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Khashan M, Strauss I, Hochberg Y, Brill S, Tellem R, Sharon H, Hochberg U. A nationwide neurosurgical inter-disciplinary service for cancer-related refractory pain. BMC Palliat Care 2024; 23:181. [PMID: 39033144 PMCID: PMC11264704 DOI: 10.1186/s12904-024-01501-8] [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: 07/13/2023] [Accepted: 07/04/2024] [Indexed: 07/23/2024] Open
Abstract
PURPOSE Neurosurgical ablative procedures, such as cordotomy and cingulotomy, are often considered irreversible and destructive but can provide an effective and individualized solution for cancer-related refractory pain, when all other approaches have been unsuccessful. This paper provides an in-depth exploration of a novel approach to managing refractory cancer pain. It involves an interdisciplinary team led by a neurosurgeon at a renowned national referral center. METHODS a retrospective analysis of the medical records of all sequential patients who underwent their initial evaluation at our interdisciplinary refractory cancer pain clinic from February 2017 to January 2023. RESULTS A total of 207 patients were examined in the clinic for a first visit during the study period. All patients were referred to the clinic due to severe pain that was deemed refractory by the referring physician. The mean age was 61 ± 12.3 years, with no significant sex difference (P = 0.58). The mean ECOG Performance Status score was 2.35. Conservative measures had not yet been exhausted in 28 patients (14%) and 9 patients were well controlled (4%). Neurosurgical ablative procedures were recommended for 151 (73%) of the patients. Sixty-six patients (32%) eventually underwent the procedure. 91 patients (44%) received a negative recommendation for surgery. Thirty-five patients (17%) were referred for further invasive procedures at the pain clinic. CONCLUSION An Interdisciplinary cooperation between palliative care specialists, pain specialists, and neurosurgeons ensures optimal patient selection and provides safe and effective neurosurgery for the treatment of refractory cancer-related pain.
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Affiliation(s)
- Morsi Khashan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurosurgery, Spine Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Strauss
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurosurgery, Spine Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Silviu Brill
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pain Medicine, Division of Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rotem Tellem
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Palliative Care Service, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Haggai Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pain Medicine, Division of Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Uri Hochberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Institute of Pain Medicine, Division of Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Korkut S, Saatçi G. The relationship between nurses' professional values and ethical attitudes to pain. Nurs Ethics 2024:9697330241263993. [PMID: 39031935 DOI: 10.1177/09697330241263993] [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: 07/22/2024]
Abstract
Background: Pain management is a fundamental human right for everyone who experiences it. The management of pain is an ethical obligation for all health professionals. Professional values have an important place in appropriate clinical decision-making. Research aim: This study was conducted to determine the relationship between nurses' ethical attitudes in pain management and their compliance with professional values. Research design: The study was conducted as a descriptive and correlational research. The study data were collected by online survey method using the Introductory Characteristics Form, Ethical Attitude Scale for Pain Management in Nursing, and Nurses Professional Values Scale - Revised. Participants and research context: The population of the study consisted of nurses working in tertiary treatment centers in a country. A total of 388 nurses participated in the study. Ethical considerations: Ethical approval was obtained from the University Ethics Committee. Consent was obtained from the nurses. Results: The mean total score of the Ethical Attitude Scale for Pain Management in Nursing was 98.96 ± 9.37, and the mean total score of the Nurses Professional Values Scale was 101.51 ± 15.20. The scores of the Ethical Attitude Scale for Pain Management in Nursing were positively and moderately correlated with the total scores of the Professional Values Scale. Compliance with professional values explained 41% of the total variance of ethical attitude for pain management. Conclusions: In this study, it was found that nurses' ethical attitudes for pain management and compliance with professional values were at a high level, compliance with professional values was associated with ethical attitudes for pain management, and ethical attitudes for pain management decreased with increasing working years. A nurse with high ethical sensitivity and compliance with professional values can easily recognize ethical problems, effectively manage the ethical decision-making process, and provide appropriate patient care.
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Kamdar M, Jethwani K, Centi AJ, Agboola S, Fischer N, Traeger L, Rinaldi S, Strand J, Ritchie C, Temel JS, Greer JA, Kvedar J, El-Jawarhi A, Jackson V. A Digital Therapeutic Application (ePAL) to Manage Pain in Patients With Advanced Cancer: A Randomized Controlled Trial. J Pain Symptom Manage 2024:S0885-3924(24)00800-5. [PMID: 38866116 DOI: 10.1016/j.jpainsymman.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Patients with advanced cancer often experience immense cancer pain that negatively impacts their quality of life. Interventions to address cancer-related pain are limited. METHODS We conducted a randomized trial of a digital therapeutic app (ePAL) for patients with advanced cancer receiving care in a specialty palliative care clinic at a tertiary care hospital. Patients were randomized to ePAL or usual care. ePAL included 1) active pain monitoring; 2) artificial intelligence algorithm to triage patient symptoms; and 3) patient education to address barriers to pain management. Participants were instructed to use ePAL over eight weeks. Patient-reported pain symptoms were assessed at baseline, Week-4, and Week-8 (primary endpoint) using the Brief Pain Inventory. Secondary outcomes include pain-related hospitalizations by Week-8. RESULTS We enrolled 112 patients who were randomly assigned to ePAL (N = 56) or usual care (N = 56). Patients utilized ePAL on average 2.1 times per week to report pain symptoms, and 47.6% reported their pain at least once per week over eight weeks. Patients randomized to ePAL reported lower pain scores at Week-4 (mean: 3.16 vs. 4.28, P = 0.010) and week-8 (mean:2.99 vs. 4.05, P = 0.017), compared to those receiving usual care. Participants randomized to ePAL were less likely to experience a pain-related hospitalization compared to those in the usual care group (7.1% vs. 23.2% P = 0.018) CONCLUSIONS: ePAL was associated with lower patient-reported pain and fewer pain-related hospitalizations compared to usual care in patients with advanced cancer. This study demonstrates the promise of digital therapeutics for improving patients' symptoms while reducing burdensome hospitalizations.
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Affiliation(s)
- Mihir Kamdar
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA.
| | | | | | | | | | - Lara Traeger
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Simone Rinaldi
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Jacob Strand
- Medicine, Mayo Clinic (J.S.), Rochester, Minnesota, USA
| | - Christine Ritchie
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Jennifer S Temel
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Joseph A Greer
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Joseph Kvedar
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Areej El-Jawarhi
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
| | - Vicki Jackson
- Massachusetts General Hospital (M.K., L.T., S.R., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA; Harvard Medical School (M.K., L.T., C.R., J.S.T., J.A.G., J.K., A.E.J., V.J.), Boston, Massachusetts, USA
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Liu J, Luo J, Chen X, Xie J, Wang C, Wang H, Yuan Q, Li S, Zhang Y, Hu J, Shi C. Opioid Nonadherence Risk Prediction of Patients with Cancer-Related Pain Based on Five Machine Learning Algorithms. Pain Res Manag 2024; 2024:7347876. [PMID: 38872993 PMCID: PMC11175844 DOI: 10.1155/2024/7347876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 06/15/2024]
Abstract
Objectives Opioid nonadherence represents a significant barrier to cancer pain treatment efficacy. However, there is currently no effective prediction method for opioid adherence in patients with cancer pain. We aimed to develop and validate a machine learning (ML) model and evaluate its feasibility to predict opioid nonadherence in patients with cancer pain. Methods This was a secondary analysis from a cross-sectional study that included 1195 patients from March 1, 2018, to October 31, 2019. Five ML algorithms, such as logistic regression (LR), random forest, eXtreme Gradient Boosting, multilayer perceptron, and support vector machine, were used to predict opioid nonadherence in patients with cancer pain using 43 demographic and clinical factors as predictors. The predictive effects of the models were compared by the area under the receiver operating characteristic curve (AUC_ROC), accuracy, precision, sensitivity, specificity, and F1 scores. The value of the best model for clinical application was assessed using decision curve analysis (DCA). Results The best model obtained in this study, the LR model, had an AUC_ROC of 0.82, accuracy of 0.82, and specificity of 0.71. The DCA showed that clinical interventions for patients at high risk of opioid nonadherence based on the LR model can benefit patients. The strongest predictors for adherence were, in order of importance, beliefs about medicines questionnaire (BMQ)-harm, time since the start of opioid, and BMQ-necessity. Discussion. ML algorithms can be used as an effective means of predicting adherence to opioids in patients with cancer pain, which allows for proactive clinical intervention to optimize cancer pain management. This trial is registered with ChiCTR2000033576.
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Affiliation(s)
- Jinmei Liu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Juan Luo
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Xu Chen
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Jiyi Xie
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Cong Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Hanxiang Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Qi Yuan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Shijun Li
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Jianli Hu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chen Shi
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
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5
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Nagar SD, Nagar SJ, Jordan V, Dawson J. Sympathetic nerve blocks for persistent pain in adults with inoperable abdominopelvic cancer. Cochrane Database Syst Rev 2024; 6:CD015229. [PMID: 38842054 PMCID: PMC11154857 DOI: 10.1002/14651858.cd015229.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Persistent visceral pain is an unpleasant sensation coming from one or more organs within the body. Visceral pain is a common symptom in those with advanced cancer. Interventional procedures, such as neurolytic sympathetic nerve blocks, have been suggested as additional treatments that may play a part in optimising pain management for individuals with this condition. OBJECTIVES To evaluate the benefits and harms of neurolytic sympathetic nerve blocks for persistent visceral pain in adults with inoperable abdominopelvic cancer compared to standard care or placebo and comparing single blocks to combination blocks. SEARCH METHODS We searched the following databases without language restrictions on 19 October 2022 and ran a top-up search on 31 October 2023: CENTRAL; MEDLINE via Ovid; Embase via Ovid; LILACS. We searched trial registers without language restrictions on 2 November 2022: ClinicalTrials.gov; WHO International Clinical Trials Registry Platform (ICTRP). We searched grey literature, checked reference lists of reviews and retrieved articles for additional studies, and performed citation searches on key articles. We also contacted experts in the field for unpublished and ongoing trials. Our trial protocol was preregistered in the Cochrane Database of Systematic Reviews on 21 October 2022. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) comparing any sympathetic nerve block targeting sites commonly used to treat abdominal pelvic pain from inoperable malignancies in adults to standard care or placebo. DATA COLLECTION AND ANALYSIS We independently selected trials based on predefined inclusion criteria, resolving any differences via adjudication with a third review author. We used a random-effects model as some heterogeneity was expected between the studies due to differences in the interventions being assessed and malignancy types included in the study population. We chose three primary outcomes and four secondary outcomes of interest. We sought consumer input to refine our review outcomes and assessed extracted data using Cochrane's risk of bias 2 tool (RoB 2). We assessed the certainty of evidence using the GRADE system. MAIN RESULTS We included 17 studies with 1025 participants in this review. Fifteen studies with a total of 951 participants contributed to the quantitative analysis. Single block versus standard care Primary outcomes No included studies reported our primary outcome, 'Proportion of participants reporting no worse than mild pain after treatment at 14 days'. The evidence is very uncertain about the effect of sympathetic nerve blocks on reducing pain to no worse than mild pain at 14 days when compared to standard care due to insufficient data (very low-certainty evidence). Sympathetic nerve blocks may provide small to 'little to no' improvement in quality of life (QOL) scores at 14 days after treatment when compared to standard care, but the evidence is very uncertain (standardised mean difference (SMD) -0.73, 95% confidence interval (CI) -1.70 to 0.25; I² = 87%; 4 studies, 150 participants; very low-certainty evidence). The evidence is very uncertain about the risk of serious adverse events as defined in our review as only one study contributed data to this outcome. Sympathetic nerve blocks may have an 'increased risk' to 'no additional risk' of harm compared with standard care (very low-certainty evidence). Secondary outcomes Sympathetic nerve blocks showed a small to 'little to no' effect on participant-reported pain scores at 14 days using a 0 to 10 visual analogue scale (VAS) for pain compared with standard care, but the evidence is very uncertain (mean difference (MD) -0.44, 95% CI -0.98 to 0.11; I² = 56%; 5 studies, 214 participants; very low-certainty evidence). There may be a 'moderate to large' to 'little to no' reduction in daily consumption of opioids postprocedure at 14 days with sympathetic nerve blocks compared with standard care, but the evidence is very uncertain (change in daily consumption of opioids at 14 days as oral milligrams morphine equivalent (MME): MD -41.63 mg, 95% CI -78.54 mg to -4.72 mg; I² = 90%; 4 studies, 130 participants; very low-certainty evidence). The evidence is very uncertain about the effect of sympathetic nerve blocks on participant satisfaction with procedure at 0 to 7 days and time to need for retreatment or treatment effect failure (or both) due to insufficient data. Combination block versus single block Primary outcomes There is no evidence about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks on the proportion of participants reporting no worse than mild pain after treatment at 14 days because no studies reported this outcome. There may be a small to 'little to no' effect on QOL score at 14 days after treatment, but the evidence is very uncertain (very low-certainty evidence). The evidence is very uncertain about the risk of serious adverse events with combination sympathetic nerve blocks compared with single sympathetic nerve blocks due to limited reporting in the included studies (very low-certainty evidence). Secondary outcomes The evidence is very uncertain about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks on participant-reported pain score and change in daily consumption of opioids postprocedure, at 14 days. There may be a small to 'little to no' effect, but the evidence is very uncertain (very low-certainty evidence). There is no evidence about the effect on participant satisfaction with procedure at 0 to 7 days and time to need for retreatment or treatment effect failure (or both) due to these outcomes not being measured by the studies. Risk of bias The risk of bias was predominately high for most outcomes in most studies due to significant concerns regarding adequate blinding. Very few studies were deemed as low risk across all domains for any outcome. AUTHORS' CONCLUSIONS There is limited evidence to support or refute the use of sympathetic nerve blocks for persistent abdominopelvic pain due to inoperable malignancy. We are very uncertain about the effect of combination sympathetic nerve blocks compared with single sympathetic nerve blocks. The certainty of the evidence is very low and these findings should be interpreted with caution.
