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Mendieta CV, Calvache JA, Rondón MA, Rincón-Rodríguez CJ, Ahmedzai SH, de Vries E. Validation of the Spanish translation Sheffield Profile for Assessment and Referral for Care (SPARC-Sp) at the Hospital Universitario San Jose of Popayan, Colombia. Palliat Support Care 2024:1-12. [PMID: 38533614 DOI: 10.1017/s1478951524000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVES We determined the validity and reliability of the Spanish translation Sheffield Profile for Assessment and Referral for Care (SPARC-Sp) questionnaire to identify the palliative care (PC) needs of patients with chronic noncommunicable diseases (NCDs) in Colombia. METHODS We developed a cross-sectional observational study of scale assessment in adults with the aim of determining the validity and reliability of the SPARC-Sp questionnaire to identify the PC needs of patients with NCDs receiving outpatient or inpatient care at the Hospital Universitario San Jose of Popayan - ESE, Colombia, from 2021 to 2022. RESULTS We applied a questionnaire consisting of demographic, clinical data, and SPARC-Sp to 507 participants. The constructed model explained 75% of the variance with an adequate fit according to the root mean square residual (0.03), the comparative fit index (0.98), and acceptable reliability (McDonald's total omega 0.4-0.9). Opportunities for improvement are the reformulation and inclusion of particular words to improve the representativeness and clarity of the domains of communication and information, religious, and spiritual issues. SIGNIFICANCE OF RESULTS This research represents the first validation of SPARC in Spanish. SPARC-Sp is an instrument that allows initiating a conversation of the patient's main needs through a systematic assessment of the patients' main needs. Its psychometric validation demonstrated good fit and acceptable reliability.
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Affiliation(s)
- Cindy V Mendieta
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Department of Nutrition and Biochemistry, Faculty of Sciences, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Jose A Calvache
- Department of Anesthesiology, Universidad del Cauca, Popayan, Colombia
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martín A Rondón
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Carlos Javier Rincón-Rodríguez
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Sam H Ahmedzai
- School of Medicine, The University of Sheffield, Sheffield, UK
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
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Moreno S, Mendieta CV, de Vries E, Ahmedzai SH, Rivera K, Cortes-Mora C, Calvache JA. Translation and linguistic validation of the Sheffield Profile for Assessment and Referral for Care (SPARC) to Colombian Spanish. Palliat Support Care 2024:1-10. [PMID: 38327224 DOI: 10.1017/s1478951524000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVES We aimed to translate and linguistically and cross-culturally validate Sheffield Profile for Assessment and Referral for Care (SPARC) in Spanish for Colombia (SPARC-Sp). METHODS The linguistic validation of SPARC followed a standard methodology. We conducted focus groups to assess the comprehensibility and feasibility. The acceptability was assessed using a survey study with potential users. RESULTS The comprehensibility assessment showed that additional adjustments to those made during the translation-back-translation process were required to apply SPARC-Sp in rural and low-schooled populations. It also identified the need for alternative administration mechanisms for illiterate people. The acceptability survey showed that potential users found SPARC-Sp as not only acceptable but also highly desirable. However, they desired to expand the number of items in all domains. SIGNIFICANCE OF RESULTS Beyond the semantic and conceptual validity attained through the back-translation process, actual cultural validity could be acquired thanks to the comprehensibility tests. Although extending the instrument is something potential users would like to do, it would make it less feasible to utilize the SPARC-Sp in clinical settings. Nonetheless, the instrument might benefit from the inclusion of a domain that evaluates challenges encountered when accessing the health-care system. For communities lacking literacy, alternate administration methods must also be considered.
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Affiliation(s)
- Socorro Moreno
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Cindy V Mendieta
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Nutrition and Biochemistry, Faculty of Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sam H Ahmedzai
- School of Medicine, The University of Sheffield, Sheffield, UK
| | - Karen Rivera
- Department of Anesthesiology, Universidad del Cauca, Popayán, Colombia
| | | | - Jose A Calvache
- Department of Anesthesiology, Universidad del Cauca, Popayán, Colombia
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Tsai MC, Chou YY, Loh EW, Lin AP, Wu HC, Hsiao LS, Chang CL, Chen SF, Ahmedzai SH, Tam KW. Validation of traditional Chinese version of Sheffield Profile for Assessment and Referral for Care Questionnaire in Taiwanese patients. J Chin Med Assoc 2024; 87:58-63. [PMID: 37713325 DOI: 10.1097/jcma.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Holistic health care considers all aspects of patient care, namely the physical, psychological, spiritual, and social aspects. To assess which patient needs are unmet, a screening questionnaire covering the four aforementioned aspects is required. Therefore, the Sheffield Profile for Assessment and Referral for Care (SPARC), a multidimensional, self-reported questionnaire designed to screen patients regardless of diagnosis, was developed. This study developed a translated and validated traditional Chinese version of the SPARC for patients in Taiwan. METHODS The original English version of the SPARC was translated into a traditional Chinese version (SPARC-T) through forward-backward translation. Semistructured debriefing interviews were conducted with participants to evaluate the SPARC-T. The reliability and validity of the SPARC-T were assessed through Cronbach's alpha coefficients and a correlation analysis conducted using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. RESULTS Fifty-three patients were enrolled from our hospital: 22 had cancer but the majority had nonmalignant chronic conditions. About internal consistency, the Cronbach's alpha values for all domains of the SPARC-T were favorable. A correlation analysis of the SPARC-T and FACT-G revealed significant correlations for the domains of physical symptoms, independence and activity, family and social issues, sleep, and treatment issues; no significant correlation was identified for the "psychological issues" domain. CONCLUSION This study revealed that the SPARC-T is an effective tool for screening Mandarin-speaking patients. Thus, it can be used in hospitals to holistically screen and identify the needs of patients to ensure they can receive appropriate professional support and holistic health care.
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Affiliation(s)
- Ming-Chieh Tsai
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yun-Yun Chou
- Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - El-Wui Loh
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Medical Imaging, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan, ROC
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan, ROC
| | - Ashleigh Peng Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Hsueh-Chi Wu
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Li-Sin Hsiao
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chia-Li Chang
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan, ROC
| | - Shu-Fen Chen
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Sam H Ahmedzai
- Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Ka-Wai Tam
- Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
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Mendieta CV, de Vries E, Calvache JA, Ahmedzai SH, Prue G, McConnell T, Reid J. Co-Designing a Strategy for Implementing the SPARC Holistic Needs Assessment Tool in the Colombian Clinical Context. Healthcare (Basel) 2023; 11:2917. [PMID: 37998409 PMCID: PMC10671711 DOI: 10.3390/healthcare11222917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023] Open
Abstract
In Colombia, timely access to palliative care (PC) is hampered by difficulties in identifying and referring to necessary services. The SPARC (Sheffield Profile for Assessment and Referral for Care) instrument provides a holistic needs assessment to improve referrals for different forms of care. SPARC was recently validated in Colombian Spanish (SPARC-Sp) but has not yet been implemented in clinical practice. We undertook workshops that aimed to co-design an implementation strategy to inform a future trial testing SPARC-Sp in the Colombian healthcare system. Workshop attendees included patients, informal caregivers, healthcare professionals, volunteers, administrative staff and decision makers. Discussions within the workshops refined implementation and dissemination strategies for SPARC-Sp in practical scenarios. Results include the need for education, clarification and demystification of PC and the lack of time and skills of professionals to identify patients' needs. Attendees recognized SPARC-Sp as a valuable tool for highlighting patients' concerns, whose adaptations are needed in Colombia to address the low literacy of the population and specificities of the healthcare system. We proposed local adaptations to SPARC-Sp and produced five educational videos aimed at health professionals, patients and caregivers to strengthen understanding of holistic needs in PC while building a strategy for SPARC-Sp implementation in the Colombian context.
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Affiliation(s)
- Cindy V. Mendieta
- PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota 110231, Colombia;
- Department of Nutrition and Biochemistry, Faculty of Sciences, Pontificia Universidad Javeriana, Bogota 110231, Colombia
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
| | | | - Sam H. Ahmedzai
- Medical School, The University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK;
| | - Gillian Prue
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (G.P.); (T.M.)
| | - Tracey McConnell
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (G.P.); (T.M.)
| | - Joanne Reid
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (G.P.); (T.M.)
