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Shen MJ, Stokes T, Yarborough S, Harrison J. Improving Pain Self-Management Among Rural Older Adults With Cancer. JAMA Netw Open 2024; 7:e2421298. [PMID: 39018074 PMCID: PMC11255907 DOI: 10.1001/jamanetworkopen.2024.21298] [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] [Received: 01/12/2024] [Accepted: 05/10/2024] [Indexed: 07/18/2024] Open
Abstract
Importance Undertreated cancer pain is a major public health concern among older adults in rural communities. Interventions to improve pain management among this vulnerable population are needed. Objective To test the feasibility, acceptability, and changes in pain outcomes from exposure to an adapted intervention, Cancer Health Empowerment for Living without Pain (CA-HELP), to improve patients' communication about pain to their clinicians. Design, Setting, and Participants Older adults with cancer (aged ≥65 years) who were residing in a noninstitutional rural setting and receiving outpatient care at a rural-based clinic in Tennessee were enrolled in the study, in which everyone received the intervention, in May 2022. All patients were given assessments at baseline and 1 week after intervention. Mean score differences were analyzed using 1-tailed paired sample t tests (α = .05). Data were analyzed in June 2022. Exposure The adapted version of CA-HELP included an 18-page patient-facing workbook and a 30-minute telephone coaching call with a registered nurse to coach patients on pain education and communication techniques to discuss pain with their medical team. Main Outcomes and Measures Feasibility was examined through accrual and completion rates. Acceptability was measured by helpfulness, difficulty, and satisfaction with the intervention. Changes in outcomes were measured using mean score differences from pre-post assessments of pain self-management, self-efficacy for communicating with clinicians about pain, patient-reported pain, and misconceptions about pain. Results Among the 30 total participants, the mean (SD) age was 73.0 (5.1) years; 17 participants (56.7%) were female, 5 (16.7%) were Black or African American, 30 (100%) were non-Hispanic or non-Latino, 24 (80.0%) were White, 16 (53.3%) had less than a high school education, and 15 (50.0%) reported income less than $21 000 per year. Based on accrual and completion rates of 100%, this intervention was highly feasible. Fidelity rates for delivering intervention components (100%) and communication competence (27 participants [90%]) were also high. Regarding acceptability, all patients rated the intervention as helpful, with the majority (24 participants [80%]) rating it as "very helpful." Most patients rated the intervention as "not at all difficult" (27 participants [90%]), enjoyed participating (21 participants [70%]), and reported being "very satisfied" (25 participants [83.3%]). Pre-post changes in outcomes suggested significant improvements in pain self-management and self-efficacy for communicating with clinicians about pain, as well as significant reductions in patient-reported pain and pain misconceptions. Conclusions and Relevance In this case-series study of CA-HELP, results suggested the adapted version of CA-HELP was feasible and acceptable and showed changes in pain-related outcome measures among older adults with cancer in a rural setting.
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Affiliation(s)
- Megan J. Shen
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Tammy Stokes
- Maury Regional Medical Center, Columbia, Tennessee
| | - Sarah Yarborough
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jill Harrison
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
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Koutake Y, Fujimoto A, Nakahara M, Tsuruyama M, Miyoshi T, Yamaguchi Y, Fukazawa M, Kawamata Y, Hanada K, Hashimoto M. Predictors for the Clinical Efficacy of Tramadol for Cancer Pain. Am J Hosp Palliat Care 2023; 40:1303-1309. [PMID: 36647180 DOI: 10.1177/10499091231152854] [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: 01/18/2023] Open
Abstract
CONTEXT Tramadol is conditionally recommended for cancer pain and is a less expensive drug compared to strong opioids. Thus, tramadol may help reduce health care costs. OBJECTIVES To investigate factors that predict the clinical efficacy of tramadol for cancer pain. METHODS A retrospective study using electronic medical records was conducted on patients who received tramadol for cancer pain from January 2016 to December 2020. Patients who continued tramadol for >28 days or discontinued tramadol before 28 days owing to pain improvement were considered as clinical efficacy cases. RESULTS We identified 183 eligible patients; 104 cases had clinical efficacy. The median starting tramadol daily dose was 100 mg, and the median administration duration was 22 days. Overall, 169 patients (92.3%) discontinued tramadol; pain improvement was the most common reason (34.9%). Age (>70 years), a performance status of 0-1, and an albumin-bilirubin grade of 1 were independent predictors for the clinical efficacy of tramadol. Patients with multiple predictors had significantly higher achievement rates than those without. CONCLUSION Tramadol could have greater clinical efficacy for cancer pain in patients who are elderly, have good performance status, and have good liver function.