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Affiliation(s)
- Sachin D Nagar
- Department of Hospital Palliative Care, North Shore Hospital, Te Whatu Ora - Waitemata, Auckland, New Zealand
| | - Sarah J Nagar
- Neurogenetics, Center for Brain Research, University of Auckland, Auckland, New Zealand
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jennifer Dawson
- Department of Hospital Palliative Care, Middlemore Hospital, Te Whatu Ora - Counties Manukau, Auckland, New Zealand
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Turan SA, Yentek Balkanay A, Aydın Ş. Prevalence of Reluctance to Prescribe Opioids Among Physicians in Oncology Departments: A Descriptive Cross-Sectional Study From Turkey. J Pain Palliat Care Pharmacother 2024; 38:123-130. [PMID: 38805382 DOI: 10.1080/15360288.2024.2346630] [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: 12/01/2023] [Accepted: 04/17/2024] [Indexed: 05/30/2024]
Abstract
Cancer-related pain (CrP) is a significant public health problem, and opioids are the mainstay of CrP treatment. Considering the persistent problem of inadequate treatment of cancer pain in Turkey, the study was conducted to determine the prevalence of reluctance to prescribe opioids among physicians in oncology departments. The descriptive cross-sectional study included oncology residents and residents without oncology specialization in oncology departments. One thousand physicians were invited by e-mail to the Google Forms survey platform. Two hundred and seventy-eight physicians completed the survey and were included, of which 50% (n: 139) were female. More than half (n: 166; 59.7%) of them were oncology subspecialists. The prevalence of reluctance to prescribe opioids was calculated to be 38.1% (n: 106). A significant positive association was found between the factor associated with reluctance to prescribe opioids and fear of opioid use disorder (β = 0.964; 95% CI = 0.362-1.566; p = .002). Reluctance to prescribe opioids was inversely related to the oncology subspecialty (β = -0.878; 95% CI = -1.54 to -0.213; p = 0.010) and education about CrP and opioid management (β = -1.707; 95% CI = -2.404 to -1.009; p = 0.01). Reluctance to prescribe opioids appears to be associated with a lack of knowledge and fear of opioid use disorder.
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Affiliation(s)
- Suna Aşkın Turan
- Pain Department, University of Health Sciences, Mersin City Hospital, Mersin, Turkey
| | - Ayben Yentek Balkanay
- Department of Radiation Oncology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Şenay Aydın
- Department of Neurology, University of Health Sciences, Yedikule Chest Disease and Surgery Training and Research Hospital, Istanbul, Turkey
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Dawson E, Greenfield K, Carter B, Bailey S, Anderson AK, Rajapakse D, Renton K, Mott C, Hain R, Harrop E, Johnson M, Liossi C. Definition and Assessment of Paediatric Breakthrough Pain: A Qualitative Interview Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:485. [PMID: 38671702 PMCID: PMC11049523 DOI: 10.3390/children11040485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
Infants, children and young people with life-limiting or life-threatening conditions often experience acute, transient pain episodes known as breakthrough pain. There is currently no established way to assess breakthrough pain in paediatric palliative care. Anecdotal evidence suggests that it is frequently underdiagnosed and undertreated, resulting in reduced quality of life. The development of a standardised paediatric breakthrough pain assessment, based on healthcare professionals' insights, could improve patient outcomes. This study aimed to explore how healthcare professionals define and assess breakthrough pain in paediatric palliative care and their attitudes towards a validated paediatric breakthrough pain assessment. This was a descriptive qualitative interview study. Semi-structured interviews were conducted with 29 healthcare professionals working in paediatric palliative care across the UK. An inductive thematic analysis was conducted on the data. Five themes were generated: 'the elusive nature of breakthrough pain', 'breakthrough pain assessment', 'positive attitudes towards', 'reservations towards' and 'features to include in' a paediatric breakthrough pain assessment. The definition and assessment of breakthrough pain is inconsistent in paediatric palliative care. There is a clear need for a validated assessment questionnaire to improve assessment, diagnosis and management of breakthrough pain followed by increased healthcare professional education on the concept.
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Affiliation(s)
- Eleanor Dawson
- School of Psychology, University of Southampton, Highfield SO17 1BJ, UK (K.G.)
| | - Katie Greenfield
- School of Psychology, University of Southampton, Highfield SO17 1BJ, UK (K.G.)
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, St Helens Road, Ormskirk L39 4QP, UK;
| | - Simon Bailey
- Department of Children’s Oncology, Great North Children’s Hospital, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | | | - Dilini Rajapakse
- The Louis Dundas Centre, Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Kate Renton
- University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK
- Naomi House & Jacksplace, Stockbridge Road, Sutton Scotney, Winchester SO21 3JE, UK
| | - Christine Mott
- Acorns Children’s Hospice, 103 Oak Tree Lane, Selly Oak, Birmingham B29 6HZ, UK
- Birmingham Children’s Hospital, Birmingham, Steelhouse Lane, Birmingham B4 6NH, UK
| | - Richard Hain
- Department of Child Health, Swansea University, Swansea SA2 8PP, UK;
| | - Emily Harrop
- Helen & Douglas House Hospices, 14A Magdalen Road, Oxford OX4 1RW, UK;
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | | | - Christina Liossi
- School of Psychology, University of Southampton, Highfield SO17 1BJ, UK (K.G.)
- Psychological Medicine, Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
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8
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Riano I, Velazquez AI, Viola L, Abuali I, Jimenez K, Abioye O, Florez N. State of Cancer Control in South America: Challenges and Advancement Strategies. Hematol Oncol Clin North Am 2024; 38:55-76. [PMID: 37353378 DOI: 10.1016/j.hoc.2023.05.013] [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] [Indexed: 06/25/2023]
Abstract
Cancer is a major public health problem in South America. The cancer mortality burden is increasing in the region due to its presentation at later stages, which is related to limited access to cancer care. This results in a noticeable inequity in provisions of cancer care including specialized screening programs, as well as cancer-related treatments such as personalized medicine, radiation therapy, palliative care, and survivorship services. Consequently, South America faces many challenges for cancer control, most of them deriving from a lack of funding and unequal distribution of resources and cancer services, affecting mostly the underserved populations in the region.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, One Medical Drive, Lebanon, NH 03766, USA.
| | - Ana I Velazquez
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. https://twitter.com/AnaVManana
| | - Lucia Viola
- Fundación Neumológica Colombiana, Centro de Tratamiento e Investigación Sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Cra. 13b #161 - 85, Bogotá, Colombia. https://twitter.com/LuciaViola9
| | - Inas Abuali
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. https://twitter.com/Inas_md
| | - Kathya Jimenez
- Universidad Evangelica de El Salvador, El Salvador. https://twitter.com/KathyaJimenezMD
| | - Oyepeju Abioye
- University of the Witwatersrand, School of Public Health, Johannesburg, South Africa. https://twitter.com/AbioyeOyepeju
| | - Narjust Florez
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA. https://twitter.com/NarjustFlorezMD
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9
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DeForge SM, Smith K, Anderson KA, Baltazar AR, Beck M, Enzinger AC, Tulsky JA, Allsop M, Edwards RR, Schreiber KL, Azizoddin DR. Pain coping, multidisciplinary care, and mHealth: Patients' views on managing advanced cancer pain. Psychooncology 2024; 33:e6308. [PMID: 38366975 PMCID: PMC11071444 DOI: 10.1002/pon.6308] [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: 11/28/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Pain is common among people with advanced cancer. While opioids provide significant relief, incorporating psycho-behavioral treatments may improve pain outcomes. We examined patients' experiences with pain self-management and how their self-management of chronic, cancer-related pain may be complemented by behavioral mobile health (mHealth) interventions. METHODS We conducted semi-structured qualitative interviews with patients with advanced cancer and pain. Each participant reviewed content from our behavioral mHealth application for cancer pain management and early images of its interface. Participants reflected on their experiences self-managing cancer pain and on app content. Interviews were transcribed verbatim and analyzed using a combination of inductive and deductive thematic analysis. RESULTS Patients (n = 28; 54% female; mean age = 53) across two geographic regions reported using psychological strategies (e.g., reframing negative thoughts, distraction, pain acceptance, social support) to manage chronic cancer-related pain. Patients shared their perspectives on the integration of psycho-behavioral pain treatments into their existing medical care and their experiences with opioid hesitancy. Patient recommendations for how mHealth interventions could best support them coalesced around two topics: 1.) convenience in accessing integrated pharmacological and psycho-behavioral pain education and communication tools and 2.) relevance of the specific content to their clinical situation. CONCLUSIONS Integrated pharmacological and psycho-behavioral pain treatments were important to participants. This underscores a need to coordinate complimentary approaches when developing cancer pain management interventions. Participant feedback suggests that an mHealth intervention that integrates pain treatments may have the capacity to increase advanced cancer patients' access to destigmatizing, accessible care while improving pain self-management.
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Affiliation(s)
- Sara M. DeForge
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Kyla Smith
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Kris-Ann Anderson
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Ashton R. Baltazar
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Meghan Beck
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrea C. Enzinger
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Matthew Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Desiree R. Azizoddin
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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10
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Shepherd WS, Wiese AD, Cho HE, Rork WC, Baig MU, Kostick KM, Nguyen D, Carter EM, Murali CN, Robinson ME, Schneider SC, Lee B, Sutton VR, Storch EA. Psychosocial Outcomes of Pain and Pain Management in Adults with Osteogenesis Imperfecta: A Qualitative Study. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09991-z. [PMID: 38281305 DOI: 10.1007/s10880-023-09991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/30/2024]
Abstract
Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and fractures, short stature, dental abnormalities, hearing loss, scoliosis, and chronic pain. Despite a growing literature on the functional outcomes of OI, limited research has explicitly examined the psychosocial outcomes of pain within OI. Adults with OI (N = 15) were interviewed to understand pain-related experiences through a thematic analysis of semi-structured interview data. Research team members, genetic research experts, and OI clinicians developed an interview guide focused on topics related to pain and mental health challenges. Participants' transcripts were coded by two independent coders; codes were then merged across coders and quotation outputs were subsequently abstracted (paraphrased then thematically classified) to identify common themes. Themes related to pain management variability regarding pain type, pain risk management and accessibility, pain outcomes (e.g., behavior, cognitive, affective), and pain exacerbating factors (e.g., individual, contextual) were identified. Participants reported chronic and acute pain, and despite the inaccessibility and stigmatization of pain medications (e.g., opioids), pharmacological treatments were the most common pain management approach. Participants reported negative pain outcomes, such as limited daily functioning and activity participation, fear, anger, anxiety, depression, and difficulty concentrating. Lastly, participants suggested that lack of physician and community knowledge on chronic pain in OI indirectly exacerbates both subjective pain intensity and outcomes. Although limited by a small, nondiverse sample, the current study provides valuable exploration of the unique pain experiences of adults with OI that may have implications for proactive management, treatment development, and clinician training.
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Affiliation(s)
- Whitney S Shepherd
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Hannah E Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - W Conor Rork
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - M Usman Baig
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Kristin M Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Dianne Nguyen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Erin M Carter
- Hospital for Special Surgery, New York City, NY, USA
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | | | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA.
