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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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McCaffrey N, Cheah SL, Luckett T, Phillips JL, Agar M, Davidson PM, Boyle F, Shaw T, Currow DC, Lovell M. Treatment patterns and out-of-hospital healthcare resource utilisation by patients with advanced cancer living with pain: An analysis from the Stop Cancer PAIN trial. PLoS One 2023; 18:e0282465. [PMID: 36854021 PMCID: PMC9974128 DOI: 10.1371/journal.pone.0282465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND About 70% of patients with advanced cancer experience pain. Few studies have investigated the use of healthcare in this population and the relationship between pain intensity and costs. METHODS Adults with advanced cancer and scored worst pain ≥ 2/10 on a numeric rating scale (NRS) were recruited from 6 Australian oncology/palliative care outpatient services to the Stop Cancer PAIN trial (08/15-06/19). Out-of-hospital, publicly funded services, prescriptions and costs were estimated for the three months before pain screening. Descriptive statistics summarize the clinico-demographic variables, health services and costs, treatments and pain scores. Relationships with costs were explored using Spearman correlations, Mann-Whitney U and Kruskal-Wallis tests, and a gamma log-link generalized linear model. RESULTS Overall, 212 participants had median worst pain scores of five (inter-quartile range 4). The most frequently prescribed medications were opioids (60.1%) and peptic ulcer/gastro-oesophageal reflux disease (GORD) drugs (51.6%). The total average healthcare cost in the three months before the census date was A$6,742 (95% CI $5,637, $7,847), approximately $27,000 annually. Men had higher mean healthcare costs than women, adjusting for age, cancer type and pain levels (men $7,872, women $4,493, p<0.01) and higher expenditure on prescriptions (men $5,559, women $2,034, p<0.01). CONCLUSIONS In this population with pain and cancer, there was no clear relationship between healthcare costs and pain severity. These treatment patterns requiring further exploration including the prevalence of peptic ulcer/GORD drugs, and lipid lowering agents and the higher healthcare costs for men. TRIAL REGISTRATION ACTRN12615000064505. World Health Organisation unique trial number U1111-1164-4649. Registered 23 January 2015.
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Affiliation(s)
- Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood Campus, Burwood, VIC, Australia
- * E-mail:
| | - Seong Leang Cheah
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Tim Luckett
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Jane L. Phillips
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove Brisbane, Queensland
| | - Meera Agar
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation Sydney), University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Patricia M. Davidson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital North Sydney, and University of Sydney, Sydney, NSW, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - David C. Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Melanie Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, NSW, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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Imeraj Z, Veseli (Bego) D, Pirushi R. The Role of Nursing Staff in Pain Management of Patients with Cancer. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Nurses spend more time with patients than any other member of the healthcare team. They play a critical, active and very important part in controlling cancer patients' pain and alleviating suffering. This study aimed to explore current nursing practices in the oncology hospital and the level of knowledge they possess about pain and its management in clinical settings.
Methods: This is a transversal type study developed on the basis of cluster sampling type on nurses in the Oncology Hospital, Tirana. The study was conducted in the period 2016-2018 and the sample consisted of 119 nurses.
Results: In total, 119 questionnaires were completed by oncology hospital nurses. Regarding the gender of was seen a predominance of women nurses compared to men 78.15% and 21.85% respectively. Nurses between the age 30 until to 39 years old were 34.4% of participants. Nurses of different gender, education level, and place of birth showed statistically significant difference. Only 23.5 % of nurses had pain training and education, and less than half of nurses (43.7%) had 5-10 years in oncology hospital. In this study, knowledge and practice of nurse’s participant on non-and pharmacological pain management were more than 55%. Related to the pain assessment 36.1% were based on the information provided by the patients, while 31.1% of nurses had used the visual analogue scale for pain assessment. According to the ways of pain management, almost 76.5% of nurses think that the best ways of pain management were pharmacology and 71.4% selected opioid analgesic medication while 28.6% selected non-opioid analgesic medication. Contacting the physician for the prescription of opioids was cited as the main delaying process by 43.7% of participants.
Conclusions: The results of the study demonstrated that the nurses had limited knowledge of pain management, because of non-training courses for consequence all of it was associated with poor attitude toward pain management. Most of them did not have formal training in pain management either at the local level. Many of them are familiar with oral route of administration of opioids but still the logistics of administration is not clear to them. Nowadays training and education in pain management is a necessity for medical staff especially for nurses because the adequate knowledge is vital in the provision of quality pain management to patients.
