Prospective, Observational Study of Pain and Analgesic Prescribing in Medical Oncology Outpatients With Breast, Colorectal, Lung, or Prostate Cancer

The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 04/2012; 30(16):1980-8. DOI: 10.1200/JCO.2011.39.2381
Source: PubMed

ABSTRACT Pain is prevalent among patients with cancer, yet pain management patterns in outpatient oncology are poorly understood.
A total of 3,123 ambulatory patients with invasive cancer of the breast, prostate, colon/rectum, or lung were enrolled onto this prospective study regardless of phase of care or stage of disease. At initial assessment and 4 to 5 weeks later, patients completed a 25-item measure of pain, functional interference, and other symptoms. Providers recorded analgesic prescribing. The pain management index was calculated to assess treatment adequacy.
Of the 3,023 patients we identified to be at risk for pain, 2,026 (67%) reported having pain or requiring analgesics at initial assessment; of these 2,026 patients, 670 (33%) were receiving inadequate analgesic prescribing. We found no difference in treatment adequacy between the initial and follow-up visits. Multivariable analysis revealed that the odds of a non-Hispanic white patient having inadequate pain treatment were approximately half those of a minority patient after adjusting for other explanatory variables (odds ratio, 0.51; 95% CI, 0.37 to 0.70; P = .002). Other significant predictors of inadequate pain treatment were having a good performance status, being treated at a minority treatment site, and having nonadvanced disease without concurrent treatment.
Most outpatients with common solid tumors must confront issues related to pain and the use of analgesics. There is significant disparity in pain treatment adequacy, with the odds of undertreatment twice as high for minority patients. These findings persist over 1 month of follow-up, highlighting the complexity of these problems.