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Nanton V, Appleton R, Ahmed N, Loew J, Roscoe J, Muthuswamy R, Patel P, Dale J, Ahmedzai SH. Correction: A Web-Based Prostate Cancer–Specific Holistic Needs Assessment (CHAT-P): Multimethod Study From Concept to Clinical Practice. JMIR Cancer 2022; 8:e43856. [PMID: 36318763 PMCID: PMC9667376 DOI: 10.2196/43856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Veronica Nanton
- Warwick Medical SchoolUniversity of WarwickCoventryUnited Kingdom
| | - Rebecca Appleton
- Mental Health Policy Research UnitDivision of PsychiatryUniversity College LondonLondonUnited Kingdom
| | - Nisar Ahmed
- Medical SchoolUniversity of SheffieldSheffieldUnited Kingdom
| | - Joelle Loew
- Lucerne School of BusinessLucerneSwitzerland
| | - Julia Roscoe
- Warwick Medical SchoolUniversity of WarwickCoventryUnited Kingdom
| | | | - Prashant Patel
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUnited Kingdom
| | - Jeremy Dale
- Warwick Medical SchoolUniversity of WarwickCoventryUnited Kingdom
| | - Sam H Ahmedzai
- Medical SchoolUniversity of SheffieldSheffieldUnited Kingdom
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Appleton R, Nanton V, Ahmed N, Loew J, Roscoe J, Muthuswamy R, Patel P, Dale J, Ahmedzai SH. A Web-Based Prostate Cancer-Specific Holistic Needs Assessment (CHAT-P): Multimethod Study From Concept to Clinical Practice. JMIR Cancer 2022; 8:e32153. [PMID: 36260380 DOI: 10.2196/32153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 05/03/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Men with prostate cancer experience immediate and long-term consequences of the disease and its treatment. They require both long-term monitoring for recurrence or progression and follow-up to identify and help manage psychosocial and physical impacts. Holistic Needs Assessment aims to ensure patient-centered continuing cancer care. However, paper-based generic tools have had limited uptake within cancer services, and there is little evidence of their impact. With the expansion of remote methods of care delivery and to enhance the value of generic tools, we developed a web-based Composite Holistic Needs Assessment Adaptive Tool-Prostate (CHAT-P) specifically for prostate cancer. OBJECTIVE This paper described the context, conceptual underpinning, and approach to design that informed the development of CHAT-P, starting from the initial concept to readiness for deployment. Through this narrative, we sought to contribute to the expanding body of knowledge regarding the coproduction process of innovative digital systems with potential for enhanced cancer care delivery. METHODS The development of CHAT-P was guided by the principles of coproduction. Men with prostate cancer and health care professionals contributed to each stage of the process. Testing was conducted iteratively over a 5-year period. An initial rapid review of patient-reported outcome measures identified candidate items for inclusion. These items were categorized and allocated to overarching domains. After the first round of user testing, further items were added, improvements were made to the adaptive branching system, and response categories were refined. A functioning version of CHAT-P was tested with 16 patients recruited from 3 outpatient clinics, with interviewers adopting the think-aloud technique. Interview transcripts were analyzed using a framework approach. Interviews and informal discussions with health care professionals informed the development of a linked care plan and clinician-facing platform, which were incorporated into a separate feasibility study of digitally enhanced integrated cancer care. RESULTS The findings from the interview study demonstrated the usability, acceptability, and potential value of CHAT-P. Men recognized the benefits of a personalized approach and the importance of a holistic understanding of their needs. Preparation for the consultation by the completion of CHAT-P was also recognized as empowering. The possible limitations identified were related to the importance of care teams responding to the issues selected in the assessment. The subsequent feasibility study highlighted the need for attention to men's psychological concerns and demonstrated the ability of CHAT-P to capture red flag symptoms requiring urgent investigation. CONCLUSIONS CHAT-P offers an innovative means by which men can communicate their concerns to their health care teams before a physical or remote consultation. There is now a need for a full evaluation of the implementation process and outcomes where CHAT-P is introduced into the clinical pathway. There is also scope for adapting the CHAT-P model to other cancers.
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Affiliation(s)
- Rebecca Appleton
- Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Veronica Nanton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nisar Ahmed
- Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Joelle Loew
- Lucerne School of Business, Lucerne, Switzerland
| | - Julia Roscoe
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Prashant Patel
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sam H Ahmedzai
- Medical School, University of Sheffield, Sheffield, United Kingdom
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Snowden JA, Ahmedzai SH, Cox A, Cairns DA, Ashcroft AJ, Williams C, Cavenagh JD, Hockaday A, Brown JM, Brock IW, Morris TCM, Cook G. Association of genetic variants with patient reported quality of life and pain experience in patients in the UK NCRI Myeloma X Relapse [Intensive]) trial; an exploratory study. Bone Marrow Transplant 2022; 57:1507-1513. [PMID: 35768571 PMCID: PMC9532240 DOI: 10.1038/s41409-022-01738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/18/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022]
Abstract
The Myeloma X trial provided a platform to explore genetics in relation to systematic assessment of patient-reported outcomes at key points during salvage treatment in multiple myeloma (MM) patients. Blood DNA was obtained in 191 subjects for single nucleotide polymorphism (SNP) genotyping. By univariable analysis, the non-coding rs2562456 SNP, upstream of LINC00664, was associated with several relevant pain and health-related quality-of-life (HRQoL) scores at 100 days after allocation to consolidation with autologous stem cell transplantation or weekly cyclophosphamide. Presence of the minor (C) allele was associated with lower pain interference (p = 0.014) and HRQoL pain (p = 0.003), and higher HRQoL global health status (p = 0.011) and physical functioning (p = 0.007). These effects were not modified by treatment arm and were no longer significant at 6 months. Following induction therapy, the rs13361160 SNP near the CCT5 and FAM173B genes was associated with higher global health (p = 0.027) and physical functioning (p = 0.013). This exploratory study supports associations between subjective parameters in MM with SNPs previously identified in genome-wide association studies of pain. Conversely, SNPs in candidate genes involved in opioid and transporter pathways showed no effect. Further studies are warranted in well-defined cancer populations, and potentially assisted by whole genome sequencing with germline analysis in routine diagnostics in haematological cancers.
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Affiliation(s)
- John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
- Department of Oncology and Metabolism, Sheffield Medical School, The University of Sheffield, Sheffield, UK.
| | - Sam H Ahmedzai
- Department of Oncology and Metabolism, Sheffield Medical School, The University of Sheffield, Sheffield, UK
| | - Angela Cox
- Department of Oncology and Metabolism, Sheffield Medical School, The University of Sheffield, Sheffield, UK
| | - David A Cairns
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - A John Ashcroft
- Leeds Cancer Centre, Leeds Teaching Hospitals, Leeds, UK
- Mid-Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Cathy Williams
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Anna Hockaday
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia M Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ian W Brock
- Department of Oncology and Metabolism, Sheffield Medical School, The University of Sheffield, Sheffield, UK
| | - Treen C M Morris
- College of Myeloma (UK), United Kingdom Myeloma Forum, London, UK
| | - Gordon Cook
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals, Leeds, UK
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Ahmedzai SH. Legal right to palliative care wouldn't be needed if the hospice movement didn't operate outside the NHS. BMJ 2022; 377:o1422. [PMID: 35710112 DOI: 10.1136/bmj.o1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sallnow L, Smith R, Ahmedzai SH, Bhadelia A, Chamberlain C, Cong Y, Doble B, Dullie L, Durie R, Finkelstein EA, Guglani S, Hodson M, Husebø BS, Kellehear A, Kitzinger C, Knaul FM, Murray SA, Neuberger J, O'Mahony S, Rajagopal MR, Russell S, Sase E, Sleeman KE, Solomon S, Taylor R, Tutu van Furth M, Wyatt K. Report of the Lancet Commission on the Value of Death: bringing death back into life. Lancet 2022; 399:837-884. [PMID: 35114146 PMCID: PMC8803389 DOI: 10.1016/s0140-6736(21)02314-x] [Citation(s) in RCA: 170] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Afsan Bhadelia
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Yali Cong
- Peking University Health Science Center, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | - Julia Neuberger
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Sarah Russell
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Eriko Sase
- Georgetown University, Washington, DC, USA
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Calvache JA, Moreno S, Prue G, Reid J, Ahmedzai SH, Arango-Gutierrez A, Ardila L, Arroyo LI, de Vries E. Knowledge of end-of-life wishes by physicians and family caregivers in cancer patients. BMC Palliat Care 2021; 20:140. [PMID: 34507567 PMCID: PMC8434705 DOI: 10.1186/s12904-021-00823-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/15/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To describe communication regarding cancer patient's end-of-life (EoL) wishes by physicians and family caregivers. METHODS An online questionnaire and telephone-based surveys were performed with physicians and family caregivers respectively in three teaching hospitals in Colombia which had been involved in the EoL care of cancer patients. RESULTS For 138 deceased patients we obtained responses from physicians and family caregivers. In 32 % physicians reported they spoke to the caregiver and in 17 % with the patient regarding EoL decisions. In most cases lacking a conversation, physicians indicated the treatment option was "clearly the best for the patient" or that it was "not necessary to discuss treatment with the patient". Twenty-six percent of the caregivers indicated that someone from the medical team spoke with the patient about treatment, and in 67% who had a conversation, caregivers felt that the provided information was unclear or incomplete. Physicians and family caregivers were aware if the patient had any advance care directive in 6% and 26% of cases, respectively, with low absolute agreement (34%). CONCLUSIONS There is a lack of open conversation regarding EoL in patients with advanced cancer with their physicians and family caregivers in Colombia. Communication strategies are urgently needed.
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Affiliation(s)
- Jose A Calvache
- Department of Anesthesiology, Universidad del Cauca, Popayán, Colombia
- Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Socorro Moreno
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Gillian Prue
- Reader in Chronic Illness, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Joanne Reid
- Professor of Cancer and Palliative Care, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Sam H Ahmedzai
- Academic Unit of Supportive Care, Section of Oncology, School of Medicine and Biomedical Sciences, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | | | | | - Lucia I Arroyo
- Departamento de Fonoaudiología, Universidad del Cauca, Popayan, Colombia
- MPH programme Public Health, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
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Abstract
Healthcare aims to help older people to live well, but ultimately must also support them to die well. Most people die in old age, but predicting death in both short- and long-term is impossible for many, although not all, older people. Frail older people live with hope and pride in coping, and often anticipate recovery when ill. Key objectives of healthcare for older people are to maintain independence, minimise suffering and preserve dignity, which requires active medical, mental health and rehabilitation management, even when extending life is not the main goal. Thorough medical diagnosis and appropriate treatment and rehabilitation minimise disability, physical and mental distress and problems resulting from acute illness and crises. In these terms, 'health gain' can be achieved from medical intervention, even when life expectancy is short. Assumptions derived from cancer care about lack of reversibility with medical interventions are sometimes unwarranted. This has to be balanced against investigation- and treatment-burden, including that associated with hospital admission and the adverse effects of drugs and therapy interventions, and the need to respect the identity and autonomy of individuals. The resolution of these tensions requires anticipation of care options, multi-professional assessment, judicious and targeted treatment, good communication with patients and stakeholders and rigorous shared decision-making. In this commentary, we compare geriatric and palliative medicine, and describe how the geriatric medical approach can deliver appropriate healthcare towards the end of life. This is well supported by the broad knowledge, skill-set, flexibility and professional values displayed by geriatricians working in multi-professional teams.
