy, Mohammed V-Rabat University, Rabat, Morocco
| | - Abderrahmane Achbani
- Department of Biology, Faculty of Sciences, Laboratory of Cell Biology and Molecular Genetics, University Ibn Zohr, Agadir, Morocco.,Higher Institute of Nursing Professions and Health Techniques, Marrakech, Morocco
| | - Karim Filali
- Clinical Epidemiology and Medico-Surgical Sciences, Faculty of Medicine and Pharmacy, Mohammed V-Rabat University, Rabat, Morocco
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Almeida AR, Santana RF, Brandão MAG. Compromised end-of-life syndrome: Concept development from the condition of adults and older adults in palliative care. Int J Nurs Knowl 2021; 33:128-135. [PMID: 34546666 DOI: 10.1111/2047-3095.12344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to develop the nursing diagnosis concept "compromised end-of-life syndrome" in palliative care. METHODS The authors used the integrative strategy by Meleis to develop the concept in this study and identifying clinical indicators from a literature review. For data organization, we applied the Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA). FINDINGS Some clusters of unpleasant signs and symptoms in palliative care patients at the end of life, such as pain, dyspnea, depression, constipation, and anxiety, were identified. Through conceptualization, the authors propose a new nursing diagnosis, "compromised end-of-life syndrome." The manuscript includes a model case of a patient with nursing diagnosis syndrome as a clinical example. CONCLUSIONS Simultaneous patterns of signs and symptoms present in the literature reinforce the utility of the proposition of end-of-life syndrome as a nursing diagnostic construct. IMPLICATIONS FOR NURSING PRACTICE The concept development related to patients' unpleasant signs and symptoms critically ill at palliative care supports the proposition of a new nursing diagnosis relevant to selecting adequate nursing interventions and nursing outcomes. Some clusters of unpleasant signs and symptoms in palliative care patients at the end of life, such as pain, dyspnea, depression, constipation, and anxiety were identified. Conceptualization was used to propose a new nursing diagnosis, "compromised end-of-life syndrome." A model case of a patient with nursing diagnosis syndrome is described as a clinical example. CONCLUSION Simultaneous patterns of signs and symptoms present in the literature reinforce the utility of the proposition of end-of-life syndrome as nursing diagnostic construct. IMPLICATIONS FOR NURSING PRACTICE The concept development related to patients' unpleasant signs and symptoms critically ill at palliative care supports the proposition of a new nursing diagnosis relevant to selecting adequate nursing interventions and nursing outcomes.
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Affiliation(s)
- Antônia Rios Almeida
- Nurse, Department of Neurosurgery and Thoracic Surgery, José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, Brazil
| | - Rosimere Ferreira Santana
- Nurse, Teacher, Aurora de Afonso Costa Nursing School, Fluminense Federal University, Rio de Janeiro, Brazil
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Yanaizumi R, Nagamine Y, Harada S, Kojima K, Tazawa T, Goto T. Prevalence of neuropathic pain in terminally ill patients with cancer admitted to a general ward: a prospective observational study. J Int Med Res 2021; 49:300060520987726. [PMID: 33478318 PMCID: PMC7841688 DOI: 10.1177/0300060520987726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives To determine the prevalence of neuropathic pain among terminally ill patients with cancer admitted to a general ward, using the International Association for the Study of Pain algorithm. Methods This prospective observational study was conducted at a tertiary care center. We enrolled terminally ill patients with cancer admitted to the general ward between September 2018 and September 2019. On the day of consultation with our palliative care team, pain management clinicians examined and diagnosed neuropathic pain using the International Association for the Study of Pain diagnostic criteria. Results A total of 108 patients were enrolled during the study period. The median age was 69 years (interquartile range [IQR] 58.3–76.8 years), 72 patients (66.7%) were men, and the median survival time was 33 days (IQR 14.3–62 days). Of the 108 patients, 33 (30.6%) had neuropathic pain. Patients with neuropathic pain had more severe pain than those without neuropathic pain. Conclusions The prevalence of neuropathic pain in terminally ill patients with cancer admitted to a Japanese general ward was 30.6%. Further studies are warranted to elucidate whether the accurate diagnosis of neuropathic pain can improve pain control and/or patient conditions.
