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Objective:
The World Health Organization's (WHO) guidelines for cancer pain management were intentionally made simple in order to be widely implemented by all physicians treating cancer patients. Referrals to pain specialists are advised if pain does not improve within a short time. The present study examined whether or not a reasonable use of the...
Context in source publication
Context 1
... The magnitude and severity of the problem was the main reason for the development of the World Health Organization's (WHO) guideline for cancer pain management. 5 A principal concept of the WHO guideline, the "three steps analgesic ladder," refers to the pharmacological management of cancer-related pain (Fig- ure 1). It emphasizes matching the strength of the analgesic drug to the intensity of the reported pain, so that non-opioid analgesics are administered for mild pain intensity, "weak" opioids for moderate pain, and "strong" opioids for severe pain. ...
Citations
... Alternatively, establishing healthcare centers that bring together multiple medical specialties, also known as pain clinics, can help improve coordination and treatment. However, because of the scarce availability of such centers, attempts are often made to optimize analgesic treatment based on the WHO's guidelines prior to referring patients to pain specialists [26]. Lastly, another proposal is the creation of a multidisciplinary oncological committee to assess pain treatment efficacy for each patient, making sure that the pain-relief strategy is the appropriate to their needs throughout their evolution, assuming the obligation to indicate and propose a change when necessary. ...
A consensus is needed among healthcare professionals involved in easing oncological pain in patients who are suitable candidates for intrathecal therapy. A Delphi consultation was conducted, guided by a multidisciplinary scientific committee. The 18-item study questionnaire was designed based on a literature review together with a discussion group. The first-round questionnaire assessed experts’ opinion of the current general practice, as well as their recommendation and treatment feasibility in the near future (2–3-year period) using a 9-point Likert scale. Items for which consensus was not achieved were included in a second round. Consensus was defined as ≥75% agreement (1–3 or 7–9). A total of 67 panelists (response rate: 63.2%) and 62 (92.5%) answered the first and second Delphi rounds, respectively. The participants were healthcare professionals from multiple medical disciplines who had an average of 17.6 (7.8) years of professional experience. A consensus was achieved on the recommendations (100%). The actions considered feasible to implement in the short term included effective multidisciplinary coordination, improvement in communication among the parties, and an assessment of patient satisfaction. Efforts should focus on overcoming the barriers identified, eventually leading to the provision of more comprehensive care and consideration of the patient’s perspective.
... 1,5,27 The presence of moderate to severe pain among more than a quarter (27.5%) in the current study suggests that pain in this population is also undertreated, indicating the need for better cancer pain assessment, evidence-based pain treatment recommendations, and referrals for individuals for pain management. [28][29][30] Previous studies have reported that individuals from underserved populations are less likely to receive treatment for cancer pain. [31][32][33] Additional research is needed to better understand how assessment, reporting, and treatment of pain differ by race and/or ethnicity, socioeconomic status, cancer type, and treatment modality and how pain severity in these populations may affect employment and financial outcomes. ...
Purpose:
Although pain is a frequently reported symptom among individuals with cancer, there is limited information on the impact of pain on employment or financial outcomes. This study used nationally representative data to examine the role of pain levels on employment and financial outcomes.
Methods:
We used data from the 2016-2017 Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement to identify 1,213 adults diagnosed with cancer. Multivariable logistic regression analyses were used to examine association of pain levels and self-reported employment and financial outcomes.
Results:
Approximately 43% of adults with a cancer history reported no pain, 29% mild pain, 18% moderate pain, and 10% severe pain over the past 7 days. Compared with those reporting no pain, individuals reporting any pain had significantly increased likelihood of adverse employment outcomes including early retirement, feeling less productive, and staying at a job because of concerns about losing insurance. Individuals with any pain (compared with no pain) also had significantly increased likelihood of adverse financial outcomes including borrowing money or going into debt, inability to cover medical costs, and worrying about paying medical bills. For both employment and financial outcomes, there were dose-response relationships, with worse outcomes generally associated with greater pain levels.
Conclusion:
Pain is frequently associated with adverse employment and financial outcomes among cancer survivors, and greater pain is associated with worse outcomes. Better assessment of pain severity among survivors and implementation of strategies to assist with employment and financial objectives may be important steps to enhance patient-centered care.
Context
Recent years show a sharp increase in research on opioid use among cancer survivors, but evidence syntheses are lacking, leaving knowledge gaps. Corresponding research needs are unclear.
Objectives
To provide an evidence synthesis.
Methods
We searched PubMed and Embase, identifying articles related to cancer and opioid prescribing/use published through September 2020. We screened resulting titles/abstracts. Relevant studies underwent full-text review. Inclusion criteria were quantitative examination of and primary focus on opioid prescribing or use, and explicit inclusion of cancer survivors. Exclusion criteria included end-of-life opioid use and opioid use as a secondary or downstream outcome (for intervention studies). We extracted information on the opioid-related outcome(s) examined (including definitions and terminology used), study design, and methods.
Results
Research returned 16,591 articles; 296 were included. Only 22/296 studies evaluated an intervention. There were 105 studies evaluating outcomes indicative of potentially high-risk, non-recommended, or avoidable opioid use, e.g., continuous use—described as chronic use, prolonged use, and persistent use (n=17); use after completion of curative-intent treatment—described as chronic opioid use, long-term opioid use, persistent opioid use, prolonged opioid use, continued opioid use, late opioid use, post-treatment opioid use (n=27); use of opioids concurrent with other potentially high-risk medications (n=13), and opioid misuse (n=14).
Conclusions
We found lack of consistency in the measurement of and terms used to describe similar opioid use outcomes, and a lack of interventional research targeting well-documented patterns of potentially non-recommended, potentially avoidable, or potentially high-risk opioid prescribing or use.