18 Reads
    • "In particular Virtual Reality has been used during the following procedures or conditions: C h e m o t h e r a p y Frequently reported symptoms associated with cancer chemotherapy are nausea and vomiting (Pickett, 1991; Watson and Marvell, 1993). Other common physical and psychological symptoms associated with chemotherapy include anorexia, fatigue, and anxiety (Watson and Marvell, 1993; Sarna et al., 1993; Basch, 2010; Fisch et al., 2012). Virtual Reality has been introduced during Chemotherapy infusion in order to reduce the experience of acute and chronic symptoms caused both by the often toxic treatments employed in oncology care and by their underlying disease. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Virtual Reality (VR), a computer-generated virtual environment, has been increasingly used in the entertainment world becoming a very new evolving field, but VR technology has also found a variety of applications in the biomedical field. VR can offer to subjects a safe environment within which to carry on different interventions ranging from the rehabilitation of discharged patients directly at home, to the support of hospitalized patients during different procedures and also of oncological inpatient subjects. VR appears as a promising tool for support and monitoring treatments in cancer patients influencing psychological and physiological functions. The aim of this systematic review is to provide an overview of all the studies that used VR intervention on cancer patients and analyze their main findings. Nineteen studies across nearly a thousand articles were identified that explored effects of VR interventions on cancer patients. Although these studies varied greatly in setting and design, this review identified some overarching themes. Results found that VR improved patients' emotional well-being, and diminished cancer related psychological symptoms. The studies explored various relevant variables including different types of settings (i.e. during chemotherapy, during pain procedures, during hospitalization). Here, we point to the need of a global and multi-disciplinary approach aimed at analyzing the effects of VR taking advantage of the new technology systems like bio sensors as well as electroencephalogram monitoring pre-during and after intervention. Devoting more attention to bio physiological variables, standardized procedures, extending duration to longitudinal studies and adjusting for motion sickness related to VR treatment need to become standard of this research field. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cellular Physiology 08/2015; DOI:10.1002/jcp.25117 · 3.84 Impact Factor
  • Source
    • "However, there is still not enough attention being drawn to it. Two studies published in the Journal of Clinical Oncology (JCO) indicated that an appropriate understanding of pain importance, cancer pain evaluation, and correct pain treatment was still lacking [3] [4] . "
    [Show abstract] [Hide abstract]
    ABSTRACT: To improve cancer pain management, the Medical Oncology Department of Sun Yat-sen University Cancer Center (SYSUCC) launched the Good Pain Management (GPM) Ward Program, which has been recognized by the Chinese Ministry of Health (MOH) and promoted throughout the nation. This retrospective case-control study was designed to evaluate the effectiveness of the program. Patients diagnosed with malignant solid tumors with bone metastasis were eligible. Patients who were admitted 6 months before the initiation of theGPM program were used as the control group, and patients admitted 6 months after the initiation of the program were used as the GPM group. The pain-reporting rate and pain management index (PMI) were calculated. The pain levels before and after pain management were compared. A total of 475 patients (244 in the control group and231 in the GPM group) were analyzed. The pain-reporting rate of the GPM group was significantly higher than that of the control group(62.8%vs. 37.7%, P<0.001). The PMI of the GPM group was significantly higher than that of the control group (0.083 vs. -0.261, P<0.001). Therefore, the GPM Ward Program improved the pain management of cancer patients and provided experience for improving cancer pain management in the future.
    Ai zheng = Aizheng = Chinese journal of cancer 05/2014; 33(7). DOI:10.5732/cjc.014.10031 · 2.16 Impact Factor
  • Source
    • "Lack of an analgesic optimization phase prior to study entry, which could potentially have altered results, is a limitation of the current study. However, patients received narcotics with much greater frequency than in community-based samples among populations with similar pain severity [31], suggesting that some of the obstacles to analgesic use (eg, physician failure to recognize pain and patient concerns for addiction) were being well-managed in this patient cohort. Taken together, the results reported here, which are based on contemporary methods and regulatory guidance for PRO assessment, found pain palliation rates were well in excess of those seen in control arms of registration trials in mCRPC, many of which used prednisone in the control arm, rather than placebo. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pain negatively affects quality of life for cancer patients. Preliminary data in metastatic castration-resistant prostate cancer (mCRPC) suggested a benefit of the oral tyrosine kinase inhibitor cabozantinib to pain palliation. Prospective evaluation of cabozantinib's benefits on pain and narcotic use in mCRPC. This was a nonrandomized expansion (NRE) cohort (n=144) of a phase 2 randomized discontinuation trial in docetaxel-refractory mCRPC patients. Pain and interference of symptoms with sleep and general activity were electronically self-reported daily for 7-d intervals at baseline and regularly scheduled throughout the study. Mean per-patient scores were calculated for each interval. Narcotic use was recorded daily during the same intervals. Open-label cabozantinib (100mg or 40mg). The following stringent response definition was used: clinically meaningful pain reduction (≥30% improvement in mean scores from baseline) confirmed at a later interval without concomitant increases in narcotics. Only patients with moderate or severe baseline pain were analyzed. Sixty-five patients with moderate or severe baseline pain were evaluable. Of these, 27 (42%) experienced pain palliation according to the stringent response definition. Thirty-seven patients (57%) had clinically meaningful pain relief at two consecutive intervals, reported ≥6 wk apart in the majority. Forty-four patients (68%) had palliation at one or more intervals; 36 (55%) decreased narcotics use during one or more intervals. Clinically meaningful pain reduction was associated with significant (p ≤ 0.001) improvements in sleep quality and general activity. A limitation of this study was its open-label design. Cabozantinib demonstrated clinically meaningful pain palliation, reduced or eliminated patients' narcotic use, and improved patient functioning, thus meriting prospective validation in phase 3 studies. We evaluated the potential of cabozantinib to improve symptoms in patients with metastatic prostate cancer that no longer responds to standard therapies. We saw a promising reduction in pain and reduced need for narcotic painkillers. Larger, well-controlled trials are necessary to confirm these findings.
    European Urology 02/2014; 67(2). DOI:10.1016/j.eururo.2014.02.013 · 13.94 Impact Factor
Show more