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Courade M, Bertrand A, Guerrini-Rousseau L, Pagnier A, Levy D, Lervat C, Cojean N, Ribrault A, Dugue S, Thouvenin S, Piguet C, Schmitt C, Marec-Berard P. Low-dose ketamine adjuvant treatment for refractory pain in children, adolescents and young adults with cancer: a pilot study. BMJ Support Palliat Care 2019; 12:e656-e663. [PMID: 31151954 DOI: 10.1136/bmjspcare-2018-001739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/11/2019] [Accepted: 05/01/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Ketamine, an N-methyl-D-aspartate receptor antagonist, is effective at relieving adult cancer pain, although there have been very few reports to date regarding its use in children and in adolescents and young adults (AYA). This study assessed the efficacy, safety and opioid-sparing effects of low doses of ketamine added to opioid analgesics to alleviate persistent cancer pain. METHODS This prospective, multicentre, observational trial collected data regarding demographics, pain characteristics, pain score assessment within the first 48 hours of ketamine administration, tolerance and satisfaction from 38 patients aged 2-24 years prescribed with ketamine as an adjuvant antalgic for refractory cancer pain in 10 French paediatric oncology centres. RESULTS The mean visual analogue scale pain score decreased from 6.7 to 4.3 out of 10 (n=39, p<0.001) from day 1 to day 3 and by at least 2 points in 56% of the patients (n=22) 48 hours after initiation of ketamine. Nine patients experienced poor tolerance (≥2 side effects), all with infusion rates lower than 0.05 mg/kg/hour. None had limiting toxicities. An opioid-sparing effect was highlighted in four patients. Fifty-four per cent of the prescribers and 47% of the patients found the addition of ketamine 'very helpful'. CONCLUSIONS Low doses of ketamine as an adjuvant to opioids significantly reduced the intensity of pain in half of the study population. A tendency towards better pain control is shown, although a lack of statistical power somewhat limits our conclusions, especially in children. Nevertheless, ketamine may be a useful option for improving the treatment of refractory pain in children and AYA with cancer.
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Affiliation(s)
- Magali Courade
- Unité de Traitement de la Douleur de l' Enfant, Centre Leon Berard, Lyon, France
| | | | | | - Anne Pagnier
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | | | - Cyril Lervat
- Oncologie pédiatrique, Centre Oscar Lambret, Lille, France
| | | | | | - Sophie Dugue
- Oncologie pédiatrique, Hopital Universitaire Robert-Debre, Paris, France
| | - Sandrine Thouvenin
- Oncologie pédiatrique, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | | | - Claudine Schmitt
- Hématologie Oncologie et Centre de la Douleur pédiatrique, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Perrine Marec-Berard
- Unité de Traitement de la Douleur de l' Enfant, Centre Leon Berard, Lyon, France
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Doyle KE, El Nakib SK, Rajagopal M, Babu S, Joshi G, Kumarasamy V, Kumari DP, Chaudhuri P, Mohanthy S, Jatua D, Lohman D, Amon JJ, Palat G. Predictors and Prevalence of Pain and Its Management in Four Regional Cancer Hospitals in India. J Glob Oncol 2018; 4:1-9. [PMID: 30241192 PMCID: PMC6180789 DOI: 10.1200/jgo.2016.006783] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE More than 1 million new occurrences of cancer are diagnosed in India annually. Among patients with cancer, pain is a common and persistent symptom of the disease and its treatment. However, few studies to date have evaluated the prevalence of pain and the adequacy of pain management in Indian hospitals. This cross-sectional study aimed to assess the prevalence and sociodemographic patterns of cancer pain and pain management among a sample of inpatients and newly registered outpatients at four large regional cancer centers in India. METHODS A sample of 1,600 patients with cancer who were current inpatients or newly registered outpatients were recruited and administered a questionnaire that was based on the Brief Pain Inventory. The survey tool included questions on demographics, medical history, and extent of clinical pain experienced. In addition, a pain management index score was created to link the severity of cancer pain with medication prescribed to treat it. RESULTS A total of 88% of patients reported pain in the past 7 days, and approximately 60% reported that their worst pain was severe. Several demographic and medical characteristics of the study population predicted severe pain, including the following: lower educational level, outpatient status, and debt incurred as a result of illness. A total of 67% of patients were inadequately treated with analgesics. Inadequate pain management was associated with both treatment hospital and patient type, and patients who reported debt as a result of their illness were more likely to have inadequate pain management. CONCLUSION A majority of Indian patients with cancer experience significant pain and receive inadequate pain management. Improvement of pain management for Indian patients with cancer is needed urgently.
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Affiliation(s)
- Katherine E. Doyle
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Shatha K. El Nakib
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - M.R. Rajagopal
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Sunil Babu
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Geeta Joshi
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Vidya Kumarasamy
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - D. Priya Kumari
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Prabir Chaudhuri
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Sumita Mohanthy
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Debasish Jatua
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Diederik Lohman
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Joseph J. Amon
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
| | - Gayatri Palat
- Katherine E. Doyle and Shatha K. El Nakib,
Columbia University Mailman School of Public Health; Diederik
Lohman and Joseph J. Amon, Human Rights Watch, New York,
NY; M.R. Rajagopal, Pallium India, Trivandrum, India; Vidya
Kumarasamy, D. Priya Kumari, Gayatri Palat,
and MNJ Institute of Oncology, Hyderabad, India; Geeta Joshi,
Gujarat Cancer and Research Institute, Ahmedabad, India; Prabir
Chaudhuri, no institution; Sumita Mohanthy, AHRCC,
Cuttack, India; Debasish Jatua, Chittaranjan National Cancer
Institute, Kolkata, India; and Sunil Babu, no institution
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