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Kalichman L, Menahem I, Treger I. Myofascial component of cancer pain review. J Bodyw Mov Ther 2019; 23:311-315. [PMID: 31103113 DOI: 10.1016/j.jbmt.2019.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pain is a common complaint of cancer patients, experienced by 38%-85% of patients. Some studies have shown a high incidence of myofascial pain syndrome (MPS) in cancer patients. AIMS 1) To estimate the prevalence of MPS in cancer patients; 2) to examine the efficacy of current treatment options for MPS in cancer patients. METHODS Narrative review. PubMed, CINAHL, PEDro, and Google Scholar databases were searched from inception until November 2017, for the keywords: cancer; cancer pain; breast cancer; mastectomy; lumpectomy; myofascial pain; trigger points. Trials of any methodological quality were included. All published material with an emphasis on randomized control trials was analyzed. RESULTS MPS is prevalent in cancer patients who suffer from pain, with a prevalence of between 11.9% and 44.8% in those diagnosed either with neck or head or breast cancer. Clinical studies showed conflicting results. Four interventional studies found that specific treatment for MPS may reduce the prevalence of active myofascial trigger points and therefore decrease pain level, sensitivity, and improve range of motion (in shoulder) in cancer patients. Two recent randomized control trials showed that pressure release of trigger points provides no additional beneficial effects to a standard physical therapy program for upper limb pain and function after breast cancer surgery. CONCLUSIONS We recommend including the evaluation of myofascial pain in routine clinical examination of cancer patients suffering from pain. Future studies are needed to investigate the long- and short-term effect of MPS treatments in cancer patients.
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Affiliation(s)
- Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Itay Menahem
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Iuly Treger
- Rehabilitation Department, Soroka Medical Center, Beer Sheva, Israel
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Abstract
Pain is one of the most common symptoms in individuals with cancer and is directly associated with significantly reduced quality of life. The purpose of this project was to enhance assessment and management of cancer-related pain for patients in the hospice setting. Nurse attitudes and knowledge about pain were evaluated using the Nurses' Knowledge and Attitudes Survey Regarding Pain before and 6 weeks after an educational program. Nurses completed a pain assessment at each home visit and followed an algorithm based on the National Comprehensive Cancer Network Clinical Practice Guidelines to manage pain. Baseline data were collected on the last 30 patients admitted into hospice with cancer as the primary diagnosis before project implementation. Following the practice change, chart audits of the patients' reported pain and adherence to recommended management were manually extracted from 26 patient records. Results revealed statistically significant differences in acquired knowledge (t = 3.95, P < .05) and attainment of patient-identified pain goals (t = 23.904, P < .05). Patient-reported pain levels decreased by 21%, and comprehensive pain assessment completion rates increased by 10% during the project. Current knowledge of evidence-based pain interventions and a management algorithm improved pain control in patients with cancer.
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Zhang P, Meng X, Tang X, Ren L, Liang J. The effect of a coix seed oil injection on cancer pain relief. Support Care Cancer 2018; 27:461-465. [PMID: 29971522 DOI: 10.1007/s00520-018-4313-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/06/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pain is one of the most commonly reported symptoms in patients with advanced cancer, but is still less than optimally treated. The effect of traditional Chinese medicine in cancer pain treatment is nowadays getting more and more attention. OBJECTIVE To investigate the effect of a coix seed oil injection on cancer pain relief in a cancer center in a tertiary hospital in China. METHODS Patients in the treatment group received a coix seed oil injection for 2 weeks, while patients in the control group received equivalent 0.9% saline. The numeric rating scale was used to assess the pain level. The Quality of Life Questionnaire-Core 30 was used to assess life quality. The adverse drug reactions during the treatment process were observed. RESULTS Patients in the coix seed treatment group had significantly superior efficacy on pain control over those in the control group. Coix seed therapy significantly improved patients' scores reflecting by the Quality of Life Questionnaire-Core 30 (QLQ-C30) scale. In addition, the occurrence of adverse reactions such as constipation and nausea in the treatment group was significantly lower than that in the control group. CONCLUSION The coix seed oil injection effectively reduced the pain level of cancer patients, significantly improved their life quality, and had no obvious adverse effects.