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Affiliation(s)
- Ryota Yanaizumi
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Nagamine
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
| | | | - Keiko Kojima
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiharu Tazawa
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan.,Department of Anesthesiology, Saint Marianna University School of Medicine, Kawasaki, Japan
| | - Takahisa Goto
- Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan.,Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
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Deribe B, Ayalew M, Geleta D, Gemechu L, Bogale N, Mengistu K, Gadissa A, Dula D, Ababi G, Gebretsadik A. Perceived Quality of Nursing Care Among Cancer Patients Attending Hawassa University Comprehensive Specialized Hospital Cancer Treatment Center; Hawassa Southern Ethiopia: Cross-Sectional Study. Cancer Manag Res 2021; 13:1225-1231. [PMID: 33603468 PMCID: PMC7882431 DOI: 10.2147/cmar.s275729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Cancer has become one of the most common and the second leading cause of death. According to grounded theory, quality care is meeting all the needs of the patients. Low-quality nursing care relates omission of nursing care required to meet patients' need. Quality of nursing care in oncologic setting was nursing practice area where studies are limited. Objective The aim of the study was to assess the perceived quality of nursing care among patients with cancer attending Hawassa University comprehensive specialized Hospital. Methods A quantitative Cross-sectional study was conducted. Among the proposed 422 patients with cancer, using a simple random sampling technique 415 patients were included in this study. Seven data were discarded due to incompleteness and inconsistency between collected data and patient medical record. Data were collected using structured questionnaires and Quality of Oncology Nursing Care Scale. We carried out statistical analysis using SPSS V-20. We used descriptive analysis to examine the quality of oncology nursing care. Results The mean age of patients was 42.51 (±14.24) years, among patients diagnosed with cancer more than one-third 148 (35.70%) had breast cancer. The majority of patients with cancer 173 (41.70%) were in stage-III. Nearly two-third 266 (64.10%) of patients were on chemotherapy. Among study participants on treatment, 249 (60.00%) perceived they received good quality of nursing care. The mean score related to the domain of support and confirmation is 62.73 ± 7.26. In terms of spiritual care, the mean score is 21.03 ± 5.37. Conclusion The perceived quality of nursing care was high however not all domains of oncology care were achieved. We recommend Detail and focused study to explore important predictors’ quality nursing care.
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Affiliation(s)
- Bedilu Deribe
- Hawassa University School of Nursing, Hawassa, Ethiopia
| | | | - Dereje Geleta
- Hawassa University School of Public Health, Hawassa, Ethiopia
| | - Lalisa Gemechu
- Hawassa University Department of Environmental Health, Hawassa, Ethiopia
| | | | | | | | - Dubale Dula
- Hawassa University Department of Midwifery, Hawassa, Ethiopia
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Al-Ansari AM, Abd-El-Gawad WM, AboSerea SM, ElShereafy EES, Ali FAS, ElSayed MAE. The pattern of change in opioid and adjuvant prescriptions for cancer pain before and after referral to a comprehensive program in the Palliative Care Center in Kuwait. BMC Palliat Care 2021; 20:25. [PMID: 33536013 PMCID: PMC7860188 DOI: 10.1186/s12904-021-00717-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cancer-related pain is a complicated symptom that often coincides with fatigue, depression, and anxiety. Although many safe treatments are available, inadequate control of Cancer-related pain continues to lead to suffering in cancer patients. This study’s aim is to describe pain control, and the pattern of change in opioid and adjuvant medication prescriptions, before and after referral to the Palliative Care Center. Methods We conducted a prospective cohort study in adult cancer patients the Palliative Care Center between January 1, 2016 and December 30, 2017. We measured pain intensity and other associated symptoms via the Revised Edmonton Symptom Assessment System (ESAS-r) and documented detailed