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Affiliation(s)
- Yoshimichi Koutake
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Airi Fujimoto
- Department of Pharmacy, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Moeko Nakahara
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Moeko Tsuruyama
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takanori Miyoshi
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasuhiro Yamaguchi
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Mami Fukazawa
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yosei Kawamata
- Department of Pharmacy, National Hospital Organization Miyazaki Higashi Hospital, Miyazaki, Japan
| | - Kiyonori Hanada
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masashi Hashimoto
- Department of Pharmacy, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Mensah ABB, Mikare M, Mensah KB, Okyere J, Amaniampong EM, Poku AA, Apiribu F, Lamptey JNC. Impact of cancer diagnosis and treatment: a qualitative analysis of strains, resources and coping strategies among elderly patients in a rural setting in Ghana. BMC Geriatr 2023; 23:540. [PMID: 37670259 PMCID: PMC10481500 DOI: 10.1186/s12877-023-04248-8] [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: 12/12/2022] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Rurality is fraught with numerous difficulties including a lack of advanced health facilities to provide health services, and an absence of specialist cancer services, and qualified personnel, among others. These factors exacerbate the challenges of elderly patients diagnosed with cancer and further pose limitations to activities/instrumental activities of daily living. Yet, there is limited scholarship on the strains that affect elderly patients diagnosed with cancer and the resources that helps them to overcome them. This study explores the strains, resources, and coping strategies of elderly patients diagnosed with cancer and undergoing treatment in rural Ghana. METHODS An exploratory, descriptive qualitative design was adopted. Purposive sampling was used to recruit 20 individuals to participate in in-depth interviews. The collected data was analysed inductively using Collaizi's framework. QSR NVivo-12 was used in managing the data. RESULTS The results were grouped into two main categories, namely: strains and resources. Within the category of strains, three main themes with their corresponding sub-themes emerged: cancer-related strains (systemic side effects from treatment, altered physical appearance and body image, and experience of pain), elderly strains (altered functional ability, limited social interactions and participation, psycho-emotional reactions, limited/restricted economic participation, and financial strains), and health system strains (negative attitude and insensitive communication, delay in diagnosis, lack of geriatric oncology care, lack of community-based specialist cancer centre and long travel distance to access care, and limited availability of essential cancer medicines and other radiations services). Four types of resources were available to cancer patients: personal resources, family resources, community resources, and healthcare systems resources. CONCLUSION In conclusion, elderly patients diagnosed with cancer experience physical, economic, psychological, and emotional strains that threaten their health and well-being. However, they are able to leverage family, community, and health system-related resources to navigate through the strains. There is, therefore, a need to expand advanced health facilities with geriatric oncology units and specialists to improve access to cancer care in rural areas. The government needs to assist elderly persons with costs associated with their diagnosis and treatment through the expansion of the National Health Insurance Scheme to include this as part of the benefits package.
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Affiliation(s)
- Adwoa Bemah Boamah Mensah
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana.
| | - Maurice Mikare
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
- Nursing and Midwifery Training College - Zuarungu, P. O. Box 660, Bolgatanga, Ghana
| | - Kofi Boamah Mensah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, University Post Office, Private Mail bag, Kumasi, Ghana
| | - Joshua Okyere
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
- Department of Population and Health, University of Cape Coast, University Post Office, Cape Coast, Ghana
| | - Er-Menan Amaniampong
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
- Department of Sociology and Social Work, Faculty of Social Sciences, College of Humanities and Social Sciences, Kwame Nkrumah University of Science and Technology, University Post Office, Private Mail bag, Kumasi, Ghana
| | - Abena Agyekum Poku
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
- Department of Komfo Anokye Teaching Hospital, P. O. Box, 1934, Kumasi, Ghana
| | - Felix Apiribu
- School of Nursing & Midwifery, College of Health Sciences, Private Mail bag, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
| | - Joe-Nat Clegg Lamptey
- Department of Surgery, University of Ghana Medical School, University of Ghana, Accra, Ghana
- Korle-Bu Teaching Hospital, Accra, Ghana
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Krysa K, Kowalczyk E, Borysowski J, Lachota M, Pasierski T. Exclusion of older adults from clinical trials in cancer-related pain. Front Med (Lausanne) 2022; 9:945481. [PMID: 35991635 PMCID: PMC9385985 DOI: 10.3389/fmed.2022.945481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is one of the most common symptoms in cancer patients including older adults. The objective of this study was to evaluate the enrollment criteria that can limit the inclusion of older adults in clinical trials concerning cancer-related pain (CRP). The study included 356 trials registered with ClinicalTrials.gov. Our primary outcome measures were the proportion of trials that excluded patients based on upper age limits (80 years of age or less), strict organ-specific exclusion criteria, broad and imprecise criteria, and inadequate performance score. One hundred and twenty-six trials (35.4%) had upper age limits. Strict exclusion criteria were used in 95 (26.7%) trials. Broad and imprecise exclusion criteria were listed in 57 (16.2%) trials. Low performance score was used as an exclusion criterion in 4 trials (1.1%). Overall, in 241 trials (67.7%) there was either an upper age limit or at least one strict or broad and imprecise exclusion criterion, or a criterion involving the performance status. The odds of excluding older adults were significantly higher in certain neoplasm types, study objectives, intervention types, and center locations. In conclusion, considerable proportion of recent clinical trials concerning CRP either explicitly exclude older adults or create high risk of such exclusion which substantially limits the evidence base for the treatment of such patients in clinical practice. Sponsors and investigators should consider careful modification of the enrollment criteria to improve the inclusion of older individuals who make up the major proportion of cancer patients population.