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Affiliation(s)
- Peirong Zhang
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China
| | - Xiaoyan Meng
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China
| | - Xiaohua Tang
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China
| | - Li Ren
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, No. 1, Life Science Park Road, Beijing, 102206, China.
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Tamang S, Patel MI, Blayney DW, Kuznetsov J, Finlayson SG, Vetteth Y, Shah N. Detecting unplanned care from clinician notes in electronic health records. J Oncol Pract 2016; 11:e313-9. [PMID: 25980019 DOI: 10.1200/jop.2014.002741] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Reduction in unplanned episodes of care, such as emergency department visits and unplanned hospitalizations, are important quality outcome measures. However, many events are only documented in free-text clinician notes and are labor intensive to detect by manual medical record review. METHODS We studied 308,096 free-text machine-readable documents linked to individual entries in our electronic health records, representing care for patients with breast, GI, or thoracic cancer, whose treatment was initiated at one academic medical center, Stanford Health Care (SHC). Using a clinical text-mining tool, we detected unplanned episodes documented in clinician notes (for non-SHC visits) or in coded encounter data for SHC-delivered care and the most frequent symptoms documented in emergency department (ED) notes. RESULTS Combined reporting increased the identification of patients with one or more unplanned care visits by 32% (15% using coded data; 20% using all the data) among patients with 3 months of follow-up and by 21% (23% using coded data; 28% using all the data) among those with 1 year of follow-up. Based on the textual analysis of SHC ED notes, pain (75%), followed by nausea (54%), vomiting (47%), infection (36%), fever (28%), and anemia (27%), were the most frequent symptoms mentioned. Pain, nausea, and vomiting co-occur in 35% of all ED encounter notes. CONCLUSION The text-mining methods we describe can be applied to automatically review free-text clinician notes to detect unplanned episodes of care mentioned in these notes. These methods have broad application for quality improvement efforts in which events of interest occur outside of a network that allows for patient data sharing.
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Affiliation(s)
- Suzanne Tamang
- Stanford University School of Medicine; Stanford Health Care, Stanford, CA; and Harvard Medical School, Boston, MA
| | - Manali I Patel
- Stanford University School of Medicine; Stanford Health Care, Stanford, CA; and Harvard Medical School, Boston, MA
| | - Douglas W Blayney
- Stanford University School of Medicine; Stanford Health Care, Stanford, CA; and Harvard Medical School, Boston, MA
| | - Julie Kuznetsov
- Stanford University School of Medicine; Stanford Health Care, Stanford, CA; and Harvard Medical School, Boston, MA
| | - Samuel G Finlayson
- Stanford University School of Medicine; Stanford Health Care, Stanford, CA; and Harvard Medical School, Boston, MA
| | - Yohan Vetteth
- Stanford University School of Medicine; Stanford Health Care, Stanford, CA; and Harvard Medical School, Boston, MA
| | - Nigam Shah
- Stanford University School of Medicine; Stanford Health Care, Stanford, CA; and Harvard Medical School, Boston, MA
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Abstract
INTRODUCTION Cancer pain is one of the most important symptoms of malignant disease, which has a major impact on the quality of life of cancer patients. Therefore, it needs to be treated appropriately after a careful assessment of the types and causes of pain. AREAS COVERED The mainstay of cancer pain management is systemic pharmacotherapy. This is, in principle, still based on the WHO guidelines initially published in 1986. Although these have been validated, they are not evidence-based. The principles are a stepladder approach using non-opioids, weak and then strong opioids. In addition, adjuvants can be added at any step to address specific situations such as bone or neuropathic pain. Patients, even if they are on long-acting opioids, need to be provided with immediate-release opioids for breakthrough pain. In case of inefficacy or severe adverse effects of one opioid, rotation to another opioid is recommended. EXPERT OPINION There is a major need for more and better randomized controlled trials in the setting of cancer pain as the lack of evidence is hampering the improvement of current treatment guidelines.
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Affiliation(s)
- Stephan A Schug
- Professor, Chair of Anaesthesiology, The University of Western Australia, School of Medicine and Pharmacology, Pharmacology, Pharmacy and Anaesthesiology Unit , Perth , Australia
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