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11
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Azizoddin DR, DeForge SM, Baltazar A, Edwards RR, Allsop M, Tulsky JA, Businelle MS, Schreiber KL, Enzinger AC. Development and pre-pilot testing of STAMP + CBT: an mHealth app combining pain cognitive behavioral therapy and opioid support for patients with advanced cancer and pain. Support Care Cancer 2024; 32:123. [PMID: 38252172 PMCID: PMC11088794 DOI: 10.1007/s00520-024-08307-7] [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: 08/29/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE We developed and piloted a mobile health app to deliver cognitive behavioral therapy for pain (pain-CBT), remote symptom monitoring, and pharmacologic support for patients with pain from advanced cancer. METHODS Using an iterative process of patient review and feedback, we developed the STAMP + CBT app. The app delivers brief daily lessons from pain-CBT and pain psychoeducation, adapted for advanced cancer. Daily surveys assess physical symptoms, psychological symptoms, opioid utilization and relief. Just-in-time adaptive interventions generate tailored psychoeducation in response. We then conducted a single-arm pilot feasibility study at two cancer centers. Patients with advanced cancer and chronic pain used the app for 2 or 4 weeks, rated its acceptability and provided feedback in semi-structured interviews. Feasibility and acceptability were defined as ≥ 70% of participants completing ≥ 50% of daily surveys, and ≥ 80% of acceptability items rated ≥ 4/5. RESULTS Fifteen participants (female = 9; mean age = 50.3) tested the app. We exceeded our feasibility and accessibility benchmarks: 73% of patients completed ≥ 50% of daily surveys; 87% of acceptability items were rated ≥ 4/5. Participants valued the app's brevity, clarity, and salience, and found education on stress and pain to be most helpful. The app helped participants learn pain management strategies and decrease maladaptive thoughts. However, participants disliked the notification structure (single prompt with one snooze), which led to missed content. CONCLUSION The STAMP + CBT app was an acceptable and feasible method to deliver psychological/behavioral treatment with pharmacologic support for cancer pain. The app is being refined and will be tested in a larger randomized pilot study. TRN: NCT05403801 (05/06/2022).
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Affiliation(s)
- Desiree R Azizoddin
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Sara M DeForge
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ashton Baltazar
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael S Businelle
- Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrea C Enzinger
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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12
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Arthur J, Edwards T, Lu Z, Amoateng MD, Koom-Dadzie K, Zhu H, Long J, Do KA, Bruera E. Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic cancer pain. Support Care Cancer 2024; 32:121. [PMID: 38252311 DOI: 10.1007/s00520-024-08323-7] [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: 09/18/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE Data indicates that clinicians might be under-prescribing opioids for patients with chronic cancer pain, and this could impact adequate pain management. Few studies have sought to understand healthcare provider (HCP) perceptions and practices regarding the prescription of opioids for chronic cancer pain. We assessed HCP perceptions and practices regarding opioid prescription for patients with chronic cancer pain since the onset of the COVID-19 pandemic. METHODS An anonymous cross-sectional survey was conducted among 186 HCPs who attended an opioid educational event in April 2021 and 2022. RESULTS Sixty-one out of 143 (44%) opioid prescribers reported reluctance to prescribe opioids for chronic cancer pain. In a multivariate logistic model, younger participants (log OR - 0.04, 95% CI - 0.085, - 0.004; p = 0.033) and pain medicine clinicians (log OR - 1.89, CI - 3.931, - 0.286; p = 0.034) were less reluctant, whereas providers who worry about non-medical opioid use were more reluctant to prescribe opioids (log OR 1.58 95% CI 0.77-2.43; p < 0.001). Fifty-three out of 143 (37%) prescribers had experienced increased challenges regarding opioid dispensing at pharmacies, and 84/179 (47%) of all respondents reported similar experience by their patients. Fifty-four out of 178(30%) were aware of opioid-related harmful incidents to patients or their families, including incidents attributed to opioid misuse by a household or family member. CONCLUSION A considerable number of opioid prescribers were reluctant to prescribe opioids for patients with chronic cancer pain. Many reported challenges regarding dispensing of opioids at the pharmacies. These may be unintended consequences of policies to address the opioid crisis. Future measures should focus on addressing regulatory barriers without undermining the gains already made to combat the opioid crisis.
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Affiliation(s)
- Joseph Arthur
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Tonya Edwards
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Zhanni Lu
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Magdelene Doris Amoateng
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Kwame Koom-Dadzie
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Hongxu Zhu
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - James Long
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Kim-Anh Do
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
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13
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Diernberger K, Clausen E, Murray G, Wee B, Kaasa S, Hall P, Fallon M. Cancer pain assessment and management: does an institutional approach individualise and reduce cost of care? BMJ Support Palliat Care 2024; 13:e1258-e1264. [PMID: 37236649 PMCID: PMC10850828 DOI: 10.1136/spcare-2022-003547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/13/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To understand individual prescribing and associated costs in patients managed with the Edinburgh Pain Assessment and management Tool (EPAT). METHODS The EPAT study was a two-arm parallel group cluster randomised (1:1) trial, including 19 UK cancer centres. Study outcome assessments, including pain levels, analgesia and non-pharmacological and anaesthetic interventions, collected at baseline, 3-5 days and, if applicable, 7-10 days after admission. Costs calculated for inpatient length of stay (LoS), medications and complex pain interventions. Analysis accounted for the clustered nature of the trial design. In this post-hoc analysis, healthcare utilisation and costs are presented descriptively. PARTICIPANTS 10 centres randomised to EPAT (487 patients) and 9 (449 patients) to usual care (UC). MAIN OUTCOME MEASURES Pharmacological and non-pharmacological management, complex pain interventions, length of hospital stay and costs related to these outcomes. RESULTS The mean per patient hospital cost was £3866 with EPAT and £4194 with UC, reflecting a mean LoS of 2.9 days and 3.1 days, respectively. Costs were lower for non-opioids, Non-steroidal anti-inflammatories (NSAIDs) and opioids but slightly higher for adjuvants with EPAT than with UC. The mean per-patient opioid costs were £17.90 (EPAT) and £25.80 (UC). Mean per patient costs of all medication were £36 (EPAT) and £40 (UC).Complex pain intervention costs were £117 with EPAT per patient and £90 with UC. Overall mean cost per patient was £4018.3 (95% CI 3698.9 to 4337.8) with EPAT and £4323.8 (95% CI 4060.0 to 4587.7) with UC. CONCLUSIONS EPAT facilitated personalised medicine and may result in less opioids, more specific treatments, improved pain outcomes and cost savings.
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Affiliation(s)
| | - Eleanor Clausen
- The International Spine Centre, Adelaide, South Australia, Australia
| | - Gordon Murray
- Public Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Bee Wee
- University of Oxford, Oxford, UK
| | - Stein Kaasa
- University of Oslo Faculty of Medicine, Oslo, Norway
| | - Peter Hall
- University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Marie Fallon
- Department of Palliative Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
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14
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Cuomo A. Fentanyl in cancer pain management: avoiding hasty judgments and discerning its potential benefits. Drugs Context 2023; 12:2023-10-2. [PMID: 38148830 PMCID: PMC10751104 DOI: 10.7573/dic.2023-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/28/2023] Open
Abstract
Cancer pain is an important challenge in treatment and requires a rapid onset of action for its control. In particular, breakthrough cancer pain (BTcP) should be adequately controlled with a stable dose of a short-acting oral opioid. Fentanyl is a synthetic, highly selective opioid with many advantageous chemical properties, including high lipophilicity and distinct pharmacokinetic properties. It is recommended for pain management in a variety of settings, including acute pain, chronic pain and BTcP. To date, its variously designed formulations allow non-invasive administration; amongst others, sublingual fentanyl has proven useful in the management of BTcP and in improving the quality of life of patients with cancer. This review provides an update on the management of BTcP with fentanyl, with consideration of safety, as it remains an important tool in the treatment of cancer pain.
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Affiliation(s)
- Arturo Cuomo
- Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples,
Italy
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15
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de Munter J, Dodlek N, Khmaladze A, Parreira ST, Ullgren H, de Man R, de Jong FA, Oldenmenger WH. The role of cancer nurses in cancer-related pain management in Europe. Palliat Care Soc Pract 2023; 17:26323524231216996. [PMID: 38106339 PMCID: PMC10725126 DOI: 10.1177/26323524231216996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Cancer pain is a common symptom in patients with cancer and can largely affect their quality of life. Pain management is important to minimize the impact of pain on daily activities. Cancer nurses are significantly involved in all steps of pain management and contribute to the success of therapy through their knowledge and expertise. While they generally play an important role in the screening, assessment, diagnosis, treatment and follow-up of patients and their (pain) symptoms, this varies from country to country in Europe. An important aspect is their role in educating patients and their families about what pain is, what impact it can have, how it can be treated pharmacologically or non-pharmacologically and what effects or problems can occur during treatment. While there is a great discrepancy between education and training opportunities for cancer nurses in different European countries, there is a continued need for education and training in pain management. Cancer is increasingly becoming a chronic disease, and the management of pain in cancer survivors will be crucial to maintain an adequate quality of life. With this, the crucial role of cancer nurses is becoming even more important.
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Affiliation(s)
| | | | | | | | - Helena Ullgren
- Department of Oncology and Pathology, Karolinska Institute, ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Centre, Stockholm, Sweden
| | - Rik de Man
- Mundipharma Pharmaceuticals B.V., Leusden, The Netherlands
| | | | - Wendy H. Oldenmenger
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
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16
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Calvert CM, Burgess D, Erickson D, Widome R, Jones-Webb R. Cancer pain and alcohol self-medication. J Cancer Surviv 2023; 17:1561-1570. [PMID: 35567710 DOI: 10.1007/s11764-022-01215-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cancer survivors are at increased risk of pain due to their either cancer and/or treatments. Substances like alcohol may be used to self-medicate cancer pain; however, these substances pose their own health risks that may be more pronounced for cancer survivors. METHODS We used cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) 2012-2019 to quantify the association between cancer pain and alcohol use. We used negative binomial regression, with interaction terms added to examine variations across age, sex, and race. We also examined whether alcohol use relates to cancer pain control status. RESULTS Cancer survivors with cancer pain were more likely to be younger, female, Black, and to have been diagnosed with breast cancer. Cancer pain was associated with lower alcohol consumption (incidence rate ratio (IRR): 0.88, confidence interval (CI): 0.77, 0.99). This association was primarily among people 65 and older, women, and white and Hispanic people. Cancer pain control status was not related to alcohol use. CONCLUSIONS Lower alcohol use among cancer survivors with pain has many possible explanations, including several alternative pain management strategies or a decrease in social engagement. Our findings of racial and gender disparities in cancer pain are consistent with the broader evidence on disparities in pain. IMPLICATIONS FOR CANCER SURVIVORS Cancer pain management for marginalized groups should be improved. Healthcare providers should screen cancer survivors for both pain and substance use, to prevent unhealthy self-medication behaviors.
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Affiliation(s)
- Collin M Calvert
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454-1015, USA.
| | - Diana Burgess
- Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Mail code: 152, Bldg. 9, One Veterans Drive, Minneapolis, MN, 55417, USA
| | - Darin Erickson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454-1015, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454-1015, USA
| | - Rhonda Jones-Webb
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN, 55454-1015, USA
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17
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Bilmiç E, Selçukbiricik F, Bagcivan G. The effectiveness of online pain management education on the patient related barriers to cancer pain management: A randomized controlled trial. Eur J Oncol Nurs 2023; 67:102422. [PMID: 37812994 DOI: 10.1016/j.ejon.2023.102422] [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: 01/29/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE This study aimed to evaluate the effectiveness of an online individualized education program on patient-related barriers to cancer pain management. METHODS In this parallel randomized controlled trial, 110 participants were assigned to the intervention or control group. Online individualized education was conducted as the intervention. Depending on participants' preferences, online education sessions were completed via Microsoft Teams, Zoom, or WhatsApp. The primary outcome is patient-related barriers to cancer pain management, and the secondary outcome is pain intensity. The Patient Information Form, the Edmonton Symptom Assessment Scale (ESAS), the Brief Pain Inventory (BPI), and the Barriers Questionnaire II (BQ-II) were used for data collection. The statistical effects of the intervention on the outcomes were modeled in repeated measures ANOVA test. RESULTS The results show that both the group (F = 11.316, p = 0.001) and time effects (F = 63.878, p < 0.001) individually have significant effects on the BQII total score. Also, there is a significant difference between groups regarding BQII total score regardless of time. The interaction between group and time is also significant (F = 127.764, p < 0.001) and substantially affects the BQII total score. Regarding pain intensity, the results show that the interaction between group and time is statistically significant for all pain categories (p < 0.05). In contrast, the group effect is not statistically significant for all pain categories (p > 0.05). Time effects are statistically significant for the "least" and "average" pain only (p < 0.05). CONCLUSION The result of this study presents evidence that individualized online education of cancer patients positively impacts reducing patient-related barriers to pain management and pain intensity.