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Affiliation(s)
- Nisar Ahmed
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2HA, UK
| | - Sam H Ahmedzai
- Medical School, University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2HA, UK
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Kwon JH, Baek SK, Kim DY, Kim YJ, Lee MA, Choi HJ, Byun JM, Jeong JY, Ahmedzai SH, Jang GD. Pilot study for the Psychometric Validation of the Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients. Cancer Res Treat 2020; 53:25-31. [PMID: 32878428 PMCID: PMC7812019 DOI: 10.4143/crt.2020.235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients. Materials and Methods The English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medical oncologist fluent in English. After the first version of the Korean SPARC (K-SPARC) was developed, back-translation into English was performed by a professional translator and bilingual oncologist. The back-translated version was reviewed by the original author (S.H.A.), and modifications were made (ver. 2). The second version of the K-SPARC was tested against other questionnaires, including the Functional Assessment of Cancer Therapy-General (FACT-G) and the Edmonton Symptom Assessment System (ESAS). RESULTS Thirty patients were enrolled in the pilot trial. Fifteen were male, and the median age was 64.5 years. Six patients had an Eastern Cooperative Oncology Group performance status of 2 or more. All patients except one were receiving chemotherapy. Regarding internal consistency, the Cronbach's α scores for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.812, 0.804, 0.589, 0.843, 0.754, and 0.822, respectively. The correlation coefficients between the SPARC and FACT-G were 0.479 (p=0.007) for the physical domain and -0.130 (p=0.493) for the social domain. CONCLUSION This pilot study indicates that the K-SPARC could be a reliable tool to screen for palliative care needs among Korean cancer patients. A further study to validate our findings is ongoing.
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Affiliation(s)
- Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Myung Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jin Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Young Jeong
- Hallym Research Institute of Clinical Epidemiology, Hallym University, Chuncheon, Korea
| | - Sam H Ahmedzai
- National Institute for Health Research, Clinical Research Network - Cancer, University of Leeds, Leeds, UK
| | - Geun-Doo Jang
- Division of Hemato-Oncology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
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13
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Hawkes CA, Fritz Z, Deas G, Ahmedzai SH, Richardson A, Pitcher D, Spiller J, Perkins GD. Development of the Recommended Summary Plan for eEmergency Care and Treatment (ReSPECT). Resuscitation 2020; 148:98-107. [PMID: 31945422 DOI: 10.1016/j.resuscitation.2020.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/03/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) practice has been shown to be variable and sub-optimal. This paper describes the development of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT). ReSPECT is a process which encourages shared understanding of a patient's condition and what outcomes they value and fear, before recording clinical recommendations about cardiopulmonary-resuscitation (CPR) within a broader plan for emergency care and treatment. METHODS ReSPECT was developed iteratively, with integral stakeholder engagement, informed by the Knowledge-to-Action cycle. Mixed methods included: synthesis of existing literature; a national online consultation exercise; cognitive interviews with users; a patient-public involvement (PPI) workshop and a usability pilot, to ensure acceptability by both patients and professionals. RESULTS The majority (89%) of consultation respondents supported the concept of emergency care and treatment plans. Key features identified in the evaluation and incorporated into ReSPECT were: The importance of discussions between patient and clinician to inform realistic treatment preferences and clarity in the resulting recommendations recorded by the clinician on the form. The process is compliant with UK mental capacity laws. Documentation should be recognised across all health and care settings. There should be opportunity for timely review based on individual need. CONCLUSION ReSPECT is designed to facilitate discussions about a person's preferences to inform emergency care and treatment plans (including CPR) for use across all health and care settings. It has been developed iteratively with a range of stakeholders. Further research will be needed to assess the influence of ReSPECT on patient-centred decisions, experience and health outcomes.
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Affiliation(s)
- Claire A Hawkes
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, UK
| | - Zoe Fritz
- THIS (The Healthcare Improvement Studies) Institute, University of Cambridge, UK; Cambridge University Hospitals, UK
| | - Gavin Deas
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - Sam H Ahmedzai
- National Institute for Health Research Clinical Research Network - Cancer Cluster, University of Leeds, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
| | - David Pitcher
- Resuscitation Council UK, 5th Floor, Tavistock House North, Tavistock Square, London, WC1H 9HR, UK
| | | | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, UK; University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK.
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14
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Danson S, Mulvey MR, Turner L, Horsman J, Escott KJ, Coleman RE, Ahmedzai SH, Bennett MI, Andrew D. An exploratory randomized-controlled trial of the efficacy of the Src-kinase inhibitor saracatinib as a novel analgesic for cancer-induced bone pain. J Bone Oncol 2019; 19:100261. [PMID: 31667062 PMCID: PMC6812043 DOI: 10.1016/j.jbo.2019.100261] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 02/04/2023] Open
Abstract
Pain is a major symptom of bone metastases from advanced cancer and represents a clinical challenge to treat effectively. Basic neurobiology in preclinical animal models implicates enhanced sensory processing in the central nervous system, acting through N-methyl-D-aspartate (NMDA) glutamate receptors, as an important mechanism underpinning persistent pain. The non-receptor tyrosine kinase Src is thought to act as a hub for regulating NMDA receptor activity and the orally available Src inhibitor saracatinib has shown promise as a potential analgesic in recent animal studies. Here we tested the efficacy of saracatinib as a novel analgesic in an exploratory phase II randomized controlled trial on cancer patients with painful bone metastases. Twelve patients completed the study, with 6 receiving saracatinib 125 mg/day for 28 days and 6 receiving placebo. Pharmacokinetic measurements confirmed appropriate plasma levels of drug in the saracatinib-treated group and Src inhibition was achieved clinically by a significant reduction in the bone resorption biomarker serum cross-linked C-terminal telopeptide of type I collagen. Differences between the saracatinib and placebo groups self-reported pain scores, measured using the short form of the Brief Pain Inventory, were not clinically significant after 4 weeks of treatment. There was also no change in consumption of maintenance analgesia in the saracatinib-treated group and no improvement in Quality-of-Life scores. The data were insufficient to demonstrate saracatinib has efficacy as analgesic, although it may have a role as an anti-bone resorptive agent.
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Affiliation(s)
- Sarah Danson
- Academic Unit of Clinical Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
| | - Lesley Turner
- Academic Unit of Clinical Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, UK
| | - Janet Horsman
- Academic Unit of Clinical Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, UK
| | - KJane Escott
- Emerging Innovations Unit, BioPharmaceuticals R & D, AstraZeneca, Cambridge, UK
| | - Robert E Coleman
- Academic Unit of Clinical Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, University of Sheffield, UK
| | | | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
| | - David Andrew
- School of Clinical Dentistry, University of Sheffield, UK
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15
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Koch ED, Kapanadze S, Eerdekens MH, Kralidis G, Létal J, Sabatschus I, Ahmedzai SH. Cebranopadol, a Novel First-in-Class Analgesic Drug Candidate: First Experience With Cancer-Related Pain for up to 26 Weeks. J Pain Symptom Manage 2019; 58:390-399. [PMID: 31152783 DOI: 10.1016/j.jpainsymman.2019.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Pain is one of the most prevalent symptoms associated with cancer. Strong opioids are commonly used in the analgesic management of the disease, but carry the risk of severe side effects. Cebranopadol is a first-in-class drug candidate, combining nociceptin/orphanin FQ peptide and opioid peptide receptor agonism. For cancer patients, frequently experiencing multimorbidities and often exposed to polypharmacy, cebranopadol is easy to handle given its once-daily dosing, the small tablet size that enables swallowing, and the option to flexibly titrate to an effective dose. OBJECTIVES We assessed the safety and tolerability of prolonged treatment with oral cebranopadol for up to 26 weeks in patients suffering from chronic moderate-to-severe cancer-related pain. METHODS This was a non-randomized, multi-site, open-label, single-arm clinical trial with patients who had completed a double-blind trial comparing morphine prolonged release with cebranopadol. In this extension trial, patients were treated with oral cebranopadol for up to 26 weeks. RESULTS Cebranopadol was safe and well tolerated in patients with chronic moderate-to-severe pain related to cancer in the dose range tested (200-1000 μg once daily). The median and mean pain levels remained in the range of mild pain during the treatment period. CONCLUSION Our data suggest that cebranopadol was safe and well tolerated when administered for up to 26 weeks in patients with chronic cancer-related pain who were previously treated with cebranopadol or morphine prolonged release.