analgesics and adjuvant medication history before starting any palliative care and on days 0, 3, 6, and 14. Results The analysis included 240 patients whose cancer-related pain, anxiety, and depression scores meaningfully improved by day 6. The changes in the median (interquartile ranges) of Cancer-related pain, anxiety, and depression scores from day 0 to day 6 were: 6 (4–8) to 3 (1–4); 6 (4–9) to 2 (1–4); and 3 (2–6) to 2 (1–4), respectively, with p < 0.001 for all. Morphine was the most common opioid administered; the percentage using it increased from 20.4% (n = 49) before referral to 49.6% (n = 119) on day 6 (p < 0.001). The median morphine equivalent daily dose decreased from a median (interquartile ranges) of 60(31–93) mg/day before referral to 34(22–66) mg/day on day 6 (p < 0.001). There was also a statistically significant increase in the percentage of patients taking adjuvant medications, from 38.8% before referral to 84.2% on day 6 (p < 0.001). Comparing D0 to D6, the number of patients using Gabapentinoids significantly increased from 57(23.75%) to 79(32.9%) (p < 0.001), amitriptyline dramatically increased from 14 (5.8%) to 44 (18.3%) (p < 0.001), and other antidepressant drugs increased from 15 (6.2%) to 34 (14.1%) (p < 0.001). Conclusion After referral to the Palliative Care Center, patients’ pain and other symptoms scores decreased significantly, even with lower median morphine equivalent daily doses, arguably through more appropriately directed opioid use. This is evidence for the effectiveness of the comprehensive program at the Palliative Care Center in Kuwait. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00717-2.
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Affiliation(s)
| | - Wafaa Mostafa Abd-El-Gawad
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Al- Abbaseya, Cairo, Egypt.
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Harju E, Michel G, Roser K. A systematic review on the use of the emotion thermometer in individuals diagnosed with cancer. Psychooncology 2019; 28:1803-1818. [DOI: 10.1002/pon.5172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Erika Harju
- Department of Health Sciences and Health PolicyUniversity of Lucerne Lucerne Switzerland
| | - Gisela Michel
- Department of Health Sciences and Health PolicyUniversity of Lucerne Lucerne Switzerland
| | - Katharina Roser
- Department of Health Sciences and Health PolicyUniversity of Lucerne Lucerne Switzerland
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Usefulness of painDETECT and S-LANSS in identifying the neuropathic component of mixed pain among patients with tumor-related cancer pain. Support Care Cancer 2019; 28:279-285. [PMID: 31041583 DOI: 10.1007/s00520-019-04819-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Tumor-related cancer pain often comprises mixed pain with both nociceptive and neuropathic components. Whether tumor-related cancer pain includes a neuropathic component impacts the therapeutic strategy. The aim of this cross-sectional study was to investigate the usefulness of two screening tools for neuropathic pain, painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), in identifying the neuropathic component of mixed pain among patients with tumor-related cancer pain. METHOD This cross-sectional study recruited consecutive inpatients and outpatients at a single site. The diagnostic accuracy of painDETECT and S-LANSS was evaluated using receiver operating characteristic curve analysis and classification probability. RESULTS Of the study group, 106 patients had tumor-related cancer pain. Analyses of the nociceptive and mixed pain groups (n = 104) showed that neither painDETECT nor S-LANSS had satisfactory areas under the curve (AUCs) for identifying the neuropathic component of mixed pain (0.59 for painDETECT and 0.56 for S-LANSS). By pain intensity, the AUC for painDETECT was significantly higher in the mild pain group than in the moderate or severe pain group (0.77 vs. 0.43, P = 0.002). All parameters of classification probability for both tools were higher in the mild pain group than in the moderate or severe pain group. CONCLUSIONS painDETECT and S-LANSS could not identify the neuropathic component of mixed pain among patients with tumor-related cancer pain, especially when pain was moderate or severe. Contrarily, these screening tools might be useful for identifying the neuropathic component of mixed pain for mild pain.