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Affiliation(s)
- Ezgi Bilmiç
- Department of Medical Oncology, Bakirkoy Dr. Sadi Konuk Training & Research Hospital Istanbul, Turkiye
| | - Fatih Selçukbiricik
- Medical School and Department of Medical Oncology, Koç University, Istanbul, Turkiye
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18
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Macharia JM, Raposa BL, Sipos D, Melczer C, Toth Z, Káposztás Z. The Impact of Palliative Care on Mitigating Pain and Its Associated Effects in Determining Quality of Life among Colon Cancer Outpatients. Healthcare (Basel) 2023; 11:2954. [PMID: 37998446 PMCID: PMC10671794 DOI: 10.3390/healthcare11222954] [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: 09/22/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Pain continues to be a significant problem for cancer patients, and the impact of a population-based strategy on their experiences is not completely understood. Our study aimed to determine the impact of palliative care on mitigating pain and its associated effects in determining the quality of life (QoL) among colon cancer outpatients. Six collection databases were used to perform a structured systematic review of the available literature, considering all papers published between the year 2000 and February 2023. PRISMA guidelines were adopted in our study, and a total of 9792 papers were evaluated. However, only 126 articles met the inclusion criteria. A precise diagnosis of disruptive colorectal cancer (CRC) pain disorders among patients under palliative care is necessary to mitigate it and its associated effects, enhance health, promote life expectancy, increase therapeutic responsiveness, and decrease comorbidity complications. Physical activities, the use of validated pain assessment tools, remote outpatient education and monitoring, chemotherapeutic pain reduction strategies, music and massage therapies, and bridging social isolation gaps are essential in enhancing QoL. We recommend and place a strong emphasis on the adoption of online training/or coaching programs and the integration of formal and informal palliative care systems for maximum QoL benefits among CRC outpatients.
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Affiliation(s)
- John M. Macharia
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Bence L. Raposa
- Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Dávid Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Szent Imre Str 14/B, 7400 Kaposvár, Hungary
| | - Csaba Melczer
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary;
| | - Zoltan Toth
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
| | - Zsolt Káposztás
- Faculty of Health Sciences, University of Pécs, Vörösmarty Str 4, 7621 Pẻcs, Hungary
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19
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Abahussin AA, West RM, Wong DC, Ziegler LE, Allsop MJ. Supporting Pain Self-Management in Patients With Cancer: App Development Based on a Theoretical and Evidence-Driven Approach. JMIR Cancer 2023; 9:e49471. [PMID: 37812491 PMCID: PMC10594136 DOI: 10.2196/49471] [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: 05/30/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND To inform the development of an intervention, it is essential to have a well-developed theoretical understanding of how an intervention causes change, as stated in the UK Medical Research Council guidelines for developing complex interventions. Theoretical foundations are often ignored in the development of mobile health apps intended to support pain self-management for patients with cancer. OBJECTIVE This study aims to systematically set a theory- and evidence-driven design for a pain self-management app and specify the app's active features. METHODS The Behavior Change Wheel (BCW) framework, a step-by-step theoretical approach to the development of interventions, was adopted to achieve the aim of this study. This started by understanding and identifying sources of behavior that could be targeted to support better pain management. Ultimately, the application of the BCW framework guided the identification of the active contents of the app, which were characterized using the Behavior Change Technique Taxonomy version 1. RESULTS The theoretical analysis revealed that patients may have deficits in their capability, opportunity, and motivation that prevent them from performing pain self-management. The app needs to use education, persuasion, training, and enablement intervention functions because, based on the analysis, they were found the most likely to address the specified factors. Eighteen behavior change techniques were selected to describe precisely how the intervention functions can be presented to induce the desired change regarding the intervention context. In other words, they were selected to form the active contents of the app, potentially reducing barriers and serving to support patients in the self-management of pain while using the app. CONCLUSIONS This study fully reports the design and development of a pain self-management app underpinned by theory and evidence and intended for patients with cancer. It provides a model example of the BCW framework application for health app development. The work presented in this study is the first systematic theory- and evidence-driven design for a pain app for patients with cancer. This systematic approach can support clarity in evaluating the intervention's underlying mechanisms and support future replication.
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Affiliation(s)
- Asma A Abahussin
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Robert M West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - David C Wong
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Lucy E Ziegler
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
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Yu Y, Zhang P, Chen D, Jiang SF. Knowledge and practice of the management of breakthrough cancer pain among general practitioners providing palliative care in Shanghai, China: a cross-sectional survey. BMJ Open 2023; 13:e073670. [PMID: 37770268 PMCID: PMC10546098 DOI: 10.1136/bmjopen-2023-073670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE This study examined knowledge and practice of breakthrough cancer pain (BTcP) management among general practitioners (GPs) providing palliative care in Shanghai. DESIGN Cross-sectional study using a self-administered questionnaire. SETTING AND PARTICIPANTS A total of 393 GPs providing palliative care in 32 community health service centres in Shanghai were recruited by stratified cluster random sampling between 1 May and 30 June 2022. OUTCOME MEASURES Knowledge and practice concerning BTcP management. RESULTS A total of 375 questionnaires were collected and declared valid. The median knowledge score was 11 out of 21 points. Only 36.3% (n=136) of the participating GPs scored 11 points or more, which was categorised as good knowledge. Only 24.8% (n=93) of the GPs used Davies' adapted diagnostic algorithm as the gold standard for diagnosis. All of the GPs assessed the intensity of BTcP; however, less than a quarter of the GPs evaluated the relationship between background pain and BTcP (22.1%, n=83), the impact of BTcP on activities of daily living (24.0%, n=90), the impact of BTcP on social relationships (14.4%, n=54) and the impact of BTcP on mood (10.1%, n=38). 56.5% (n=212) of the GPs reported that they used pain tools in the assessment of BTcP. All of the GPs prescribed immediate-release morphine as rescue medication for relieving BTcP; however, 60.5% (n=227) prescribed the dose based on their personal experiences, irrespective of the basal opioid dose, and 57.3% (n=215) did not conduct dose titration after providing the initial dose. No GPs reported that they ever administered interventional treatment to their patients. CONCLUSIONS Insufficient knowledge and inappropriate behaviours in BTcP diagnosis, assessment and treatment were identified. There is an urgent need to improve BTcP management among GPs providing palliative care in Shanghai.
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Affiliation(s)
- Ying Yu
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, China
| | - Panpan Zhang
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, China
| | - Danxia Chen
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, China
| | - Sun Fang Jiang
- Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Health Management Center, Zhongshan Hospital Fudan University, Shanghai, China
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21
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Arthur J, Edwards T, Lu Z, Amoateng DM, Koom-Dadzie K, Zhu H, Long J, Do KA, Bruera E. Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic pain. RESEARCH SQUARE 2023:rs.3.rs-3367358. [PMID: 37841840 PMCID: PMC10571602 DOI: 10.21203/rs.3.rs-3367358/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
PURPOSE Data indicates that clinicians might be under-prescribing opioids for patients with chronic cancer pain, and this could impact adequate chronic pain management. Few studies have sought to understand healthcare provider (HCP) perceptions and practices regarding the prescription of opioids for chronic pain. We assessed HCP perceptions and practices regarding opioid prescription for patients with chronic pain since the onset of the COVID-19 pandemic. METHODS An anonymous cross-sectional survey was conducted among 186 HCPs who attended an opioid educational event in April 2021 and 2022. RESULTS 61/143(44%) opioid prescribers reported reluctance to prescribe opioids for chronic pain. In a multivariate logistic model, younger participants (log OR -0.04, 95% CI: -0.085, -0.004; p = 0.033) and pain medicine clinicians (log OR -1.89, CI: -3.931, -0.286; p = 0.034) were less reluctant, whereas providers who worry about non-medical opioid use (NMOU) were more reluctant to prescribe opioids (log OR 1.58 95% CI: 0.77-2.43; p < 0.001). 53/143(37%) respondents had experienced increased challenges regarding opioid dispensing at pharmacies, and 84/179(47%) reported similar experience by their patients. 54/178(30%) HCPs were aware of opioid-related harmful incidents to patients or their families, including incidents attributed to opioid misuse by a household or family member. CONCLUSION A significant number of opioid prescribers were reluctant to prescribe opioids for patients with chronic pain. Many reported challenges regarding dispensing of opioids at the pharmacies. These may be unintended consequences of policies to address the opioid crisis. Future measures should focus on addressing regulatory barriers without undermining the gains already made to combat the opioid crisis.
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Affiliation(s)
| | | | - Zhanni Lu
- The University of Texas MD Anderson Cancer
| | | | | | - Hongxu Zhu
- The University of Texas MD Anderson Cancer
| | - James Long
- The University of Texas MD Anderson Cancer
| | - Kim-Anh Do
- The University of Texas MD Anderson Cancer
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22
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MacNeil E, Lau J, Tedesco A, Babaei-Rad R, Hutton L. Managing opioids and mitigating opioid risks in patients with cancer: An environmental scan of the attitudes, confidence, and practices of ambulatory, community and hospital pharmacists practicing in Canada. J Oncol Pharm Pract 2023:10781552231200169. [PMID: 37743630 DOI: 10.1177/10781552231200169] [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: 09/26/2023]
Abstract
INTRODUCTION Canada is in the midst of an overdose crisis. The use of prescription opioids in Canada has increased steadily over the past two decades, with stark increases in opioid-induced respiratory depression and related deaths. Opioids are the mainstay of treatment for cancer-related pain. Patients with cancer are not immune to the risks associated with opioid use but are underrepresented in available literature outlining risk mitigation strategies. Pharmacists are ideally placed to employ opioid risk mitigation practices to support safe and effective opioid use for patients with cancer-related pain. However, the current attitudes, confidence, and safety practices of pharmacists around how to best support these patients are not known. METHODS This study was a descriptive environmental scan of pharmacists who provide direct patient care in Canada. An electronic questionnaire was built using the web based Opinio software. It was distributed via email by several provincial and national pharmacy organizations and online platforms. The questionnaire consisted of Likert-scale and open-ended questions and was open to participants for a 6-week period from February 12th to March 23rd, 2020. Analysis was conducted using descriptive statistics and qualitative content analysis. RESULTS Eighty-one responses from pharmacists in nine provinces were included in the analysis. Respondents endorsed limited and varied practices when caring for patients receiving opioids for cancer-related pain. Further, they demonstrated wide ranging confidence and attitudes regarding opioid risk mitigation practices and beliefs. Less than 50% of pharmacists were aware of resources available for their patients with non-medical opioid use, and/or patients at high risk of opioid-induced respiratory depression. Education, resources, and communication were the most commonly reported perceived facilitators and barriers to resource use. CONCLUSIONS Pharmacists in Canada report employing opioid risk mitigation practices with low and varied frequency when caring for patients receiving opioids for cancer-related pain. They endorsed varied confidence and limited awareness of available provider and patient resources. These findings may help inform the development of new education models and evidence-based guidelines. New education models and evidence-based guidelines will support pharmacists in their pharmaceutical care of this vulnerable patient population, ultimately aiming to improve patient outcomes.