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Affiliation(s)
- E Dietlind Koch
- Innovation Unit Pain, Clinical Science, Grünenthal GmbH, Aachen, Germany.
| | - Sofia Kapanadze
- Innovation Unit Pain, Clinical Science, Grünenthal GmbH, Aachen, Germany
| | | | - Georg Kralidis
- Data Sciences-Statistics, Grünenthal GmbH, Aachen, Germany
| | - Jiří Létal
- Data Sciences-Statistics, Grünenthal GmbH, Aachen, Germany
| | | | - Sam H Ahmedzai
- Department of Oncology, University of Sheffield, Sheffield, UK
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16
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Ahmedzai SH, Snowden JA, Ashcroft AJ, Cairns DA, Williams C, Hockaday A, Cavenagh JD, Ademokun D, Tholouli E, Allotey D, Dhanapal V, Jenner M, Yong K, Cavet J, Hunter H, Bird JM, Pratt G, Parrish C, Brown JM, Morris TCM, Cook G. Patient-Reported Outcome Results From the Open-Label, Randomized Phase III Myeloma X Trial Evaluating Salvage Autologous Stem-Cell Transplantation in Relapsed Multiple Myeloma. J Clin Oncol 2019; 37:1617-1628. [PMID: 30969846 PMCID: PMC6858007 DOI: 10.1200/jco.18.01006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Salvage autologous stem-cell transplantation (sASCT) in patients with multiple myeloma (MM) relapsing after a prior autologous stem-cell transplantation leads to increased remission duration and overall survival. We report a comprehensive study on patient-reported outcomes, including quality of life (QoL) and pain in sASCT. METHODS Patients were randomly assigned to either sASCT or nontransplantation consolidation (NTC). Pain and QoL were assessed as secondary outcomes using validated QoL instruments (European Organisation for Research and Treatment of Cancer QLQ-C30 and myeloma-specific module, QLQ-MY20; the Brief Pain Inventory [Short Form]; and the Leeds Assessment of Neuropathic Symptoms and Signs [Self-Assessment] scale). RESULTS A total of 288 patients (> 96%) consented to the QoL substudy. The median follow-up was 52 months. The European Organisation for Research and Treatment of Cancer QLQ-C30 Global health status scores were higher (better) in the NTC group at 100 days after random assignment (P = .0496), but not at later time points. Pain interference was higher (worse) in the sASCT group than in the NTC group at 6 months after random assignment (P = .0267), with patients with sASCT reporting higher scores for Pain interference with daily living for up to 2 years after random assignment. Patients reporting lower concerns about adverse effects of treatment after sASCT had a time to progression advantage. CONCLUSION Patients with sASCT with relapsed MM demonstrated a comparative reduction in QoL and greater impact of treatment adverse effects lasting for 6 months and up to 2 years for pain, after which patients who had received sASCT reported better outcomes. Patients who experienced lower adverse effects after sASCT had longer time to progression and overall survival, showing the need to improve symptom management peritransplantation. To our knowledge, this study provides the most comprehensive picture of QoL before and after sASCT in patients with relapsed MM.
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Affiliation(s)
- Sam H Ahmedzai
- 1 The University of Sheffield, Sheffield, United Kingdom
| | - John A Snowden
- 2 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | | | - Cathy Williams
- 5 Nottingham City Hospitals, Nottingham City, United Kingdom
| | | | - Jamie D Cavenagh
- 6 Barts Health NHS Trust and The London NHS Trust, London, United Kingdom
| | - Debo Ademokun
- 7 Ipswich Hospital NHS Trust, Ipswich, United Kingdom
| | - Eleni Tholouli
- 8 Manchester Royal Infirmary, Manchester, United Kingdom
| | | | | | - Matthew Jenner
- 11 University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Kwee Yong
- 12 University College Hospital, London, United Kingdom
| | - Jim Cavet
- 13 The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hannah Hunter
- 14 Plymouth Hospitals Trust, Plymouth, United Kingdom
| | - Jennifer M Bird
- 15 University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Guy Pratt
- 16 University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | | | - Gordon Cook
- 4 University of Leeds, Leeds, United Kingdom
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17
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Bennett MI, Eisenberg E, Ahmedzai SH, Bhaskar A, O'Brien T, Mercadante S, Krčevski Škvarč N, Vissers K, Wirz S, Wells C, Morlion B. Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain. Eur J Pain 2019; 23:660-668. [PMID: 30480345 PMCID: PMC7027571 DOI: 10.1002/ejp.1346] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/26/2018] [Accepted: 11/23/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Evidence from meta-analyses suggests that pain remains poorly controlled for a large proportion of patients; barriers to good management include poor assessment of pain, inadequate support for patient self-management and late or inadequate access to strong opioid analgesia in those with advanced disease. METHODS The European Pain Federation (EFIC) established a Task Force in 2017 which convened a European group of experts, drawn from a diverse range of relevant clinical disciplines, to prepare a position paper on appropriate standards for the management of cancer-related pain. The expert panel reviewed the available literature and made recommendations using the GRADE system to combine quality of evidence with strength of recommendation. The panel took into account the desirable and undesirable effects of the management recommendation, including the cost and inconvenience of each when deciding the recommendation. RESULTS AND CONCLUSIONS The 10 standards presented are aimed to improve cancer pain management and reduce variation in practice across Europe. The Task Force believes that adoption of these standards by all 37 countries will promote the quality of care of patients with cancer-related pain and reduce unnecessary suffering. SIGNIFICANCE Pain affects up to 40% of cancer survivors and affects at least 66% of patients with advanced progressive disease, many of whom experience poor pain control. These 10 standards are aimed to improve cancer pain management, promote the quality of care of patients and reduce variation across Europe.
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Affiliation(s)
- Michael I Bennett
- St Gemma's Academic Unit of Palliative Care, University of Leeds, Leeds, UK
| | - Elon Eisenberg
- Pain Research Unit, Institute of Pain Medicine, Rambam Health Care Campus and Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Arun Bhaskar
- Imperial College Healthcare NHS Trust, London, UK
| | - Tony O'Brien
- Marymount University Hospital & Hospice, Curraheen, Ireland.,Cork University Hospital, Wilton, Ireland.,College of Medicine & Health, University College Cork, Cork, Ireland
| | | | - Nevenka Krčevski Škvarč
- Faculty of Medicine, University of Maribor, Institute for Palliative Medicine and Care, Slovenia
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Stefan Wirz
- Centre for Pain Medicine, Department of Anesthesiology, Intensive Medicine, Pain/Palliative Medicine, GFO-Hospitals Bonn and University of Bonn
| | | | - Bart Morlion
- The Leuven Center for Algology and Pain Management, University Hospitals Leuven, KU Leuven, Belgium
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18
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Ahmedzai SH, Bautista MJ, Bouzid K, Gibson R, Gumara Y, Hassan AAI, Hattori S, Keefe D, Kraychete DC, Lee DH, Tamura K, Wang JJ. Optimizing cancer pain management in resource-limited settings. Support Care Cancer 2018; 27:2113-2124. [PMID: 30242544 PMCID: PMC6499735 DOI: 10.1007/s00520-018-4471-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
Abstract
Purpose Adequate cancer pain management (CPM) is challenging in resource-limited settings, where current international guideline recommendations are difficult to implement owing to constraints such as inadequate availability and accessibility of opioids, limited awareness of appropriate opioid use among patients and clinicians, and lack of guidance on how to translate the best evidence into clinical practice. The multinational and multidisciplinary CAncer Pain managEment in Resource-limited settings (CAPER) Working Group proposes a two-step initiative to bridge clinical practice gaps in CPM in resource-limited settings. Methods A thorough review of the literature, a steering committee meeting in February 2017, and post-meeting teleconference discussions contributed to the development of this initiative. As a first step, we developed practical evidence-based CPM algorithms to support healthcare providers (HCPs) in tailoring treatment according to availability of and access to resources. The second part of the initiative proposes a framework to support an effective implementation of the CPM algorithms that includes an educational program, a pilot implementation, and an advocacy plan. Results We developed CPM algorithms for first-line use, breakthrough cancer pain, opioid rotation, and refractory cancer pain based on the National Comprehensive Cancer Network guidelines and expert consensus. Our proposed educational program emphasizes the practical elements and illustrates how HCPs can provide optimal CPM according to evidence-based guidelines despite varied resource limitations. Pilot studies are proposed to demonstrate the effectiveness of the algorithms and the educational program, as well as for providing evidence to support a draft advocacy document, to lobby policymakers to improve availability and accessibility of analgesics in resource-limited settings. Conclusions These practical evidence-informed algorithms and the implementation framework represent the first multinational step towards achieving optimal CPM in resource-limited settings. Electronic supplementary material The online version of this article (10.1007/s00520-018-4471-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sam H Ahmedzai
- National Institute of Health Research Clinical Research Network for Cancer, Leeds, UK
| | | | - Kamel Bouzid
- Medical Oncology Department, Pierre & Marie Curie Center, Algiers, Algeria
| | - Rachel Gibson
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Yuddi Gumara
- National Cancer Center Dharmais Hospital, Jakarta, Indonesia
| | - Azza Adel Ibrahim Hassan
- Supportive & Palliative Care Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.,Cancer Management & Research, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Seiji Hattori
- Department of Cancer Pain Management, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Dorothy Keefe
- Department of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | | | - Dae Ho Lee
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kazuo Tamura
- General Medical Research Center, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Jie Jun Wang
- Department of Oncology, Shanghai Changzheng Hospital, Second Military Medical University, No. 64 He Tian Road, Shanghai, 200070, People's Republic of China.