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Affiliation(s)
| | - Ewa Kowalczyk
- Clinical Research Development Centre, Medical Research Agency, Warsaw, Poland
| | - Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
- Centre for Studies on Research Integrity, Institute of Law Studies, Polish Academy of Sciences, Warsaw, Poland
- *Correspondence: Jan Borysowski
| | - Mieszko Lachota
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Pasierski
- Department of Medical Ethics and Palliative Medicine, Medical University of Warsaw, Warsaw, Poland
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Freo U, Ruocco C, Valerio A, Scagnol I, Nisoli E. Paracetamol: A Review of Guideline Recommendations. J Clin Med 2021; 10:jcm10153420. [PMID: 34362203 PMCID: PMC8347233 DOI: 10.3390/jcm10153420] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/11/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023] Open
Abstract
Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and otherwise healthy individuals but are often contraindicated in elderly and frail patients. As a result of its favorable safety and tolerability record, paracetamol has long been the most common drug for treating pain. Strikingly, recent reports questioned its therapeutic value and safety. This review aims to present guideline recommendations. Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain. It is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety. However, a lack of significant efficacy and hepatic toxicity have also been reported. Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol. A dose reduction is recommended in patients with liver disease or malnourished. Genotyping may improve efficacy and safety. Within the current trend toward the minimization of opioid analgesia, it is consistently included in multimodal, non-opioid, or opioid-sparing therapies. Paracetamol is being recommended by guidelines as a first or second-line drug for acute pain and chronic pain, especially for patients with limited therapeutic options and for the elderly.
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Affiliation(s)
- Ulderico Freo
- Anesthesiology and Intensive Care, Department of Medicine—DIMED, University of Padua, 35122 Padua, Italy;
- Correspondence: ; Tel.: +39-049-821-3090
| | - Chiara Ruocco
- Center for the Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, 20129 Milan, Italy; (C.R.); (E.N.)
| | - Alessandra Valerio
- Department of Molecular and Translational Medicine, University of Brescia, 25100 Brescia, Italy;
| | - Irene Scagnol
- Anesthesiology and Intensive Care, Department of Medicine—DIMED, University of Padua, 35122 Padua, Italy;
| | - Enzo Nisoli
- Center for the Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, 20129 Milan, Italy; (C.R.); (E.N.)
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Milecki J, Żmijewska-Tomczak M, Osmola K, Wierzbicka M. The impact of radiotherapy on the quality of life in patients with early-stage clinical head and neck cancer. Otolaryngol Pol 2021; 75:1-8. [PMID: 34552020 DOI: 10.5604/01.3001.0014.8759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Radiotherapy (RT) for patients with head and neck squamous cell carcinoma (HNSCC) affects vital functions related to the irradiation volume of the head and neck region and, in addition, has a negative impact on social functioning, thereby significantly impairing patients' quality of life (QoL). The aim of this study was to assess changes in the quality of life in patients with head and neck cancer treated with curative RT at 12 months after completion of RT. The aim of this study was to assess the differences between the baseline QoL of patients with early clinical stage HNSCC and at 12 months after curative/radical RT. The prospective clinical study included 92 patients in good general condition (ECOG 0-1 - Eastern Cooperative Oncology Group performance status), without regional or distant metastases, diagnosed with pathomorphologically confirmed early-stage head and neck squamous cell carcinoma treated with definitive RT. All patients participating in the study signed an informed consent form. QoL was assessed using the standard EORTC QLQ-C30 and QLQH&N35 questionnaires. In addition, information on clinical aspects and data relating to socio-demographic factors were obtained from each patient. Statistical analysis was performed using a statistical package (SPSS 17.0). T-test was used for dependent and independent samples. A general linear model was used for repeated measures. Patients' QoL deteriorated significantly after definitive RT. Worse QoL Core-30 scores in patients 12 months after the end of RT, compared with baseline QoL, before the start of RT, were observed in domains such as physical performance, fulfillment of life roles, cognitive functioning, loss of appetite, fatigue and constipation. For the QLQ-H&N35 questionnaires, patients 12 months after the end of RT reported problems in relation to aspects of life such as senses, mouth opening, dry mouth, thick saliva, pain, and weight loss. RT, even in early clinical stage head and neck cancer, has a negative impact on QoL, despite modern treatment techniques.
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Affiliation(s)
- Jakub Milecki
- Medical University of Karol Marcinkowski in Poznan, Poland
| | - Małgorzata Żmijewska-Tomczak
- Department of Radiotherapy of the Greater Poland Cancer Center, Medical University of Karol Marcinkowski in Poznan, Poland
| | - Krzysztof Osmola
- Maxillofacial Surgery Clinic, Medical University of Karol Marcinkowski in Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Medical University of Karol Marcinkowski in Poznan, Poland
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