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Affiliation(s)
- Erin MacNeil
- Department of Pharmacy, Nova Scotia Health, Nova Scotia, Canada
| | - Jenny Lau
- Department of Supportive Care, University Health Network, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Alissa Tedesco
- Temmy Latner Centre for Palliative Care, Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Lauren Hutton
- Department of Pharmacy, Nova Scotia Health, Nova Scotia, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia
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23
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Marshall VK, Chavez M, Efre A, Lake PW, Rigg KK, Lubrano B, Pabbathi S, Rajasekhara S, Tyson DM. Barriers to Adequate Pain Control and Opioid Use Among Cancer Survivors: Implications for Nursing Practice. Cancer Nurs 2023; 46:386-393. [PMID: 37607374 PMCID: PMC10232667 DOI: 10.1097/ncc.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cancer survivors can experience long-term negative effects from cancer and its treatment. Pain is one of the most common and distressing symptoms that cancer survivors experience. Opioids are often prescribed for pain; however, cancer survivors who have completed active treatment may have unique challenges with regard to pain management. OBJECTIVE The aim of this study was to explore barriers to pain management and perceptions of opioid use among cancer survivors. METHODS This research was an exploratory pilot study using in-depth qualitative interviews with adult cancer survivors who were recruited from community-based survivorship organizations. Data were analyzed using applied thematic analysis techniques. RESULTS Participants (n = 25) were mostly women (96%), diagnosed with breast cancer (88%) and stages I to III disease (84%), with a mean age of 56.2 years. Three themes on barriers to adequate pain control emerged: (1) taking just enough to take the edge off: self-medicating behaviors and nonadherence to prescribed regimen; (2) lack of insurance coverage and costly alternative pain treatment options; and (3) chronicity of cancer-related pain not adequately addressed and often mismanaged. CONCLUSIONS Discussions with cancer survivors unveiled personal accounts of unmanaged pain resulting from limited pain management/opioid education, fear of opioid addiction, negative perceptions/experiences with opioids, lack of insurance coverage for alternative pain therapies, and regulatory policies limiting access to opioids. IMPLICATIONS FOR PRACTICE There is a clear need for improved access to multimodal pain management options and nonopioid alternatives for cancer survivors. Oncology nurses should endeavor to support policies and procedures aimed at opioid education, training, and legislation.
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Affiliation(s)
- Victoria Kate Marshall
- Author Affiliations: Colleges of Nursing (Drs Marshall and Efre) and Public Health (Mss Chavez and Lake and Dr Tyson) and Department of Mental Health Law and Policy, College of Behavioral and Community Science (Dr Rigg), University of South Florida; and Moffitt Cancer Center (Drs Lubrano, Pabbathi, and Rajasekhara), Tampa, Florida
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24
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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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25
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Sridharan B, Sharma AK, Lim HG. The Role of Ultrasound in Cancer and Cancer-Related Pain-A Bibliometric Analysis and Future Perspectives. SENSORS (BASEL, SWITZERLAND) 2023; 23:7290. [PMID: 37631826 PMCID: PMC10458834 DOI: 10.3390/s23167290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/26/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
Ultrasound has a deep penetrating ability with minimal or no tissue injury, while cancer-mediated complications during diagnosis, therapy, and surgery have become a serious challenge for clinicians and lead to the severity of the primary condition (cancer). The current study highlights the importance of ultrasound imaging and focused ultrasound therapy during cancer diagnosis, pain reduction, guidance for surgical resection of cancer, and the effectiveness of chemotherapy. We performed the bibliometric analysis on research domains involving ultrasound, cancer management, pain, and other challenges (chemotherapy, surgical guidance, and postoperative care), to observe the trend by which the research field has grown over the years and propose a possible future trend. The data was obtained from the Web of Science, processed, and exported as plain text files for analysis in the Bibliometrix R web interface using the Biblioshiny package. A total of 3248 documents were identified from 1100 journal sources. A total of 390 articles were published in 2022, with almost a 100% growth rate from previous years. Based on the various network analysis, we conclude that the outcome of the constant research in this domain will result in better patient care during the management of various diseases, including cancer and other co-morbidities.
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Affiliation(s)
- Badrinathan Sridharan
- Department of Biomedical Engineering, Pukyong National University, Busan 48513, Republic of Korea;
| | - Alok Kumar Sharma
- Department of Information Management, Chaoyang University of Technology, Taichung 413310, Taiwan;
| | - Hae Gyun Lim
- Department of Biomedical Engineering, Pukyong National University, Busan 48513, Republic of Korea;
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26
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Azizoddin DR, Wilson JM, Flowers KM, Beck M, Chai P, Enzinger AC, Edwards R, Miaskowski C, Tulsky JA, Schreiber KL. Daily pain and opioid administration in hospitalized patients with cancer: the importance of psychological factors, recent surgery, and current opioid use. Pain 2023; 164:1820-1827. [PMID: 36893325 PMCID: PMC10363176 DOI: 10.1097/j.pain.0000000000002880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023]
Abstract
ABSTRACT Pain is common and variable in its severity among hospitalized patients with cancer. Although biopsychosocial factors are well established as modulators of chronic pain, less is known about what patient-level factors are associated with worse pain outcomes among hospitalized cancer patients. This prospective cohort study included patients with active cancer presenting to the emergency department (ED) with pain severity of ≥4/10 and followed pain outcomes longitudinally throughout hospital admission. Baseline demographic, clinical, and psychological factors were assessed on ED presentation, and daily average clinical pain ratings and opioid consumption during hospitalization were abstracted. Univariable and multivariable generalized estimating equation analyses examined associations of candidate biopsychosocial, demographic, and clinical predictors with average daily pain and opioid administration. Among 113 hospitalized patients, 73% reported pain as the primary reason for presenting to the ED, 43% took outpatient opioids, and 27% had chronic pain that predated their cancer. Higher pain catastrophizing ( B = 0.1, P ≤ 0.001), more recent surgery ( B = -0.2, P ≤ 0.05), outpatient opioid use ( B = 1.4, P ≤ 0.001), and history of chronic pain before cancer diagnosis ( B = 0.8, P ≤ 0.05) were independently associated with greater average daily pain while admitted to the hospital. Higher pain catastrophizing ( B = 1.6, P ≤ 0.05), higher anxiety ( B = 3.7, P ≤ 0.05), lower depression ( B = -4.9, P ≤ 0.05), metastatic disease ( B = 16.2, P ≤ 0.05), and outpatient opioid use ( B = 32.8, P ≤ 0.001) were independently associated with higher daily opioid administration. Greater psychological distress, especially pain catastrophizing, as well as pain and opioid use history, predicted greater difficulty with pain management among hospitalized cancer patients, suggesting that early assessment of patient-level characteristics may help direct consultation for more intensive pharmacologic and nonpharmacologic interventions.
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Affiliation(s)
- Desiree R. Azizoddin
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jenna M. Wilson
- Department of Anesthesiology, Perioperative and Pain medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kelsey Mikayla Flowers
- Department of Anesthesiology, Perioperative and Pain medicine, Brigham and Women’s Hospital, Boston, MA
| | - Meghan Beck
- Department of Anesthesiology, Perioperative and Pain medicine, Brigham and Women’s Hospital, Boston, MA
| | - Peter Chai
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Fenway Health, Boston, MA
| | - Andrea C. Enzinger
- Harvard Medical School, Boston, MA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Edwards
- Department of Anesthesiology, Perioperative and Pain medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Christine Miaskowski
- Schools of Nursing and Medicine, University of California San Francisco, San Francisco, CA
| | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative and Pain medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Wu W, He X, Li S, Jin M, Ni Y. Pain nursing for gynecologic cancer patients. Front Oncol 2023; 13:1205553. [PMID: 37564934 PMCID: PMC10410261 DOI: 10.3389/fonc.2023.1205553] [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: 04/14/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Gynecological malignancy remains a prevalent cause of mortality among women. Chronic cancer pain, as a severe complication of malignancy and its therapies, accounts for a substantial burden of physical and psychological distress in affected patients. Accordingly, early identification, assessment, and standardized management of such pain are crucial in the prevention or delay of its progression. In the present review, we provide a comprehensive overview of the pathological factors that contribute to pain in patients with gynecological malignancy while highlighting the underlying mechanisms of pain in this population. In addition, we summarize several treatment modalities targeting pain management in gynecologic cancer patients, including surgery, radiotherapy, and chemotherapy. These interventions are crucial for tumor elimination and patient survival. Chronic cancer pain exerts a significant impact on wellbeing and quality of life for patients with gynecologic cancer. Therefore, our review emphasizes the importance of addressing this pain and its psychological sequelae and advocates for a multidisciplinary approach that encompasses nursing and psychological support. In summary, this review offers valuable insights into the pathological factors underlying pain, reviews pain management modalities, and stresses the critical role of early intervention and comprehensive care in enhancing the quality of life of these patients.
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Affiliation(s)
| | - Xiaodan He
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
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28
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Winger JG, Kelleher SA, Ramos K, Check DK, Yu JA, Powell VD, Lerebours R, Olsen MK, Keefe FJ, Steinhauser KE, Porter LS, Breitbart WS, Somers TJ. Meaning-centered pain coping skills training for patients with metastatic cancer: Results of a randomized controlled pilot trial. Psychooncology 2023; 32:1096-1105. [PMID: 37173865 PMCID: PMC10330450 DOI: 10.1002/pon.6151] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE For patients with advanced cancer, pain is a common and debilitating symptom that can negatively impact physical, emotional, and spiritual well-being. This trial examined the feasibility and initial effects of Meaning-Centered Pain Coping Skills Training (MCPC), a cognitive-behavioral pain management intervention with an emphasis on enhancing meaning (i.e., a personal sense of purpose, worth, and significance) and peace. METHODS We enrolled 60 adults with stage IV solid tumor cancers and moderate-severe pain between February 2021 and February 2022. Participants were randomized 1:1 to MCPC + usual care or usual care alone. Meaning-Centered Pain Coping Skills Training consisted of four weekly 60-min individual sessions via videoconference or telephone, delivered by a trained therapist using a manualized protocol. Participants completed validated measures of pain severity, pain interference, pain self-efficacy, spiritual well-being (i.e., meaning, peace, and faith), and psychological distress at baseline and 5-week and 10-week follow-ups. RESULTS All feasibility metrics exceeded prespecified benchmarks. Fifty-eight percent of screened patients were eligible, and 69% of eligible patients consented. Of those assigned to MCPC, 93% completed all sessions and 100% of those who completed follow-ups reported using coping skills weekly. Retention was strong at 5-week (85%) and 10-week (78%) follow-ups. Meaning-Centered Pain Coping Skills Training participants reported better scores than control participants across outcome measures, including moderate-to-large sized differences at 10-week follow-up in pain severity (Cohen's d = -0.75 [95% confidence interval: -1.36, -0.14]), pain interference (d = -0.82 [-1.45, -0.20]), and pain self-efficacy (d = 0.74 [0.13, 1.35]). CONCLUSIONS MCPC is a highly feasible, engaging, and promising approach for improving pain management in advanced cancer. Future efficacy testing is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04431830, registered 16 June 2020.
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Affiliation(s)
- Joseph G. Winger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Sarah A. Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, (GRECC) Durham VA Health Care System, Durham, NC, USA
- Center for the Study of Human Aging and Development, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, 27705, USA
| | - Devon K. Check
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Justin A. Yu
- Division of Pediatric Palliative and Supportive Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Victoria D. Powell
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), LTC Charles S. Kettles VA Medical Center, Ann Arbor, MI, USA
| | - Reginald Lerebours
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Maren K. Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Karen E. Steinhauser
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Center for the Study of Human Aging and Development, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, 27705, USA
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - William S. Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tamara J. Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
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Zhang Q, Yuan Y, Zhang M, Qiao B, Cui Y, Wang Y, Feng L. Efficacy and safety of acupuncture-point stimulation combined with opioids for the treatment of moderate to severe cancer pain: a network meta-analysis of randomized controlled trials. Front Oncol 2023; 13:1166580. [PMID: 37333815 PMCID: PMC10272816 DOI: 10.3389/fonc.2023.1166580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Background Pain is one of the most common and troublesome symptoms of cancer. Although potential positive effects of acupuncture-point stimulation (APS) on cancer pain have been observed, knowledge regarding the selection of the optimal APS remains unclear because of a lack of evidence from head-to-head randomized controlled trials (RCTs). Objective This study aimed to carry out a network meta-analysis to compare the efficacy and safety of different APS combined with opioids in treating moderate to severe cancer pain and rank these methods for practical consideration. Methods A comprehensive search of eight electronic databases was conducted to obtain RCTs involving different APS combined with opioids for moderate to severe cancer pain. Data were screened and extracted independently using predesigned forms. The quality of RCTs was appraised with the Cochrane Collaboration risk-of-bias tool. The primary outcome was the total pain relief rate. Secondary outcomes were the total incidence of adverse reactions, the incidence of nausea and vomiting, and the incidence of constipation. We applied a frequentist, fixed-effect network meta-analysis model to pool effect sizes across trials using rate ratios (RR) with their 95% confidence intervals (CI). Network meta-analysis was performed using Stata/SE 16.0. Results We included 48 RCTs, which consisted of 4,026 patients, and investigated nine interventions. A network meta-analysis showed that a combination of APS and opioids was superior in relieving moderate to severe cancer pain and reducing the incidence of adverse reactions such as nausea, vomiting, and constipation compared to opioids alone. The ranking of total pain relief rates was as follows: fire needle (surface under the cumulative ranking curve (SUCRA) = 91.1%), body acupuncture (SUCRA = 85.0%), point embedding (SUCRA = 67.7%), auricular acupuncture (SUCRA = 53.8%), moxibustion (SUCRA = 41.9%), transcutaneous electrical acupoint stimulation (TEAS) (SUCRA = 39.0%), electroacupuncture (SUCRA = 37.4%), and wrist-ankle acupuncture (SUCRA = 34.1%). The ranking of total incidence of adverse reactions was as follows: auricular acupuncture (SUCRA = 23.3%), electroacupuncture (SUCRA = 25.1%), fire needle (SUCRA = 27.2%), point embedding (SUCRA = 42.6%), moxibustion (SUCRA = 48.2%), body acupuncture (SUCRA = 49.8%), wrist-ankle acupuncture (SUCRA = 57.8%), TEAS (SUCRA = 76.3%), and opioids alone (SUCRA = 99.7%). Conclusions APS seemed to be effective in relieving cancer pain and reducing opioid-related adverse reactions. Fire needle combined with opioids may be a promising intervention to reduce moderate to severe cancer pain as well as reduce opioid-related adverse reactions. However, the evidence was not conclusive. More high-quality trials investigating the stability of evidence levels of different interventions on cancer pain must be conducted. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier CRD42022362054.