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19
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Nanton V, Appleton R, Dale J, Roscoe J, Hamborg T, Ahmedzai SH, Arvanitis TN, Badger D, James N, Mendelsohn R, Khan O, Parashar D, Patel P. Integrated Care in Prostate Cancer (ICARE-P): Nonrandomized Controlled Feasibility Study of Online Holistic Needs Assessment, Linking the Patient and the Health Care Team. JMIR Res Protoc 2017; 6:e147. [PMID: 28754653 PMCID: PMC5554351 DOI: 10.2196/resprot.7667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 12/30/2022] Open
Abstract
Background The potential of technology to aid integration of care delivery systems is being explored in a range of contexts across a variety of conditions in the United Kingdom. Prostate cancer is the most common cancer in UK men. With a 10-year survival rate of 84%, there is a need to explore innovative methods of care that are integrated between primary health care providers and specialist teams in order to address long-term consequences of the disease and its treatment as well as to provide continued monitoring for recurrence. Objective Our aim was to test the feasibility of a randomized controlled trial to compare a model of prostate cancer continuing and follow-up care integration, underpinned by digital technology, with usual care in terms of clinical and cost-effectiveness, patient-reported outcomes, and experience. Methods A first phase of the study has included development of an online adaptive prostate specific Holistic Needs Assessment system (HNA), training for primary care-based nurses, training of an IT peer supporter, and interviews with health care professionals and men with prostate cancer to explore views of their care, experience of technology, and views of the proposed intervention. In Phase 2, men in the intervention arm will complete the HNA at home to help identify and articulate concerns and share them with their health care professionals, in both primary and specialist care. Participants in the control arm will receive usual care. Outcomes including quality of life and well-being, prostate-specific concerns, and patient enablement will be measured 3 times over a 9-month period. Results Findings from phase 1 indicated strong support for the intervention among men, including those who had had little experience of digital technology. Men expressed a range of views on ways that the online system might be used within a clinical pathway. Health care professionals gave valuable feedback on how the output of the assessment might be presented to encourage engagement and uptake by clinical teams. Recruitment to the second phase of the study, the feasibility trial, commenced March 2017. Conclusions To our knowledge, this study is the first in the United Kingdom to trial an online holistic needs assessment for men with prostate cancer, with data shared between patients and primary and secondary care providers. This study addresses recommendations in recent policy documents promoting the importance of data sharing and enhanced communication between care providers as a basis for care integration. We anticipate that this model of care will ultimately provide important benefits for both patients and the National Health Service. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 31380482; http://www.isrctn.com/ISRCTN31380482 (Archived by WebCite at http://www.webcitation.org/6s8I42u5N)
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Affiliation(s)
- Veronica Nanton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Rebecca Appleton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jeremy Dale
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Julia Roscoe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Thomas Hamborg
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sam H Ahmedzai
- Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Theodoros N Arvanitis
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Douglas Badger
- South Warwickshire Prostate Support Association, Stratford, United Kingdom
| | - Nicholas James
- The Cancer Centre, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Omar Khan
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Deepak Parashar
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Prashant Patel
- Department of Urology, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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20
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Affiliation(s)
- Sam H Ahmedzai
- Department of Oncology and Metabolism, School of Medicine and Biomedical Science, The University of Sheffield, Sheffield, UK
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21
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Iliffe S, Davies N, Manthorpe J, Crome P, Ahmedzai SH, Vernooij-Dassen M, Engels Y. Improving palliative care in selected settings in England using quality indicators: a realist evaluation. BMC Palliat Care 2016; 15:69. [PMID: 27484414 PMCID: PMC4970274 DOI: 10.1186/s12904-016-0144-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. METHODS 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service change in selected settings (general practice, community palliative care teams, care homes, hospital wards, in-patient hospices) with a before-and-after evaluation, and 3) realist evaluation of processes and outcomes across settings. Participants in each setting were supported to identify no more than three Quality Indicators to work on over an eight-month period in 2013/2014. RESULTS General practices could not be recruited to the study. Care homes were recruited but not retained. Hospital wards were recruited and retained, and using the Quality Indicator (QI) set achieved some of their desired changes. Hospices and community palliative care teams were able to use the QI set to achieve almost all their desired changes, and develop plans for quality improvements. Improvements included: increasing the utility of electronic medical records, writing a manual for end of life care, establishing working relationships with a hospice; standardising information transfer between settings, holding regular multi-disciplinary team meetings, exploration of family carers' views and experiences; developing referral criteria, and improvement of information transfer at patient discharge to home or to hospital. Realist evaluation suggested that: 1) uptake and use of QIs are determined by organisational orientation towards continuous improvement; 2) the perceived value of a QI package was not powerful enough for GPs and care homes to commit to or sustain involvement; 3) the QI set may have been to narrow in focus, or more specialist than generalist; and 4) the greater the settings' 'top-down' engagement with this change project, the more problematic was its implementation. CONCLUSIONS Whilst use of QIs may facilitate improvements in specialist palliative care services, different QI sets may be needed for generalist care settings.
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Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Nathan Davies
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, Strand, London, WC2B 6NR, UK
| | - Peter Crome
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Sam H Ahmedzai
- Department of Oncology and Metabolism, School of Medicine and Biomedical Science, The University of Sheffield, Sheffield, S10 2RX, UK
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, 6500 HB, Nijmegen, The Netherlands
| | - Yvonne Engels
- Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, 6500 HB, Nijmegen, The Netherlands
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Coyne KS, Sexton C, LoCasale RJ, King FR, Margolis MK, Ahmedzai SH. Opioid-Induced Constipation among a Convenience Sample of Patients with Cancer Pain. Front Oncol 2016; 6:131. [PMID: 27376025 PMCID: PMC4896913 DOI: 10.3389/fonc.2016.00131] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/17/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Little is known regarding the burden of opioid-induced constipation (OIC) among patients who suffer from cancer-related pain. METHODS A prospective longitudinal study was conducted among cancer patients in the United Kingdom (UK), Canada, and Germany, which included medical record data abstraction, Internet-based patient surveys, and physician surveys. Patients on daily opioid therapy (≥30 mg for ≥4 weeks) for treatment of cancer pain with self-reported OIC were recruited. Response to laxatives was defined by classifying participants into categories of laxative use and evaluating the prevalence of inadequate response. Descriptive statistics were used to evaluate outcomes, including the patient assessment of constipation-symptom (PAC-SYM), patient assessment of constipation-quality of life, EuroQOL-5 dimensions, and global assessment of treatment benefit, satisfaction, and willingness to continue. RESULTS Recruitment was difficult for this study with only 31 participants completing the baseline survey and meeting criteria for opioid use and OIC (26 UK, 1 Canada, and 4 Germany). Fifty-two percent (n = 16) of participants were male, and all were White. Breast (23%, n = 7), pancreatic (13%, n = 4), and multiple myeloma (13%, n = 4) were the most common cancers. Mean duration of chronic pain and opioid use were 2.3 and 1.3 years, respectively. Participants reported having a mean of 4.4 bowel movements/week in the 2 weeks prior to baseline, of which a mean of 0.9 were spontaneous. Most participants (90%, n = 28) were using at least 1 lifestyle approach to manage their constipation; 65% (n = 20) were taking ≥1 over-the-counter laxative; 19% (n = 6) were taking ≥1 prescription laxative; 23% (n = 7) reported no laxative use in the prior 2 weeks. Moderate-to-severe constipation symptoms on the PAC-SYM were common, and mean scores on health-related quality of life outcomes were comparable to chronic pain populations. CONCLUSION In this primarily UK sample, there appears to be considerable unmet OIC treatment needs among cancer patients.
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Affiliation(s)
| | | | - Robert J LoCasale
- Medical Evidence and Observational Research in Global Medical Affairs, AstraZeneca , Gaithersburg, MD , USA
| | - Frederic R King
- Global Payer Evidence and Pricing in Global Medicines and Development, AstraZeneca , Gaithersburg, MD , USA
| | | | - Sam H Ahmedzai
- Department of Oncology, University of Sheffield , Sheffield , UK
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Abstract
Care of people in their last days of life should be based on compassion, respect and, wherever possible, on research evidence. Previously the Liverpool Care Pathway attempted to facilitate this but it was withdrawn after an independent government report found that its uncritical implementation could lead to poor care. This Concise Guideline overviews NICE Clinical Guideline (NG31), which addresses: recognising dying; communication and shared decision making; maintaining hydration; and pharmacological symptom control, including anticipatory prescribing. Doctors may need to change their attitudes to care of dying people and those important to them. Specific areas where practices will need to reflect the individualised approach to care are highlighted. Limitations of the guideline are discussed. Potential barriers to implementation include need for further training and 24/7 availability of specialist support to front-line clinicians.
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Affiliation(s)
| | | | | | | | - Sam H Ahmedzai
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Samuelson C, O'Toole L, Boland E, Greenfield D, Ezaydi Y, Ahmedzai SH, Snowden JA. High prevalence of cardiovascular and respiratory abnormalities in advanced, intensively treated (transplanted) myeloma: The case for 'late effects' screening and preventive strategies. ACTA ACUST UNITED AC 2016; 21:272-9. [PMID: 27077780 PMCID: PMC4950454 DOI: 10.1080/10245332.2015.1122258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Modern management of myeloma has significantly improved survival, with increasing numbers of patients living beyond a decade. However, little is known about the long-term cardiovascular and respiratory status of intensively treated and multiply relapsed survivors. Methods: We performed detailed cardiovascular and respiratory evaluations in patients with intensively treated, advanced but stable myeloma. All patients had received at least two lines of treatment, including at least one haematopoietic stem cell transplantation procedure, but had stable, controlled disease and were off active treatment at the time of evaluation. Results: Thirty-two patients with a median duration of 6 years (range 2–12) from original diagnosis of myeloma and three lines (range 2–6) of treatment were evaluated. Despite normal physical examination in the majority, there was a high prevalence of sub-clinical cardiac and respiratory dysfunction, reflected by abnormalities of electrocardiography (45%), echocardiography (50%), serum N-terminal pro-B-type natriuretic peptide level (NT-pro-BNP, 50%), and pulmonary function testing (45%). NT-pro-BNP level correlated negatively with quality of life (P = 0.012) and positively with serum ferritin (P = 0.027). Dyspnoea score correlated with BMI (P = 0.001). Risk factors for cardiovascular disease (obesity, hypertension, hyperlipidaemia, and hyperinsulinaemia) were common. Discussion: Even in the absence of overt clinical features, the majority of intensively treated long-term survivors of myeloma have established cardiovascular and/or respiratory dysfunction, above levels expected in the general population of a similar age. Conclusion: This study supports routine screening and lifestyle modification combined with primary and secondary preventive strategies to reduce cardiovascular and respiratory disease and to preserve quality of life in transplanted myeloma patients.