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Which factors can aid clinicians to identify a risk of pain during the following month in patients with bone metastases? A longitudinal analyses. Support Care Cancer 2018; 27:1335-1343. [PMID: 30105665 DOI: 10.1007/s00520-018-4405-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Explore clinical factors associated with higher pain intensity and future pain in patients with bone metastases to identify patients who can benefit from closer follow-up or pain-modifying interventions. METHODS This is a secondary analysis of 606 patients with bone metastases included in a multicenter longitudinal study. The dependent variables were "average pain" and "worst pain" in the last 24 h (0-10 NRS). Twenty independent variables with potential association to pain intensity were selected based on previous literature. Cross-sectional analyses were performed with multiple linear regression to explore factors associated with pain intensity at baseline. Longitudinal data were analyzed with a generalized equation models to explore current factors associated with pain intensity at the next visit in 1 month. RESULTS Current pain intensity (p < 0.001), sleep disturbances (p 0.01 and 0.006), drowsiness (p 0.003 and 0.033) and male gender (p 0.045 and 0.001) were associated with higher average and worst pain intensity in 1 month. In addition, breakthrough pain was related to higher worst pain intensity (p 0.003) in 1 month. The same variables were also associated with higher average pain intensity at baseline. CONCLUSION Higher current pain intensity, sleep disturbances, drowsiness, male gender, and breakthrough pain are factors associated with higher pain intensity in patients with bone metastases at the next follow-up in 1 month. These factors should be assessed in clinical practice and may aid clinicians in identifying patients that can benefit from closer follow-up or interventions to prevent lack of future pain control. TRIAL REGISTRATION IN CLINICALTRIALS.GOV : NCT01362816.
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Lucenteforte E, Vagnoli L, Pugi A, Crescioli G, Lombardi N, Bonaiuti R, Aricò M, Giglio S, Messeri A, Mugelli A, Vannacci A, Maggini V. A systematic review of the risk factors for clinical response to opioids for all-age patients with cancer-related pain and presentation of the paediatric STOP pain study. BMC Cancer 2018; 18:568. [PMID: 29776346 PMCID: PMC5960169 DOI: 10.1186/s12885-018-4478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-patient variability in response to opioids is well known but a comprehensive definition of its pathophysiological mechanism is still lacking and, more importantly, no studies have focused on children. The STOP Pain project aimed to evaluate the risk factors that contribute to clinical response and adverse drug reactions to opioids by means of a systematic review and a clinical investigation on paediatric oncological patients. METHODS We conducted a systematic literature search in EMBASE and PubMed up to the 24th of November 2016 following Cochrane Handbook and PRISMA guidelines. Two independent reviewers screened titles and abstracts along with full-text papers; disagreements were resolved by discussion with two other independent reviewers. We used a data extraction form to provide details of the included studies, and conducted quality assessment using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS Young age, lung or gastrointestinal cancer, neuropathic or breakthrough pain and anxiety or sleep disturbance were associated to a worse response to opioid analgesia. No clear association was identified in literature regarding gender, ethnicity, weight, presence of metastases, biochemical or hematological factors. Studies in children were lacking. Between June 2011 and April 2014, the Italian STOP Pain project enrolled 87 paediatric cancer patients under treatment with opioids (morphine, codeine, oxycodone, fentanyl and tramadol). CONCLUSIONS Future studies on cancer pain should be designed with consideration for the highlighted factors to enhance our understanding of opioid non-response and safety. Studies in children are mandatory. TRIAL REGISTRATION CRD42017057740 .
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Affiliation(s)
- Ersilia Lucenteforte
- Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Vagnoli
- Pain and Palliative Care Unit, Meyer children's hospital, Florence, Italy
| | - Alessandra Pugi
- Clinical Trial Office, Meyer Children's Hospital, Florence, Italy
| | - Giada Crescioli
- Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Niccolò Lombardi
- Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Roberto Bonaiuti
- Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Maurizio Aricò
- Direzione Generale, Azienda Sanitaria Provinciale, Ragusa, Italy
| | - Sabrina Giglio
- Medical Genetics Unit, Meyer Children's University Hospital, Florence, Italy.,Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Andrea Messeri
- Pain and Palliative Care Unit, Meyer children's hospital, Florence, Italy
| | - Alessandro Mugelli
- Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Valentina Maggini
- Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy. .,Center for Integrative Medicine, Careggi University Hospital, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy.