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Affiliation(s)
- Qinglin Zhang
- Department of Oncology, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuntong Yuan
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Meiling Zhang
- Department of Oncology, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Baohua Qiao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yiyuan Cui
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Feng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Makhlouf SM, Ahmed S, Bennett MI. Libyan Healthcare Professionals', Patients' and Caregivers' Perceptions and Religious Beliefs about Cancer Pain and its Management: A Descriptive Qualitative Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:1897-1919. [PMID: 36810722 PMCID: PMC10133376 DOI: 10.1007/s10943-023-01763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 05/15/2023]
Abstract
Cancer pain remains a significant problem worldwide. It is often undertreated and presents in about half of cancer patients. Although several guidelines and pharmacological interventions for cancer pain management (CPM) exist, inadequate assessment and undertreatment of cancer pain are well-documented globally, especially in developing countries, including Libya. Perceptions, cultural and religious beliefs of healthcare professionals (HCP), patients, and caregivers about cancer pain and opioids are reported as barriers to CPM globally. This qualitative descriptive study aimed to explore Libyan HCPs', patients', and caregivers' views and religious beliefs about CPM and involved semi-structured interviews with 36 participants: 18 Libyan cancer patients, 6 caregivers, and 12 Libyan HCPs. Thematic analysis was used to analyse the data. Patients, caregivers, and newly qualified HCPs were concerned about poor tolerance and drug addiction. HCPs perceived a lack of policies and guidelines, pain rating scales, and professional education and training as CPM barriers. Some patients were unable to pay for medicines if they faced financial difficulties. Instead, patients and caregivers emphasised religious and cultural beliefs for managing cancer pain, including the use of the Qur'an and cautery. Our results suggest that religious and cultural beliefs, lack of knowledge and training in CPM among HCPs, and economic and Libyan healthcare system-related factors negatively affect CPM in Libya.
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Affiliation(s)
- Salim M Makhlouf
- School of Medicine, Academic Unit of Palliative Care, LIHS, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.
| | - Shenaz Ahmed
- School of Medicine, Academic Unit of Palliative Care, LIHS, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Michael I Bennett
- School of Medicine, Academic Unit of Palliative Care, LIHS, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
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Kweh TY, Yeoh CH, Chan HK, Ahmad F. Knowledge, Perception and Barriers to Cancer Pain Management among Doctors in Malaysia. Malays J Med Sci 2023; 30:184-194. [PMID: 37425393 PMCID: PMC10325136 DOI: 10.21315/mjms2023.30.3.17] [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: 07/31/2022] [Accepted: 10/11/2022] [Indexed: 07/11/2023] Open
Abstract
Background Pain remains common in people living with advanced cancer and is often inadequately managed. This study was designed to assess knowledge, perceptions and barriers to morphine use in cancer pain management among doctors in Malaysia. Methods Doctors from multiple disciplines in a general hospital were invited to complete a 39-item self-reported questionnaire between November 2020 and December 2020. Each question was based on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). 'Agree' and 'strongly agree' were considered correct or positive responses, except for nine questions worded in the opposite direction. Associations between variables were confirmed using Pearson's chi-squared and Fisher's exact tests. Results Most respondents were house officers (206/321; 64.2%) with less than two years of service, followed by medical officers (68/321; 21.2%) and specialists (47/321; 14.6%). Only 7.2% of the respondents had received formal palliative care training before the study. Of the respondents, 73.5% were aware of the World Health Organization (WHO) analgaesic ladder, 60.7% were correct on oral morphine as the first line for moderate to severe cancer pain treatment and 91.9% knew the need to add rescue morphine for breakthrough pain. Additionally, 34.0% (P < 0.001) perceived morphine use caused addiction, 57.9% (n = 186) expressed fear of respiratory depression and 18.3% of medical officers and specialists perceived limited access and a maximum dose to prescribe. There was a significant difference in knowledge and perception between junior doctors and senior clinicians. The majority strongly agreed and agreed that there were inadequate training opportunities in cancer pain management. Conclusion Inconsistent knowledge and negative perceptions of cancer pain management among doctors were demonstrated in this study.
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Affiliation(s)
- Ting-Yi Kweh
- Palliative Care Unit, Department of Medicine, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Chian-Hui Yeoh
- Palliative Care Unit, Department of Medicine, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Fazlina Ahmad
- Palliative Care Unit, Department of Medicine, Hospital Sultanah Bahiyah, Kedah, Malaysia
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Nabulsi NA, Nazari JL, Lee TA, Patel PR, Sweiss KI, Le T, Sharp LK. Perceptions of prescription opioids among marginalized patients with hematologic malignancies in the context of the opioid epidemic: a qualitative study. J Cancer Surviv 2023:10.1007/s11764-023-01370-9. [PMID: 37022642 DOI: 10.1007/s11764-023-01370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Opioids are essential for treating pain in hematologic malignancies (HM), yet are heavily stigmatized in the era of the opioid epidemic. Stigma and negative attitudes towards opioids may contribute to poorly managed cancer pain. We aimed to understand patient attitudes towards opioids for HM pain management, particularly among historically marginalized populations. METHODS We interviewed a convenience sample of 20 adult patients with HM during outpatient visits at an urban academic medical center. Semi-structured interviews were audio-recorded, transcribed, and qualitatively analyzed using the framework method. RESULTS Among 20 participants, 12 were female and half were Black. Median age was 62 (interquartile range = 54-68). HM diagnoses included multiple myeloma (n = 10), leukemia (n = 5), lymphoma (n = 4), and myelofibrosis (n = 1). Eight themes emerged from interviews that seemed to influence HM-related pain self-management, including (1) fear of opioid-related harms, (2) opioid side effects and harms to health, (3) fatalism and stoicism, (4) perceived value of opioids for HM-related pain, (5) low perceived susceptibility to opioid-related harms and externalizing blame, (6) preferences for non-opioid pain management approaches, (7) trust in providers and opioid accessibility, and (8) external sources of pain management support and information. CONCLUSIONS This qualitative study demonstrates that fears and stigmatized views of opioids can conflict with marginalized patients' needs to manage debilitating HM-related pain. Negative attitudes towards opioids were shaped by the opioid epidemic and reduced willingness to seek out or use analgesics. IMPLICATIONS FOR CANCER SURVIVORS These findings help expose patient-level barriers to optimal HM pain management, revealing attitudes, and knowledge to be targeted by future pain management interventions in HM.
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Affiliation(s)
- Nadia A Nabulsi
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA.
| | - Jonathan L Nazari
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Pritesh R Patel
- Division of Hematology and Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Karen I Sweiss
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL, USA
| | - Thy Le
- College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
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Zhao X, Xu R, Wang Y, Zhou Y, Lu J, Zhu W, Qiu Y, Yang Q, Shen Z, Guo C, Zhang J. Adherence to Analgesic Drugs and its Associated Factors among Patients with Cancer Pain: A Crosssectional Study in China. Am J Health Behav 2023; 47:30-39. [PMID: 36945089 DOI: 10.5993/ajhb.47.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objectives: Pain is one of the most common and distressing symptoms co-occurring with cancer progression and treatment, and medication adherence plays an important role in achieving good pain control. However, research on medication adherence and influential factors among individuals with cancer pain (CP) is limited in China. The present study aimed to investigate the adherence to analgesics in patients with CP in China and to identify factors that may influence adherence. Methods: A cross-sectional study was conducted from June 2020 to February 2021. Study instruments consisted of a set of validated questionnaires, 5 measurement instruments including the numerical rating scale (NRS), ID-Pain, Morisky Medication Adherence Scale-Chinese validated version (MMAS-C), Beliefs about Medicines Questionnaire (BMQ) - Specific, and the Hospital Anxiety and Depression Scale (HADS). Results: A total of 141 participants with CP including 71 males (50.4%), aged 54.5±15.5 years were surveyed in this study. Overall, 83 patients (58.9%) showed adherence, but 58 patients (41.1%) showed non-adherence to analgesics. The univariate analysis showed that analgesic adherence was associated with pain duration of>3 months, outbreaks of pain in the last 24 hours, presence of side effects, getting analgesics in time, presence of neuropathic pain, stopping analgesics or adjusting dosage by themselves, presence of anxiety and depression, and beliefs about medicines. Moreover, the multivariate logistic regression showed that getting analgesic drugs in time (odds ratio [OR]=5.218, 95% confidence interval [CI] 1.691-16.100) and high BMQ-Necessity (OR=1.907, 95% CI 1.418-2.565) were associated with high adherence, stopping analgesics or adjusting dosage by themselves (OR=7.958, 95% CI 2.443-25.926) and high BMQ-Concern (OR=0.760, 95% CI 0.600-0.964) were more likely to be associated with non-adherence. Conclusion: In view of our findings, it may be critical for individuals to have a better understanding and strong beliefs about their prescribed analgesic drugs. Pain education, counseling and follow-up of patients and their caregivers, and removal of barriers to accessing analgesic drugs could be considered in further intervention strategies.
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Affiliation(s)
- Xincai Zhao
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Xu
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yonggang Wang
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhou
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Lu
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanhu Zhu
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yao Qiu
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quanjun Yang
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zan Shen
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng Guo
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;,
| | - Jianping Zhang
- Department of Pharmacy, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China;,
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Li Y, Hong E, Ye W, You J. Moxibustion as an Adjuvant Therapy for Cancer Pain: A Systematic Review and Meta-Analysis. J Pain Res 2023; 16:515-525. [PMID: 36824500 PMCID: PMC9942498 DOI: 10.2147/jpr.s396696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/19/2023] Open
Abstract
Purpose Pain is one of the most common and feared symptoms among cancer patients. Unrelieved pain denies patients comfort and greatly affects their overall quality of life. Moxibustion is commonly used to manage chronic pain. However, its efficacy on cancer pain remains inconclusive. This study aimed to evaluate the efficacy of moxibustion for cancer pain. Methods We searched seven databases to obtain articles about moxibustion combined with pharmacotherapy for cancer pain published before November 2022. All data extraction was carried out independently by two investigators. RevMan 5.4 software was used for data analysis. Results A total of ten trials involving 999 cases were included. The results of the meta-analysis revealed that moxibustion combined with pharmacotherapy was significantly better than drug therapy alone in improving pain relief rate (RR =1.16, 95% CI = [1.04, 1.30], P = 0.01), reducing pain scores (SMD = -1.43, 95% CI = [-2.09, -0.77], P < 0.0001), Shortening the onset of analgesia (MD = -12.07, 95% CI = [-12.91, -11.22], P < 0.00001), prolonging the duration of analgesia (MD = 3.69, 95% CI = [3.21, 4.18], P < 0.00001), and improving quality of life (SMD = 2.48, 95% CI = [0.67, 4.29], P = 0.007). In addition, moxibustion combined with pharmacotherapy can effectively reduce adverse reactions of drugs (RR =0.35, 95% CI = [0.21, 0.57], P < 0.0001). Conclusion The evidence in this review supports moxibustion as an effective adjuvant therapy for cancer pain management. However, high-quality RCTs are needed to further confirm these findings. Registration Number PROSPERO CRD42022370942.