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Affiliation(s)
- Clare Samuelson
- a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - Laurence O'Toole
- b Department of Cardiology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - Elaine Boland
- c Academic Unit of Supportive Care , University of Sheffield , UK
| | - Diana Greenfield
- d Department of Oncology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - Yousef Ezaydi
- a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - Sam H Ahmedzai
- c Academic Unit of Supportive Care , University of Sheffield , UK
| | - John A Snowden
- a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
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Affiliation(s)
- Joshua Ruegger
- National Clinical Guidelines Centre, Royal College of Physicians, London NW1 4LE, UK
| | - Sarah Hodgkinson
- National Clinical Guidelines Centre, Royal College of Physicians, London NW1 4LE, UK
| | | | - Sam H Ahmedzai
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Ahmedzai SH, Boland JW. Constipation: opioid antagonists in people prescribed opioids. BMJ Clin Evid 2015; 2015:2407. [PMID: 26360669 PMCID: PMC4566814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Constipation is a common adverse effect of opioids. As an example, constipation is reported in 52% of people with advanced malignancy, and this figure rises to 87% in people who are terminally ill and taking opioids. There is no reason to believe that people with chronic non-malignant disease who are prescribed opioids will be any less troubled by this adverse effect. METHODS AND OUTCOMES We conducted a systematic overview and aimed to answer the following clinical question: What are the effects of opioid antagonists for constipation in people prescribed opioids? The population we studied included people with any condition, although most studies were in people with cancer pain. We searched Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). RESULTS At this update, searching of electronic databases retrieved 162 studies. After deduplication and removal of conference abstracts, 84 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 47 studies and the further review of 37 full publications. Of the 37 full articles evaluated, two systematic reviews and one RCT were included at this update. We performed a GRADE evaluation for three PICO combinations. CONCLUSIONS In this systematic overview we categorised the efficacy for three interventions based on information relating to the effectiveness of alvimopan, methylnaltrexone, and naloxone.
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Affiliation(s)
- Sam H Ahmedzai
- Department of Oncology, The University of Sheffield, Sheffield, UK
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Affiliation(s)
- Sam H Ahmedzai
- Department of Oncology, Medical School, The University of Sheffield, Sheffield, UK
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Collins K, Boote J, Ardron D, Gath J, Green T, Ahmedzai SH. Making patient and public involvement in cancer and palliative research a reality: academic support is vital for success: Table 1. BMJ Support Palliat Care 2014; 5:203-6. [DOI: 10.1136/bmjspcare-2014-000750] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/09/2014] [Indexed: 11/04/2022]
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Ahmedzai SH, Leppert W, Janecki M, Pakosz A, Lomax M, Duerr H, Hopp M. Long-term safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate-to-severe chronic cancer pain. Support Care Cancer 2014; 23:823-30. [PMID: 25218610 PMCID: PMC4311064 DOI: 10.1007/s00520-014-2435-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/02/2014] [Indexed: 01/22/2023]
Abstract
Aim To evaluate the long-term safety and efficacy of prolonged-release oxycodone/naloxone (OXN PR) and its impact on quality of life (QoL), in patients with moderate-to-severe cancer pain. Methods This was an open-label extension (OLE) of a 4 week, randomized, double-blind (DB) study in which patients with moderate-to-severe cancer pain had been randomized to OXN PR or oxycodone PR (OxyPR). During the OLE phase, patients were treated with OXN PR capsules (≤20/60 mg/day) for ≤24 weeks. Outcome measures included safety, efficacy and QoL. Results One hundred and twenty-eight patients entered the OLE, average pain scores based on the modified Brief Pain Inventory—Short Form were low and stable over the 24-week period. The improvement in bowel function and constipation symptoms as measured by the Bowel Function Index and patient assessment of constipation in patients treated with OXN PR during the 4-week DB study was maintained. In patients treated with OxyPR during the DB phase, bowel function and constipation symptoms were improved during the OLE. In the DB and in the OLE, health status and QoL were similar for patients treated with OXN PR and OxyPR. There were no unexpected safety or tolerability issues. Conclusions In patients with moderate-to-severe cancer pain, long-term use of OXN PR is well tolerated and effective, resulting in sustained analgesia, improved bowel function and improved symptoms of constipation.
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Affiliation(s)
- Sam H Ahmedzai
- Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
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30
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Sloot S, Boland J, Snowden JA, Ezaydi Y, Foster A, Gethin A, Green T, Chopra L, Verhagen S, Vissers K, Engels Y, Ahmedzai SH. Side effects of analgesia may significantly reduce quality of life in symptomatic multiple myeloma: a cross-sectional prevalence study. Support Care Cancer 2014; 23:671-8. [PMID: 25160491 PMCID: PMC4311060 DOI: 10.1007/s00520-014-2358-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/21/2014] [Indexed: 12/13/2022]
Abstract
Background Pain is a common symptom in patients with multiple myeloma (MM). Many patients are dependent on analgesics and in particular opioids, but there is limited information on the impact of these drugs and their side effects on health-related quality of life (HRQoL). Method In a cross-sectional study, semi-structured interviews were performed in 21 patients attending the hospital with symptomatic MM on pain medications. HRQoL was measured using items 29 and 30 of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30. Results Patients were able to recall a median of two (range 0–4) analgesics. They spontaneously identified a median of two (range 1–5) side effects attributable to their analgesic medications. Patients’ assessment of HRQoL based on the EORTC QLQ-C30 questions 29/30 was mean 48.3 (95 % CI; 38.7–57.9) out of 100. Patients’ assessment of their HRQoL in the hypothetical situation, in which they would not experience any side effects from analgesics, was significantly higher: 62.6 (53.5–71.7) (t test, p = 0.001). Conclusion This study provides, for the first time, evidence that side effects of analgesics are common in symptomatic MM and may result in a statistically and clinically significant reduction of self-reported HRQoL.
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Affiliation(s)
- Sarah Sloot
- Department of General Surgery, UMCG, Groningen, Hanzeplein, PO 30.001, 9713 GZ Groningen The Netherlands
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612 USA
| | - Jason Boland
- Hull York Medical School, University of Hull, Hull, HU6 7RX UK
| | - John A. Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF UK
| | - Yousef Ezaydi
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF UK
| | - Andrea Foster
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF UK
| | - Alison Gethin
- North Trent Consumer Research Panel, c/o Academic Unit of Supportive Care, Department of Oncology, School of Medicine and Biomedical Science, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Tracy Green
- North Trent Consumer Research Panel, c/o Academic Unit of Supportive Care, Department of Oncology, School of Medicine and Biomedical Science, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Louise Chopra
- Clinical Effectiveness Unit, Sheffield Teaching Hospitals NHS Foundation Trust, 8 Beech Hill Road, Sheffield, S10 2SB UK
| | - Stans Verhagen
- Department of Anesthesiology, pain and palliative medicine, UMC St Radboud, PO 9101, 6500 HB Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, pain and palliative medicine, UMC St Radboud, PO 9101, 6500 HB Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, pain and palliative medicine, UMC St Radboud, PO 9101, 6500 HB Nijmegen, The Netherlands
| | - Sam H. Ahmedzai
- Academic Unit of Supportive Care, Department of Oncology, School of Medicine and Biomedical Science, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
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Boland JW, McWilliams K, Ahmedzai SH, Pockley AG. Effects of opioids on immunologic parameters that are relevant to anti-tumour immune potential in patients with cancer: a systematic literature review. Br J Cancer 2014; 111:866-73. [PMID: 25025960 PMCID: PMC4150281 DOI: 10.1038/bjc.2014.384] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/02/2014] [Accepted: 06/10/2014] [Indexed: 01/18/2023] Open
Abstract
Background: The immune system has a central role in controlling cancer, and factors that influence protective antitumour immunity could therefore have a significant impact on the course of malignant disease. Opioids are essential for the management of cancer pain, and preclinical studies indicate that opioids have the potential to influence these tumour immune surveillance mechanisms. The aim of this systematic literature review is to evaluate the clinical effects of opioids on the immune system of patients with cancer. Methods: A systematic search of Ovid MEDLINE (PubMed) and Embase, Cochrane database and Web of Knowledge for clinical studies, which evaluated the effects of opioids on the immune system in patients with cancer, was performed. Results: Five human studies, which have assessed the effects of opioids on the immune system in patients with cancer, were identified. Although all of these evaluated the effect of morphine on immunologic end points in patients with cancer, none measured the clinical effects. Conclusions: Evidence from preclinical, healthy volunteer and surgical models suggests that different opioids variably influence protective anti-tumour immunity; however, actual data derived from cancer populations are inconclusive and definitive recommendations cannot be made. Appropriately designed and powered studies assessing clinical outcomes of opioid use in people with cancer are therefore required to inform oncologists and others involved in cancer care about the rational use of opioids in this patient group.