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Lawlor PG, Lawlor NA, Reis-Pina P. The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23809000.2018.1467211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Peter G Lawlor
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Niamh A Lawlor
- Ottawa Hospital Cancer Program, The Ottawa Hospital (NAL), Ottawa, Canada
| | - Paulo Reis-Pina
- Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Lin YL, Hsieh RK, Tang CH. Strong opioid prescription in cancer patients in their final year of life: A population-based analysis using a Taiwanese health insurance database. Asia Pac J Clin Oncol 2018; 14:e498-e504. [PMID: 29498207 DOI: 10.1111/ajco.12865] [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: 07/17/2017] [Accepted: 12/07/2017] [Indexed: 11/29/2022]
Abstract
AIM Pain assessment and management have been important criteria in hospital accreditation in Taiwan since 2007. We used a Taiwanese health insurance database to determine factors influencing patterns of strong opioid use in cancer patients in their final 12 months of life. METHODS Data from patients with cancer in Taiwan outpatient clinics with cancer-related deaths between 2008 and 2011 were included in the analysis. Strong opioid prescription data from the last 12 months of each patient's life, as well as patient, physician, and hospital characteristics, were collected from the National Health Insurance Research Database. RESULTS Among 162 679 patients, more were male (63.6%) than female (36.4%) and almost half (49.3%) were ≥70 years old. Most (44.9%) patients had gastrointestinal cancer. More than one-third (35.4%) of patients were prescribed strong opioids during the 12 months before death, and more than half (53.2%) of those prescribed opioids received them in the 3 months before death. Median duration of strong opioid use was 81 days before death. Patients with head/neck cancer (52.8%) or who were treated in hematology and oncology departments (45.8%) were most likely, and patients with gastrointestinal cancer (hazard ratio = 0.65; 95% confidence interval, 0.64-0.67) or treated in gastroenterology departments (hazard ratio = 0.88; 95% confidence interval, 0.84-0.93) were least likely to be prescribed strong opioids. CONCLUSION Strong opioid prescriptions varied among patients with different cancer diagnoses and physicians. Information from this study can guide efforts to improve patient and physician education about cancer pain management.
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Affiliation(s)
- Yu-Lin Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruey Kuen Hsieh
- Hematology and Oncology Section, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
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15
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Abstract
This paper is the thirty-ninth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2016 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and CUNY Neuroscience Collaborative, Queens College, City University of New York, Flushing, NY 11367, United States.
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16
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Reis-Pina P, Acharya A, Lawlor PG. Cancer Pain With a Neuropathic Component: A Cross-sectional Study of Its Clinical Characteristics, Associated Psychological Distress, Treatments, and Predictors at Referral to a Cancer Pain Clinic. J Pain Symptom Manage 2018; 55:297-306. [PMID: 28870800 DOI: 10.1016/j.jpainsymman.2017.08.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022]
Abstract
CONTEXT In patients with cancer pain, identifying a neuropathic pain component (NPC) may inform the selection of subsequent therapeutic interventions. OBJECTIVES The objective of this study was to determine the prevalence, clinical characteristics, associated psychological distress, pre-referral treatment, and predictors of cancer pain with an NPC in patients referred to a cancer pain clinic. METHODS Participants had standard assessments and documentation: Brief Pain Inventory ratings, presence of an NPC, based on a Douleur Neuropathique 4 (DN4) (neuropathic pain screening scale) score ≥4 combined with a physician's clinical assessment (blinded to DN4 result), the Hospital Anxiety Depression Scale, and Emotion Thermometer scores. Logistic regression analyses were used to determine predictors associated with an NPC. RESULTS Of 371 study participants, 120 (32.3%) had a designated NPC. Overall, psychological distress indices were similar in the NPC and nociceptive pain groups, except for a Hospital Anxiety and Depression Scale >7 score that was proportionately higher (74% vs. 63%, P = 0.03) in the nociceptive group. The final multivariable logistic regression model generated the following NPC predictors and their respective odds ratios (95% CIs): recent chemotherapy, 2.93 (1.63-5.26); recent surgery, 3.65 (2.03-6.59); adjuvant analgesic use, 2.93 (1.66-5.17); episodic incident pain, 2.63 (1.44-4.84); episodic breakthrough pain, 3.67 (2.00-6.73); pain duration three or more months, 2.35 (1.36-4.06); higher pain intensity, 1.47 (1.24-1.74); and pelvic or perineal pain location, 2.75 (1.09-6.96). CONCLUSION One in three patients with cancer have an NPC, which is independently associated with recent chemotherapy, surgery, adjuvant analgesic use, episodic incident and breakthrough pain, longer pain duration, higher pain intensity, and pelvic or perineal pain location.