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Affiliation(s)
- Yan Li
- Jiangxi University of Chinese Medicine, Nanchang, People’s Republic of China
| | - Ensi Hong
- Jiangxi University of Chinese Medicine, Nanchang, People’s Republic of China,The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, People’s Republic of China
| | - Wenguo Ye
- The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, People’s Republic of China,Correspondence: Wenguo Ye, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, Jiangxi Province, People’s Republic of China, Email
| | - Jianyu You
- Jiangxi University of Chinese Medicine, Nanchang, People’s Republic of China,Jianyu You, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi Province, People’s Republic of China, Email
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Sedney CL, Dekeseredy P, Singh SA, Holbein M. Stigmatizing Language Expressed Towards Individuals With Current or Previous OUD Who Have Pain and Cancer: A Qualitative Study. J Pain Symptom Manage 2023; 65:553-561. [PMID: 36804424 DOI: 10.1016/j.jpainsymman.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
CONTEXT Stigma is known to impact the care of patients with opioid use disorder (OUD). OBJECTIVES This qualitative study seeks to understand how stigma is expressed in the medical chart by healthcare workers towards patients with cancer pain and OUD treated at an academic medical center. METHODS This descriptive qualitative study utilized a thematic analysis approach to analyze the medical charts of 25 hospitalized patients with current or previous opioid use disorder and cancer with respect to their pain care in forty pain-related hospital admissions to a tertiary academic center from 2015 to 2020. The codebook utilized a well-characterized stigma framework and emerging themes were identified through an iterative, comparative method. COREQ guidelines were followed. RESULTS Evidence of stigma marking was present in the medical chart aligning with several intersecting stigmas. Drivers such as blame and stereotypes impeded pain care, while facilitators such as legal or policy influences and non-care advocates could be either positive or negative determinants to pain care. Care by known providers within the healthcare environment was largely a facilitator of improved pain care. CONCLUSIONS Healthcare provider stigma must be addressed as its effects are both quantitatively and qualitatively affecting patient care; in particular access to pain treatment. Continuity of care by known care providers may improve pain care for patients with cancer and OUD who are acutely hospitalized.
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Affiliation(s)
- Cara L Sedney
- Department of Neurosurgery (C.L.S., P.D.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
| | - Patricia Dekeseredy
- Department of Neurosurgery (C.L.S., P.D.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Sarah A Singh
- Department of Radiation Oncology (S.A.S.), West Virginia University, Morgantown, West Virginia, USA
| | - Monika Holbein
- Department of Medicine (M.H.), Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
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Rababa M, Al-Sabbah S, Hayajneh AA, Al-Rawashdeh S. Critical care nurses' perceived barriers and enablers of pain assessment and management. Pain Manag 2023; 13:105-114. [PMID: 36515086 DOI: 10.2217/pmt-2022-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To examine critical care nurses' perceived barriers and enablers of pain assessment and management. Materials/methods: This descriptive correlational study recruited a convenience sample of 200 Jordanian nurses. Pain Assessment and Management for the Critically Ill questionnaire was used to measure the study variables. Results: The most common barriers to pain assessment and management were patient inability to communicate (57.5%), patient instability (56.5%), and the lack of protocols/guidelines for pain assessment (55.0%). Whereas the most common enablers for effective pain management practices were the ongoing education on pain for nurses (60.5%) and physicians who prescribe adequate doses of analgesia (60.0%). Conclusion: Addressing nurses' perceived barriers and the enablers of pain assessment and management is crucial for optimal pain practice.
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Affiliation(s)
- Mohammad Rababa
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Shatha Al-Sabbah
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Audai A Hayajneh
- Department of Adult Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Sami Al-Rawashdeh
- Department of Community & Mental Health- Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
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Amaram-Davila J, Kim MJ, Reddy A, Edwards T, Dai J, Urbauer D, Shelal Z, Ross Y, Hosain M, Bruera E, Arthur J. Health Care Provider Attitudes and Beliefs Toward Nonmedical Opioid Use in Patients with Cancer Pain. J Palliat Med 2023; 26:248-252. [PMID: 36476019 PMCID: PMC9894589 DOI: 10.1089/jpm.2022.0293] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Data on health care providers' (HCPs') perceptions about patients with cancer pain and nonmedical opioid use (NMOU) are lacking. We examined the perceptions and attitudes of HCPs and assessed the usefulness of an interdisciplinary opioid stewardship program (OSP) while caring for these patients. Methods: An anonymous cross-sectional survey was conducted among the supportive care HCPs between September and November 2021. Results: Of 85 HCPs, 64 responded (75%) to the survey. Participants perceived that NMOU is underdiagnosed (42/64; 67%), and caring for such patients is difficult (58/64, 91%) and time consuming (54/64, 87%). A majority (50/51, 98%) were aware of the OSP, and (48/51; 94%) found it helpful. Conclusion: HCPs reported that NMOU is underdiagnosed and is challenging to manage. They endorsed the utility of an OSP in managing patients with concurrent cancer pain and NMOU. Future research should identify ways to standardize care and integrate OSP in routine supportive oncology practice.
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Affiliation(s)
- Jaya Amaram-Davila
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Min Ji Kim
- Department of Supportive and Palliative Care, Baylor University Medical Center, Dallas, Texas, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Tonya Edwards
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Jianliang Dai
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Diana Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Zeena Shelal
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Yvette Ross
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Monawar Hosain
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Joseph Arthur
- Department of Palliative, Rehabilitation, and Integrative Medicine and The University of Texas MD Anderson Cancer, Houston, Texas, USA
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Vahos J, Rojas-Cortés R, Daza D, Osorio-Florez LC, Macías Saint-Gerons D, Pastrana T, Muñoz S, Fitzgerald J, Porrás A, Luciani S, Castro JL. Barriers of Access to Opioid Medicines within the Context of Palliative Care in Latin America: The Perception of Health Professionals. J Palliat Med 2023; 26:199-209. [PMID: 36040320 PMCID: PMC9894602 DOI: 10.1089/jpm.2022.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Different sets of barriers have been identified to explain the difficulties in the access and availability of opioid analgesics in palliative care, particularly in low- and middle-income countries, including Latin America. Objective: To validate a structured questionnaire for the access to opioid medicines and to investigate the perception of health professionals regarding access barriers to opioid analgesics in 17 countries of the Latin American Region. Design: Survey to identify the domains and barriers of access to opioid medicines according to health professionals, including physicians, nurses, and pharmacists affiliated to institutions that provide palliative care in Latin America between August 2019 and October 2020. Results: We analyzed responses from 426 health professionals. The median age was 44 years old (ranging from 23 to 73 years) with an average experience in palliative care of 10 years (range: 1-35), 71.8% were women, and 49.8% were affiliated to specialized health care facilities of urban areas (94.6%). The main barriers perceived to be extremely relevant by the respondents were "belief that patients can develop addiction" and "financial limitations of patients" for the patient's domain and the "appropriate education, instruction, and training of professionals" for health professional's domain. Conclusions: It is necessary to develop strategies to strengthen less-developed health systems of the region to review legal frameworks, ensure integrated palliative care systems, and deploy multidisciplinary strategies for sensitizing, training, and raising the awareness of patients, caregivers and, particularly, health professionals regarding appropriate prescription and rational use of opioid analgesics.
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Affiliation(s)
- Juanita Vahos
- Department of Pharmacy, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Robin Rojas-Cortés
- Pan American Health Organization, Washington, DC, USA.,Address correspondence to: Robin Rojas-Cortés, MS, Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037, USA
| | - Daniela Daza
- Pharmaceutical Chemist, MSc Epidemiology, Bogota, Colombia
| | | | - Diego Macías Saint-Gerons
- Pan American Health Organization, Washington, DC, USA.,Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sergio Muñoz
- Department of Public Health-CIGES, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
| | | | - Analía Porrás
- Pan American Health Organization, Washington, DC, USA
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Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Barriers and Facilitators of Pain Self-Management Among Patients with Cancer: An Integrative Review. Pain Manag Nurs 2023; 24:138-150. [PMID: 36653220 DOI: 10.1016/j.pmn.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Defining the main barriers and facilitators of cancer pain self-management are essential to improve patients' overall quality of life. AIM The main purpose of this review was to identify the main barriers and facilitators for cancer pain self-management. METHOD An integrative review guided by the five-stages framework that was identified by Souza et al. (2010) was used: (1) preparing the guiding question; (2) searching or sampling the literature; (3) data collection; (4) critical analysis of the studies; and (5) discussion of results. A comprehensive literature review was conducted using the electronic databases of PubMed/MEDLINE, CINAHL, Scopus, and Psych INFO. RESULTS Twenty-two studies were identified. The main facilitators that foster the process of cancer pain self-management were supportive ambiances including family caregivers as well as health care providers, active participation of patients with cancer in health care including self-discovery and self-awareness, acquiring pain knowledge, and using a pain diary. The main barriers include concerns regarding the use of pain medications, knowledge deficit, negative beliefs and attitudes, unsupportive ambiance, and psychological distress. Some patients' characteristics could be related to these barriers such as age, sex, race, marital status, educational level, level of pain, and presence of comorbidity. CONCLUSIONS Patients with cancer pain experience multiple barriers and facilitators when attempting to take on an active role in managing their pain.
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Qiu J, Xin Y, Yao J, Xu L, Meng F, Feng L, Shu X, Zhuang Z. Pain Incidence and Associated Risk Factors among Cancer Patients within 72 Hours after Surgery: A Large Retrospective Analysis. Curr Oncol 2023; 30:854-864. [PMID: 36661714 PMCID: PMC9858544 DOI: 10.3390/curroncol30010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A fundamental principle of pain management is to determine the distribution and causes of pain. However, relevant data among postoperative cancer patients based on a large amount of data remain sparse. OBJECTIVE We aimed to investigate the incidence of postoperative pain in cancer patients and to explore the associated risk factors. METHODS We retrospectively collected information on postoperative pain-evaluation records of cancer patients who underwent surgery between 1 January 2014 and 31 December 2019. Descriptive statistics were presented, and multinominal logistic regression analysis was performed to explore the risk factors associated with postoperative pain. RESULTS Among the 11,383 patients included in the study, the incidence of mild/moderate to severe pain at the 24th hour after surgery was 74.9% and 18.3%, respectively. At the 48th and 72nd hour after surgery, the incidence of mild pain increased slightly, while the incidence of moderate to severe pain continued to decrease. Female patients experienced a higher risk of pain (ORs: 1.37-1.58). Undergoing endoscopic surgery was associated with a higher risk of pain (ORs: 1.40-1.56). Patients with surgical sites located in the respiratory system had a higher risk of pain compared to in the digestive system (ORs: 1.35-2.13), and other patients had a relatively lower risk of pain (ORs: 0.11-0.61). CONCLUSION The majority of cancer patients experienced varying degrees of postoperative pain but may not receive adequate attention and timely treatment. Female, young age and endoscopic surgery were associated with increased pain risk, and effective identification of these high-risk groups had positive implications for enhanced postoperative pain management.
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Affiliation(s)
- Junlan Qiu
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
- Department of Oncology and Hematology, The Suzhou Science & Technology Town Hospital, Suzhou 215153, China
| | - Yirong Xin
- Department of Epidemiology, School of Public Health, Soochow University, Suzhou 215123, China
| | - Jiazhen Yao
- Department of Epidemiology, School of Public Health, Soochow University, Suzhou 215123, China
| | - Lingkai Xu
- Department for Communicable Disease Control and Prevention, Suzhou Wuzhong Center for Disease Prevention and Control, Suzhou 215128, China
| | - Fang Meng
- Institute of Systems Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
- Suzhou Institute of Systems Medicine, Suzhou 215123, China
| | - Lin Feng
- Department of Oncology and Hematology, The Suzhou Science & Technology Town Hospital, Suzhou 215153, China
| | - Xiaochen Shu
- Department of Epidemiology, School of Public Health, Soochow University, Suzhou 215123, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou 215123, China
| | - Zhixiang Zhuang
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
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Li Y, Yu W, Li L, Yao Q, Jiang K, Zhu T, Jiang E. Oncology nursing on the move: a contemporary issue on Chinese oncology nursing in cancer care. Front Public Health 2023; 11:1061572. [PMID: 37181711 PMCID: PMC10173744 DOI: 10.3389/fpubh.2023.1061572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Cancers have become the primary cause of death among Chinese residents, seriously affecting their health and life. Oncology nursing is a specialized nursing practice focusing on cancer education, prevention, screening, early detection, and palliative and hospice care. China has made tremendous progress in developing oncology nursing. However, to ensure more individuals can get cancer care, the country's healthcare system still confronts several problems in oncology nursing that need to be addressed to ensure that more individuals can receive cancer care. This article reviews the current development of oncology nursing in China, especially in pain symptom control, palliative care, end-of-life care, education and training. The challenges faced in oncology nursing in China and the suggestions for developing oncology nursing in China are also discussed and proposed in this review. The growth of research on oncology nursing by Chinese nursing scholars and concerned policymakers is anticipated to ultimately improve oncology nursing and the quality of life of patients with cancer in China.