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Affiliation(s)
- J W Boland
- Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - K McWilliams
- Palliative Medicine Research Department, Beatson Oncology Centre, Glasgow G11 0YN, UK
| | - S H Ahmedzai
- Department of Oncology, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - A G Pockley
- John van Geest Cancer Research Centre, Nottingham Trent University, Nottingham NG11 8NS, UK
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Greenfield DM, Boland E, Ezaydi Y, Ross RJM, Ahmedzai SH, Snowden JA. Erratum: Endocrine, metabolic, nutritional and body composition abnormalities are common in advanced intensively-treated (transplanted) multiple myeloma. Bone Marrow Transplant 2014. [DOI: 10.1038/bmt.2014.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Personalized medicine can be defined as the tailoring of therapies to defined subsets of patients based on their likelihood to respond to therapy or their risk of adverse events. This medical model is more established in oncology but personalized pain therapy is showing potential promise. Pharmacogenomics is of growing relevance to the pain field, for example cytochrome P450 2D6 (CYP2D6) polymorphisms with resulting variation in degree of CYP2D6 expression may affect codeine analgesia. Research using quantitative sensory testing is seeking to identify phenotypic subgroups of neuropathic pain patients with different underlying pain mechanisms. Imaging studies have suggested that genetic, environmental, mood, and injury-specific factors combine to produce a unique cerebral pain "signature." The search for central nervous system (CNS) biomarkers for chronic pain is ongoing.
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Affiliation(s)
- Sam H Ahmedzai
- Department of Oncology, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK.
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Greenfield DM, Boland E, Ezaydi Y, Ross RJM, Ahmedzai SH, Snowden JA. Endocrine, metabolic, nutritional and body composition abnormalities are common in advanced intensively-treated (transplanted) multiple myeloma. Bone Marrow Transplant 2014; 49:907-12. [DOI: 10.1038/bmt.2014.63] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/30/2014] [Accepted: 02/02/2014] [Indexed: 11/09/2022]
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Fingas S, Hurst S, Davies J, Newell J, Ahmedzai SH. PATIENT CHOICE OF LAXATIVE MEDICATION FOR TREATMENT OF OPIOID INDUCED CONSTIPATION (OIC). A SERVICE EVALUATION AT SHEFFIELD CENTRAL CAMPUS. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000654.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fingas S, Ahamed A, Ahmedzai SH. KETAMINE USE IN PALLIATIVE CARE WITHIN THE NORTH TRENT CANCER NETWORK (NTCN). BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000654.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bourke AM, Theobald R, Ahmedzai SH. VARIATIONS IN METHADONE PRESCRIBING AND OUTCOMES — A SERVICE EVALUATION IN SHEFFIELD AND CHESTERFIELD. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000654.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fingas S, Bourke AM, Spawton V, Richardson S, Miller E, Ahmedzai SH. DO HOSPITAL NURSES ADMINISTER NASAL FENTANYL SPRAY CORRECTLY? – A SERVICE EVALUATION. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000654.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Woitha K, Van Beek K, Ahmed N, Jaspers B, Mollard JM, Ahmedzai SH, Hasselaar J, Menten J, Vissers K, Engels Y. Validation of quality indicators for the organization of palliative care: a modified RAND Delphi study in seven European countries (the Europall project). Palliat Med 2014; 28:121-9. [PMID: 23861161 DOI: 10.1177/0269216313493952] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. AIM To develop and validate a set of structure and process indicators for palliative care settings in Europe. DESIGN A two-round modified RAND Delphi process was conducted to rate clarity and usefulness of a previously developed set of 110 quality indicators. SETTING/PARTICIPANTS In total, 20 multi-professional palliative care teams of centers of excellence from seven European countries. RESULTS In total, 56 quality indicators were rated as useful. These valid quality indicators concerned the following domains: the definition of a palliative care service (2 quality indicators), accessibility to palliative care (16 quality indicators), specific infrastructure to deliver palliative care (8 quality indicators), symptom assessment tools (1 quality indicator), specific personnel in palliative care services (9 quality indicators), documentation methodology of clinical data (14 quality indicators), evaluation of quality and safety procedures (1 quality indicator), reporting of clinical activities (1 quality indicator), and education in palliative care (4 quality indicator). CONCLUSION The modified RAND Delphi process resulted in 56 international face-validated quality indicators to measure and compare organizational aspects of palliative care. These quality indicators, aimed to assess and improve the organization of palliative care, will be pilot tested in palliative care settings all over Europe and be used in the EU FP7 funded IMPACT project.
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Affiliation(s)
- Kathrin Woitha
- 1Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Ahmed N, Ahmedzai SH, Collins K, Noble B. Holistic assessment of supportive and palliative care needs: the evidence for routine systematic questioning. BMJ Support Palliat Care 2014; 4:238-46. [PMID: 24644199 DOI: 10.1136/bmjspcare-2012-000324] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There is evidence to suggest that patients with cancer and other non-malignant chronic progressive illnesses can experience distressing symptoms, or concerns, which can often remain unrecognised. There is little disagreement that routine systematic questioning is useful in identifying supportive or palliative care needs that would otherwise not be identified. The purpose of this article is to provide an overview of holistic needs assessment in the fields of supportive and palliative care and to present evidence of the value of routine systematic questioning. Systematic questioning allows needs to be identified and addressed. There is at present no standardised systematic, evidence-based holistic approach to screening patients for supportive and palliative care needs.
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Affiliation(s)
- Nisar Ahmed
- Academic Unit of Supportive Care, University of Sheffield, Sheffield, UK
| | - Sam H Ahmedzai
- Academic Unit of Supportive Care, University of Sheffield, Sheffield, UK
| | - Karen Collins
- Faculty of Health and Wellbeing, Sheffield Hallam University, Montgomery House, Sheffield, UK
| | - Bill Noble
- Academic Unit of Supportive Care, University of Sheffield, Sheffield, UK
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Boland JW, Foulds GA, Ahmedzai SH, Pockley AG. A preliminary evaluation of the effects of opioids on innate and adaptive human in vitro immune function. BMJ Support Palliat Care 2013; 4:357-67. [DOI: 10.1136/bmjspcare-2013-000573] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Baxter SK, Baird WO, Thompson S, Bianchi SM, Walters SJ, Lee E, Ahmedzai SH, Proctor A, Shaw PJ, McDermott CJ. The impact on the family carer of motor neurone disease and intervention with noninvasive ventilation. J Palliat Med 2013; 16:1602-9. [PMID: 24236958 DOI: 10.1089/jpm.2013.0211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The diagnosis of motor neurone disease (MND) has a profound effect on the functioning and well-being of both the patient and their family, with studies describing an increase in carer burden and depression as the disease progresses. AIM This study aimed to assess whether patient use of noninvasive ventilation (NIV) impacted on their family carer, and to explore other sources of carer burden. DESIGN The study used qualitative interviews and scaled measures of carer health and well-being completed at three monthly intervals until patient end of life. PARTICIPANTS Sixteen family carers were followed up over a period ranging from one month to two years. RESULTS NIV was perceived as having little impact on carer burden. The data however highlighted a range of sources of other burdens relating to the physical strain of caring. The Medical Outcomes Study Short Form (SF-36 Health Survey) Physical Component Summary (PCS) scores were considerably below that of the Mental Component Summary (MCS) score at baseline and at all following time points. Carers described the physical effort associated with patient care and role change; the challenge inherent in having time away; and problems relating to the timing of equipment and service delivery. CONCLUSIONS NIV can be recommended to patients without concerns regarding increasing carer burden. The predominant source of burden described related to the physical impact of caring for a patient with MND. Services face challenges if this physical burden is to be reduced by providing equipment at an optimal time and successfully coordinating their input.
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Affiliation(s)
- Susan K Baxter
- 1 School of Health and Related Research, University of Sheffield , Sheffield, United Kingdom
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Boland E, Eiser C, Ezaydi Y, Greenfield DM, Ahmedzai SH, Snowden JA. Living with advanced but stable multiple myeloma: a study of the symptom burden and cumulative effects of disease and intensive (hematopoietic stem cell transplant-based) treatment on health-related quality of life. J Pain Symptom Manage 2013; 46:671-80. [PMID: 23535325 DOI: 10.1016/j.jpainsymman.2012.11.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/07/2012] [Accepted: 11/18/2012] [Indexed: 12/24/2022]
Abstract
CONTEXT The cumulative impact of disease and treatment-related factors on health-related quality of life (HRQoL) in long-term survivors of multiple myeloma is poorly characterized. OBJECTIVES To characterize HRQoL and symptom burden in advanced, intensively treated myeloma. METHODS We performed detailed assessments in patients who had undergone hematopoietic stem cell transplantation and subsequent treatment for at least one episode of progressive disease. To exclude the impact of active disease and acute toxicity of treatment, patients were in a stable plateau phase. Patients were assessed for HRQoL (Short Form-12, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, and Multiple Myeloma Module), pain (Brief Pain Inventory-Short Form), peripheral neuropathy (self-report Leeds Assessment of Neuropathic Symptoms and Signs), and concerns (adapted from Profile of Concerns). Serum interleukin-6 and tumor necrosis factor-alpha were measured. RESULTS A total of 32 patients were enrolled, with a median age of 55 years at diagnosis and 60 years at assessment. After a median 5.5 years from diagnosis and three lines of treatment, physical functioning was significantly compromised (P<0.001) and associated with progressive work disability and concerns regarding loss of independence. Fatigue and pain were the predominant symptoms, impacting negatively on physical functioning (P<0.001). Pain was predominantly neuropathic in half the patients. Serum interleukin-6 levels positively correlated with pain (P=0.03), pain interference (P=0.003), insomnia (P=0.02), and appetite loss (P=0.02), and inversely correlated with physical functioning (P=0.03). CONCLUSION Despite disease control and supportive care, intensively treated long-term myeloma survivors have significantly compromised HRQoL related to symptom burden. Systematic assessment is routinely indicated in advanced phase myeloma, even when disease activity is stable. Further studies should investigate the utility of interventional strategies and the relationship of cytokines with symptoms.