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Affiliation(s)
- Paulo Reis-Pina
- Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal; Formerly Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Anand Acharya
- Department of Economics, Carleton University, Ottawa, Ontario, Canada
| | - Peter G Lawlor
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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17
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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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18
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Han J, Saraf SL, Zhang X, Gowhari M, Molokie RE, Hassan J, Alhandalous C, Jain S, Younge J, Abbasi T, Machado RF, Gordeuk VR. Patterns of opioid use in sickle cell disease. Am J Hematol 2016; 91:1102-1106. [PMID: 27466799 PMCID: PMC5072998 DOI: 10.1002/ajh.24498] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 01/18/2023]
Abstract
Pain, the hallmark complication of sickle cell disease (SCD), is largely managed with opioid analgesics in the United States, but comprehensive data regarding the long-term use of opioids in this patient population is lacking. The pain medication prescription records from a cohort of 203 SCD patients were analyzed. Twenty-five percent were not prescribed opioid medications while 47% took only short-acting opioids, 1% took only long-acting opioids, and 27% took a combination of short-acting and long-acting opioids. The median (interquartile range) daily opioid dose was 6.1 mg (1.7-26.3 mg) of oral morphine equivalents, which is lower than the published opioid use among patients with other pain syndromes. The dose of opioids correlated with the number of admissions due to vaso-occlusive crisis (VOC) (r = 0.53, P < 0.001). When the patients were grouped into quartiles based on daily dose opioid use, a logistic regression model showed that history of avascular necrosis (AVN) (OR: 2.87, 95% CI: 1.37-6.02, P = 0.005), 25-OHD levels (OR: 0.59, 95% CI: 0.38-0.93, P = 0.024) and total bilirubin concentration (OR: 0.64, 95% CI: 0.42-0.99, P = 0.043) were independently associated with opioid use quartiles. In conclusion, doses and types of opioid medications used by adult SCD patients vary widely. Our findings implicate AVN and lower vitamin D levels as factors associated with higher opioid use. They also suggest an association of higher bilirubin levels, possibly suggesting higher hemolytic rate, with lower opioid use. Am. J. Hematol. 91:1102-1106, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jin Han
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
| | - Santosh L Saraf
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Xu Zhang
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Michel Gowhari
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Robert E Molokie
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Jesse Brown VA Medical Center, Chicago, Illinois
| | - Joharah Hassan
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Chaher Alhandalous
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Shivi Jain
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jewel Younge
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Taimur Abbasi
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Roberto F Machado
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Victor R Gordeuk
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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19
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Barata PC, Cardoso A, Custodio MP, Alves M, Papoila AL, António B, Lawlor PG. Symptom clusters and survival in Portuguese patients with advanced cancer. Cancer Med 2016; 5:2731-2739. [PMID: 27624994 PMCID: PMC5083726 DOI: 10.1002/cam4.860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/09/2016] [Accepted: 07/17/2016] [Indexed: 01/15/2023] Open
Abstract
This study aimed to identify clusters of symptoms, to determine the patient characteristics associated with identified, and determine their strength of association with survival in patients with advanced cancer (ACPs). Consecutively eligible ACPs not receiving cancer‐specific treatment, and referred to a Tertiary Palliative Care Clinic, were enrolled in a prospective cohort study. At first consultation, patients rated 9 symptoms through the Edmonton Symptom Assessment System (0–10 scale) and 10 others using a Likert scale (1–5). Principal component analysis was used in an exploratory factor analysis to identify. Of 318 ACPs, 301 met eligibility criteria with a median (range) age of 69 (37–94) years. Three SCs were identified: neuro‐psycho‐metabolic (NPM) (tiredness, lack of appetite, lack of well−being, dyspnea, depression, and anxiety); gastrointestinal (nausea, vomiting, constipation, hiccups, and dry mouth) and sleep impairment (insomnia and sleep disturbance). Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter survival was observed for patients with the NPM cluster (58 vs. 23, P < 0.001), as well as for patients with two or more SCs (45 vs. 21, P = 0.005). In a multivariable model for survival at 30‐days, age (HR: 0.98; 95% CI: 0.97–0.99; P = 0.008), hospitalization at inclusion (HR: 2.27; 95% CI: 1.47–3.51; P < 0.001), poorer performance status (HR: 1.90, 95% CI: 1.24–2.89; P = 0.003), and NPM (HR: 1.64; 95% CI: 1.17–2.31; P = 0.005), were associated with worse survival. Three clinically meaningful SC in patients with advanced cancer were identifiable. The NPM cluster and the presence of two or more SCs, had prognostic value in relation to survival.