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Affiliation(s)
- Yingyang Li
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Wenjing Yu
- Department of Orthopedics, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Lamei Li
- Department of Neonatal Intensive Care, Zhengzhou Central Hospital, Zhengzhou, China
| | - Qianqian Yao
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Kexin Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng, China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, China
- Department of Scientific Research, Scope Research Institute of Electrophysiology, Kaifeng, China
- *Correspondence: Enshe Jiang,
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Mulonda JK, Havenga Y, de Villiers M. Healthcare Providers' Perceptions of the Cancer Pain Management Barriers at a Hospital in Zambia: A Qualitative Study. SAGE Open Nurs 2023; 9:23779608231197008. [PMID: 37675152 PMCID: PMC10478529 DOI: 10.1177/23779608231197008] [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: 04/03/2023] [Revised: 06/21/2023] [Accepted: 07/29/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Cancer incidence and mortality are increasing worldwide, and pain is the most common symptom patients experience. Despite developments in cancer pain management and guidelines, the pain often remains undertreated. Effective pain management ultimately involves overcoming several complex institutional, patient, and healthcare provider-related barriers. Objective The objective of the study was to explore and describe healthcare providers' perceptions of the cancer pain management barriers at a hospital in Zambia. Method A descriptive qualitative study was conducted. Data were collected from 10 purposively sampled medical doctors and registered nurses using prepiloted semistructured individual interviews. Interviews were audio recorded and transcribed verbatim. Thematic analysis was done, and trustworthiness was enhanced based on the criteria described by Lincoln and Guba. Ethical principles, as outlined in the Declaration of Helsinki, were adhered to. Results Three themes emerged, namely patient-related barriers (biographic characteristics, patient knowledge and perceptions), healthcare provider-related barriers (knowledge and perceptions and language barriers), and institution-related barriers (resource limitations and lack of standards and guidelines). Healthcare providers' views that cultural beliefs about cancer being caused by witchcraft and the use of traditional medicine and services are barriers to cancer pain management were unique to this study. Conclusion Cancer pain management requires a total pain management approach that addresses the barriers to pain management strategies from a patient, healthcare provider, and institutional perspective. The knowledge deficit among patients and healthcare providers is a barrier to cancer pain management and one of the most common challenges reported in the literature. This study further points toward a need to develop culturally competent healthcare providers.
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Affiliation(s)
- Jennipher Kombe Mulonda
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
| | - Yolanda Havenga
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
| | - Martjie de Villiers
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
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Satiamurthy R, Yaakob NS, Shah NM, Azmi N, Omar MS. Potential Roles of 5-HT 3 Receptor Antagonists in Reducing Chemotherapy-induced Peripheral Neuropathy (CIPN). Curr Mol Med 2023; 23:341-349. [PMID: 35549869 DOI: 10.2174/1566524022666220512122525] [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: 08/12/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 11/22/2022]
Abstract
5-HT3 receptor antagonists corresponding to ondansetron, granisetron, tropisetron, and palonosetron are clinically accustomed to treating nausea and emesis in chemotherapy patients. However, current and previous studies reveal novel potentials of those ligands in other diseases involving the nervous system, such as addiction, pruritus, and neurological disorders, such as anxiety, psychosis, nociception, and cognitive function. This review gathers existing studies to support the role of 5-HT3 receptors in CIPN modulation. It has been reported that chemotherapy drugs increase the 5-HT content that binds with the 5-HT3 receptor, which later induces pain. As also shown in pre-clinical and clinical studies that various neuropathic pains could be blocked by the 5-HT3 receptor antagonists, we proposed that 5-HT3 receptor antagonists via 5- HT3 receptors may also inhibit neuropathic pain induced by chemotherapy. Our review suggests that future studies focus more on the 5-HT3 receptor antagonists and their modulation in CIPN to reduce the gap in the current pharmacotherapy for cancer-related pain.
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Affiliation(s)
- Raajeswari Satiamurthy
- Centre for Drug and Herbal Development, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor Syafinaz Yaakob
- Centre for Drug and Herbal Development, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norazrina Azmi
- Centre for Drug and Herbal Development, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Marhanis Salihah Omar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Zhang D, Ji Y, Lv L, Zhou Q, Liu Z, Zhang C, Chen S. An Overview of Systematic Reviews and Meta-Analyses of Clinical Studies of Acupuncture for Cancer Pain. Integr Cancer Ther 2023; 22:15347354231210288. [PMID: 37942632 PMCID: PMC10637167 DOI: 10.1177/15347354231210288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/26/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Systematic reviews (SRs) and meta-analyses (MAs) for the use of acupuncture for cancer pain have been increasing, but the evidence has not been systematically and comprehensively assessed. We aimed to perform an overview of the evidence quality of SRs/MAs of acupuncture for improving cancer pain. METHODS 8 databases were systematically searched to identify SRs/MAs of acupuncture for improving cancer pain. The A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), Risk of Bias in Systematic Reviews (ROBIS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Grades of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively, were applied by 2 independent reviewers to evaluate the methodological quality, risk of bias, reporting quality, and evidence quality. RESULTS A total of 14 SRs/MAs were included in the present study. By AMSTAR-2, two reviews were rated as having high methodological quality, while 12 were given a critically low rating. All SRs/MAs in Phase 1, Domain 1, and Domain 4, according to ROBIS, were at low risk. Furthermore, 4 reviews in Domain 2, twelve reviews in Domain 3, and ten SRs/MAs in Phase 3, were rated as having low risk of bias. With reporting quality, some reporting flaws were identified in the topic of protocol and registration, additional analyses, and search strategy. According to GRADE, the level of evidence quality was "critically low" to "moderate," and risk of bias was the most common downgraded factor. CONCLUSION Acupuncture may be beneficial in improving cancer pain. However, due to the identified limitations and inconsistent findings, we recommend further rigorous, and more standardized SRs/MAs to provide strong evidence for definitive conclusions.
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Affiliation(s)
- Di Zhang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yue Ji
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Liu Lv
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | | | | | - Chenlin Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
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The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic. Pain Manag Nurs 2022; 23:742-751. [PMID: 35701331 DOI: 10.1016/j.pmn.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management. AIM Examine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication. METHODS A sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit. RESULTS Significant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001). CONCLUSIONS Patients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.
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Dupoiron D, Brill S, Eeltink C, Barragán B, Bell D, Petersen G, Eerdekens M, Ryan D, Rakuša M. Diagnosis, management and impact on patients' lives of cancer-related neuropathic pain (CRNP): A European survey. Eur J Cancer Care (Engl) 2022; 31:e13728. [PMID: 36222099 PMCID: PMC9788326 DOI: 10.1111/ecc.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study assessed the impact of cancer-related neuropathic pain (CRNP) on patients and the importance of the patient-healthcare professional (HCP) relationship in diagnosis and management. METHODS A quantitative online survey was conducted involving adult patients from 13 European countries who had been diagnosed with treatable cancer and experienced symptoms of peripheral neuropathy. RESULTS Of 24,733 screened respondents, 549 eligible persons met the inclusion criteria and completed the questionnaire. Among individuals still experiencing pain, 75% rated it as 'severe' or 'moderate'. In addition, 61% reported a negative impact on day-to-day activities, and 30% said they had stopped working as a result. A third of respondents had received no diagnosis of CRNP despite reporting painful symptoms to an HCP. HCPs spending enough time discussing pain and understanding the impact on patients' lives were each associated with an increased likelihood of a formal CRNP diagnosis. Compared with individuals currently in active cancer treatment, cancer survivors were less likely to have a diagnosis of CRNP or regular pain conversations with HCPs. CONCLUSION CRNP remains under-recognised despite its substantial impact on patients' lives. Clinical practice may be improved by strengthening patient-HCP relationships around pain discussions and increasing the focus on pain management among cancer survivors.
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Affiliation(s)
| | - Silviu Brill
- European Pain Federation EFICBrusselsBelgium,Pain InstituteTel Aviv Medical CenterTel AvivIsrael
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Post-operative pain assessment, management compliance with WHO guidelines and its barriers in hospitals of West Shoa zone, central of Ethiopia, 2021. Ann Med Surg (Lond) 2022; 84:104901. [DOI: 10.1016/j.amsu.2022.104901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022] Open
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Hodge FS, Line Itty T, Arbing RH, Samuel-Nakamura C. A window into pain: American Indian cancer survivors' drawings. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1031347. [PMID: 36341151 PMCID: PMC9634249 DOI: 10.3389/fpain.2022.1031347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/04/2022] [Indexed: 11/12/2022]
Abstract
In order to explore the cultural constructs of pain, a series of focus groups were held among adult American Indian (AI) cancer survivors and their caregivers in the Southwest USA. Thirteen focus groups held at four sites (reservation, urban setting, hospital and clinic) elicited information on the barriers to cancer pain management. In response to facilitator questions about cancer pain and existing measurement scales, participants drew pictures to better explain their pain type (i.e., "pounding"), intensity (i.e., "spider web-like"), and other more abstract aspects of their pain episodes. Noting this novel outlet, subsequent groups were prompted for illustrations of pain. A total of 17 drawings were collected from focus group participants. We discuss seven of the drawings that best opened a window into the lived experience of pain, reflected through the eyes of cancer survivors. This study provides evidence that self-expression through color, imagery and written personal accounts provides more accurate depictions of pain for Southwest AI cancer survivors than pain scales alone. It is hypothesized that cultural modes of communication (i.e., storytelling) and intergenerational influences of artwork led to the depiction of pain in drawings. Suggestions for further exploration of the use of the pain drawings for pain assessment in healthcare settings are included.
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Affiliation(s)
- Felicia S. Hodge
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States,Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States,Correspondence: Felicia S. Hodge
| | - Tracy Line Itty
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
| | - Rachel H.A. Arbing
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Kefale B, Engidaw MT, Tesfa D, Yazie TS, Molla M, Yismaw MB. Clinical pattern and drug-related problems among colorectal cancer patients at oncology center in Ethiopia: A hospital-based study. SAGE Open Med 2022; 10:20503121221131691. [PMID: 36277439 PMCID: PMC9580089 DOI: 10.1177/20503121221131691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: Despite the fact that cancer patients are highly susceptible to drug-related problems due to the effects of cytotoxic agents, data are limited due to a lack of studies on those patients. Hence, we aimed to investigate drug-related problems among patients diagnosed with colorectal cancer. Method: A registry-based cross-sectional study was conducted on colorectal cancer patients at the Felege Hiwot Comprehensive Specialized Hospital. Socio-demographic and disease-related characteristics, treatment regimens, and drug-related problems were recorded by reviewing medical records. Standard guidelines, protocols, and databases were used to evaluate the occurrence of drug-related problems and the severity of adverse drug reactions. For the analysis, Stata version 16/MP for Windows was used. Logistic regression analysis was employed to investigate the potential-associated factors of drug-related problems. A p-value ⩽ 0.05 was used to declare the statistical significance of each independent variable. Results: A total of 150 colorectal cancer patients were included, with a mean age of 51.4 ± 13.8 years. About 30% and 41.3% had stage II and stage III cancers, respectively. About three-quarters (73.8%) of the patients were given 5-fluorouracil-based combination regimens. The prevalence of drug-related problems was found to be 48.7%, with a mean of 2.12 ± 0.93 drug-related problems. In the Felege Hiwot Comprehensive Specialized Hospital, drug–drug interactions and adverse drug reactions were the most prevalent drug-related problems, which accounted for 50 (32.7%) and 49 (32%) cases, respectively. Being elderly (>50 years old) (p = 0.013), having co-morbidity (p = 0.001), and being on five or more medications (p = 0.002) were independent predictors of drug-related problems. Conclusion: Fluorouracil-based chemotherapy was the most frequently used treatment regimen. Almost, half of the colorectal cancer patients had one or more drug-related problems. About one-third of patients had adverse drug reactions and drug–drug interactions. Furthermore, age, co-morbidity status, and the number of medications used were significantly associated with drug-related problems. Clinical pharmacy services should be implemented to optimize drug therapy because the majority of colorectal cancer patients have one or more drug-related problems.
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Affiliation(s)
- Belayneh Kefale
- Clinical Pharmacy Unit and Research team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia,Belayneh Kefale, Clinical Pharmacy and Research Unit, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | - Melaku Tadege Engidaw
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Tesfa
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Taklo Simeneh Yazie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Molla
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Malede Berihun Yismaw
- Clinical Pharmacy Unit and Research team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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