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Affiliation(s)
- Elaine Boland
- Academic Unit of Supportive Care, University of Sheffield, Sheffield, United Kingdom.
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Baxter SK, Baird WO, Thompson S, Bianchi SM, Walters SJ, Lee E, Ahmedzai SH, Proctor A, Shaw PJ, McDermott CJ. Use of non-invasive ventilation at end of life. Palliat Med 2013; 27:878. [PMID: 24058005 DOI: 10.1177/0269216313495098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Susan K Baxter
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Beek KV, Woitha K, Ahmed N, Menten J, Jaspers B, Engels Y, Ahmedzai SH, Vissers K, Hasselaar J. Comparison of legislation, regulations and national health strategies for palliative care in seven European countries (Results from the Europall Research Group): a descriptive study. BMC Health Serv Res 2013; 13:275. [PMID: 23866928 PMCID: PMC3720186 DOI: 10.1186/1472-6963-13-275] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 07/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This paper aims to deliver a structured overview of the legislation, existing regulations and the different health care policies regarding palliative care in seven European countries. METHODS In 2008 an inventory of the organisation of palliative care was developed by the researchers of the Europall project. Included were two open questions about legislation, regulations, and health policy in palliative care. This questionnaire was completed using palliative care experts selected from Belgium, England, France, Germany, the Netherlands, Poland and Spain. Additionally, (grey) literature on palliative care health policy and regulations from the participating countries was collected to complete the inventory. Comparative analysis of country specific information was performed afterwards. RESULTS In all countries palliative care regulations and policies existed (either in laws, royal decrees, or national policies). An explicit right to palliative care was mentioned in the Belgium, French and German law. In addition, access to palliative care was mentioned by all countries, varying from explicit regulations to policy intentions in national plans. Also, all countries had a national policy on palliative care, although sometimes mainly related to national cancer plans. Differences existed in policy regarding palliative care leave, advance directives, national funding, palliative care training, research, opioids and the role of volunteers. CONCLUSIONS Although all included European countries have policies on palliative care, countries largely differ in the presence of legislation and regulations on palliative care as well as the included topics. European healthcare policy recommendations should support palliative care access across Europe.
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Affiliation(s)
- Karen Van Beek
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Kathrin Woitha
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Nisar Ahmed
- Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - Johan Menten
- Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Birgit Jaspers
- Department of Palliative Medicine, University of Bonn, Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
- Department of Palliative Medicine, University of Goettingen, University Medical Clinic, Goettingen, Germany
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sam H Ahmedzai
- Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Baxter SK, Baird WO, Thompson S, Bianchi SM, Walters SJ, Lee E, Ahmedzai SH, Proctor A, Shaw PJ, McDermott CJ. The use of non-invasive ventilation at end of life in patients with motor neurone disease: a qualitative exploration of family carer and health professional experiences. Palliat Med 2013; 27:516-23. [PMID: 23462702 DOI: 10.1177/0269216313478449] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Non-invasive ventilation improves quality and quantity of life in patients with motor neurone disease who have respiratory failure. Use of non-invasive ventilation may, however, result in complex clinical issues for end-of-life care, with concerns as to whether and how it should be withdrawn. AIM This study aimed to describe carer and health professional experiences of end-of-life care of motor neurone disease patients using non-invasive ventilation. DESIGN/PARTICIPANTS This article reports data from qualitative interviews with family carers and professionals following the death of patients with motor neurone disease who were using non-invasive ventilation in the final phase of the disease. RESULTS Ten of the 20 patients initiated on non-invasive ventilation were using it in the end-of-life phase of their disease, with 5 using it for 24 h/day. Interviews were carried out with nine family carers and 15 professionals. Nine recurring themes were identified in the data. Both carers and health-care professionals perceived that the terminal phase of motor neurone disease was unexpectedly rapid and that this often led to unplanned interactions with the emergency services. Carers of patients who used non-invasive ventilation perceived non-invasive ventilation as aiding patient comfort and anxiety at the end of life. CONCLUSIONS The use of non-invasive ventilation was described as beneficial and was not perceived by carers or most professionals to have adversely impacted patient's end-of-life experience. This study highlights variation in patient wishes regarding usage towards the end of life, uncertainty regarding appropriate management among professionals and the importance of disseminating end-of-life wishes.
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Affiliation(s)
- Susan K Baxter
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Leppert W, Majkowicz M, Ahmedzai SH. The adaptation of the Sheffield Profile for Assessment and Referral for Care (SPARC) to the Polish clinical setting for needs assessment of advanced cancer patients. J Pain Symptom Manage 2012; 44:916-22. [PMID: 22926084 DOI: 10.1016/j.jpainsymman.2011.12.286] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 12/18/2011] [Accepted: 12/22/2011] [Indexed: 11/12/2022]
Abstract
CONTEXT Assessment of the needs of advanced cancer patients is a very important issue in palliative care. OBJECTIVES The aim of the study was to adapt the Sheffield Profile for Assessment and Referral for Care (SPARC) to the Polish environment and evaluate its usefulness in needs assessment of patients with advanced cancer. METHODS A forward-back translation of the SPARC to Polish was done. The SPARC was used once in 58 consecutive patients with advanced cancer during follow-up. The patients were enrolled from a palliative care unit (25 patients), home care (18 patients), and a day care center (15 patients). The reliability was evaluated by establishing the internal consistency using Cronbach's alpha coefficients. Content validity was analyzed in accordance with the theories of needs by Murray and Maslow as a nonstatistical method of validity assessment. Factor analysis with principal components extraction and varimax rotation of raw data was used to reduce the set of data and assess the construct validity. RESULTS There were differences regarding religious and spiritual issues and independence and activity between patients in the palliative care unit (worse results) and those at the day care center (better scores). Communication and need for more information items were associated with psychological, social, spiritual, and treatment issues. Cronbach's alpha coefficients and factor analysis demonstrated, respectively, satisfactory reliability and construct validity of the tool. CONCLUSION The study demonstrated that the Polish version of the SPARC is a valid and reliable tool recommended for the needs assessment and symptom evaluation of patients with advanced cancer.
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Affiliation(s)
- Wojciech Leppert
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland.
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Uronis HE, Shelby RA, Currow DC, Ahmedzai SH, Bosworth HB, Coan A, Abernethy AP. Assessment of the psychometric properties of an English version of the cancer dyspnea scale in people with advanced lung cancer. J Pain Symptom Manage 2012; 44:741-9. [PMID: 22765966 DOI: 10.1016/j.jpainsymman.2011.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/25/2011] [Accepted: 11/01/2011] [Indexed: 11/30/2022]
Abstract
CONTEXT Dyspnea is a poorly understood subjective sensation. Existing dyspnea measures fail to adequately address its multidimensionality. A Japanese group developed and validated the Cancer Dyspnea Scale (CDS) for assessing dyspnea in patients with advanced lung cancer. OBJECTIVES We evaluated the validity and reliability of the English version of the CDS (CDS-E) that has 12 items and takes, on average, 140 seconds for individuals to complete. METHODS Eligible patients had advanced lung cancer, consented, and were fluent in English. Participants completed a 100 mm visual analogue scale (VAS), the modified Borg scale, the CDS-E, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy--Lung quality-of-life scale. Demographic, radiographic, and treatment information were obtained from patients' medical records. RESULTS One hundred twelve participants were enrolled at three sites in the U.S., Australia, and the U.K. Mean age was 64.5 years (SD 11.5); 90% were Caucasian, 68% had Eastern Cooperative Oncology Group performance status 0-1, and 50% had non-small cell carcinoma. All completed the CDS-E independently, without difficulty. The CDS-E had reasonable internal consistency overall (Cronbach's α = 0.71) and for each of the three factors (effort, anxiety, discomfort Cronbach's α = 0.80-0.84). CDS-E scores were significantly correlated with the 100mm VAS (r = 0.82; P < 0.001) and the modified Borg (r = 0.87; P < 0.001). After factor analysis, the CDS-E was revised by removing three items (r-CDS-E). CONCLUSION The CDS-E and r-CDS-E are reliable and valid measures of the sensation and the psychological components of dyspnea, with the shorter version having similar psychometric properties.
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Affiliation(s)
- Hope E Uronis
- Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA
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Baxter SK, Baird WO, Thompson S, Bianchi SM, Walters SJ, Lee E, Ahmedzai SH, Proctor A, Shaw PJ, McDermott CJ. The initiation of non-invasive ventilation for patients with motor neuron disease: patient and carer perceptions of obstacles and outcomes. Amyotroph Lateral Scler Frontotemporal Degener 2012; 14:105-10. [PMID: 22953736 DOI: 10.3109/17482968.2012.719238] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to examine the experiences of patients with motor neuron disease and their carers following the recommendation to use non-invasive ventilation (NIV). Qualitative interviews were carried out with 20 patients and 17 carers within one month of NIV being initiated. The study identified a range of potential barriers to usage including: adverse impressions of the technology; sleep disturbance; the sensation of pressure and pulsing; dry mouth; and mask design issues. Patients/carers perceived benefits related to: increased energy; improved sleeping; enhanced carer well-being; improved breathing and increased speech clarity. A key factor described by patients and carers was the need to persevere to overcome the challenges associated with early NIV use. The study highlights the importance of patient perceptions of gains as a factor in their NIV usage decisions. While recognizing that older individuals with limb-onset disease were over-represented in the sample, key recommendations from the study are: availability of easily accessible in-person support for patients; for clinicians to pre-empt potential obstacles by discussing options such as humidification or alternative mask interfaces; the importance of discussing potential benefits in detail with patients; and optimization of secretion management prior to NIV trial.
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Affiliation(s)
- Susan K Baxter
- School of Health and Related Research, University of Sheffield
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