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Affiliation(s)
- Pedro C Barata
- Medical Oncology, Centro Hospitalar Lisboa Central, Lisbon, Portugal.
| | - Alice Cardoso
- Palliative Care, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Maria P Custodio
- Medical Oncology, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Marta Alves
- Epidemiology and Statistics Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Ana L Papoila
- Epidemiology and Statistics Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Barbosa António
- Centre of Bioethics, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Peter G Lawlor
- Bruyere Continuing Care, Division of Palliative Care, Department of Medicine, Bruyere and Ottawa Hospital Research Institutes, University of Ottawa, Ottawa, Canada
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20
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Alkan A, Guc ZG, Senler FC, Yavuzsen T, Onur H, Dogan M, Karci E, Yasar A, Koksoy EB, Tanriverdi O, Turhal S, Urun Y, Ozkan A, Mizrak D, Akbulut H. Breast cancer survivors suffer from persistent postmastectomy pain syndrome and posttraumatic stress disorder (ORTHUS study): a study of the palliative care working committee of the Turkish Oncology Group (TOG). Support Care Cancer 2016; 24:3747-55. [PMID: 27039206 DOI: 10.1007/s00520-016-3202-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/28/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Persistent postmastectomy pain syndrome (PMPS) is one of the most important disturbing symptoms. Posttraumatic stress disorder (PTSD) is an anxiety disorder which is characterized by reactions to reminders of the trauma that has been experienced. The purpose of this study is to evaluate the predictors of PMPS and PTSD in Turkish breast cancer survivors and the correlation between PMPS and PTSD. METHOD The study is designed as a multicenter survey study. Breast cancer patients in remission were evaluated. Patients were evaluated with structured questionnaires to assess the PMPS and clinical parameters associated with it. The Turkish version of the posttraumatic stress disorder checklist-civilian version (PCL-C) was used. RESULTS Between February 2015 and October 2015, 614 breast cancer survivors in outpatient clinics were evaluated. The incidence of PMPS documented is 45.1 %. In the multivariate analysis low income, presence of PTSD and <46 months after surgery were associated with increased risk of PMPS. PTSD was documented in 75 %, and the mean PCL-C score was 32.4 ± 11.1. PMPS and being married at the time of the evaluation were linked with PTSD. CONCLUSIONS It is the first data about the association between PMPS and PTSD. The clinicians should be aware of PMPS and PTSD in breast cancer survivors.
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Affiliation(s)
- Ali Alkan
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey. .,Medical Oncology, Ankara University School of Medicine, Ankara Üniversitesi Tıp fakültesi hastanesi, Cebeci hastanesi, Tıbbi onkoloji bilim dalı, Mamak/Ankara, TR 06890, Turkey.
| | - Zeynep Gulsum Guc
- Department of Medical Oncology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Filiz Cay Senler
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Tugba Yavuzsen
- Department of Medical Oncology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Handan Onur
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Numune Training and Research Hospital, Ankara, Turkey
| | - Ebru Karci
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Arzu Yasar
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Berna Koksoy
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Ozgur Tanriverdi
- Department of Medical Oncology, Mugla Sitki Kocman University, Muğla, Turkey
| | - Serdar Turhal
- Department of Medical Oncology, Marmara University School of Medicine, İstanbul, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Asiye Ozkan
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Dilsa Mizrak
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Hakan Akbulut
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
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