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Adumala A, Palat G, Vajjala A, Brun E, Segerlantz M. Oral Methadone versus Morphine IR for Patients with Cervical Cancer and Neuropathic Pain: A Prospective Randomised Controlled Trial. Indian J Palliat Care 2023; 29:200-206. [PMID: 37325268 PMCID: PMC10261940 DOI: 10.25259/ijpc_58_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/09/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives In India, cervical cancer is the most common cancer among women and makes up for up to 29% of all registered cancer in females. Cancer-related pain is one of the major distressing symptoms for all cancer patients. Pain is characterised as somatic or neuropathic, and the total pain experience is often mixed. Conventional opioids are the backbone of analgesic treatment but are most often not sufficient in alleviating neuropathic pain, common in cervical cancer. Accumulating evidence of the advantage of methadone compared to conventional opioids, due to agonist action at both μ and q opioid receptors, N-methyl-D-aspartate (NMDA) antagonist activity and the ability to inhibit the reuptake of monoamines has been demonstrated. We hypothesised that, with these properties', methadone might be a good option for the treatment of neuropathic pain in patients with cervical cancer. Material and Methods Patients with cervical cancer stages ll-lll were enrolled in this randomized controlled trial. A comparison was made between methadone versus immediate release morphine (IR morphine), with increasing doses until pain was controlled. Inclusion-period was from October 3rd to December 31st 2020, and the total patient-study period was 12 weeks. Pain intensity was assessed according to the Numeric Rating Scale (NRS) and Douleur Neuropathique (DN4). The primary objective was to determine whether methadone was clinically superior versus noninferior to morphine as an analgesic for the treatment of cancer related neuropathic pain in women with cervical cancer. Results A total of 85 women were included; five withdrew and six died during the study period, leaving 74 patients completing the study. All participants showed a reduction in mean values of NRS and DN4 from the time of inclusion and to the end of the study period, for IR morphine and methadone 8.4-2.7 and 8.6-1.5, respectively (P < 0.001). The DN4 score mean reduction for Morphine and Methadone were 6.12-1.37 and 6.05-0, respectively (P < 0.001). Side effects were more common in the group of patients receiving IR morphine compared to the patients treated with methadone. Conclusion We found that Methadone had a superior analgesic effect with good overall tolerability compared with morphine as a first-line strong opioid for the management of cancer-related neuropathic pain.
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Affiliation(s)
- Aruna Adumala
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and RCC, Hyderabad, Telangana, India
| | - Gayatri Palat
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and RCC, Hyderabad, Telangana, India
| | - Archana Vajjala
- Pain Relief and Palliative Care Society, Hyderabad, Telangana, India
| | - Eva Brun
- Department of Clinical Sciences Lund, Oncology, Lund University and Skånes University Hospital, Lund, Sweden
| | - Mikael Segerlantz
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Institute for Palliative Care, Faculty of Medicine, Lund University, Lund, Sweden
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Mulonda JK, Havenga Y, de Villiers M. Healthcare Providers' Perceptions of the Cancer Pain Management Barriers at a Hospital in Zambia: A Qualitative Study. SAGE Open Nurs 2023; 9:23779608231197008. [PMID: 37675152 PMCID: PMC10478529 DOI: 10.1177/23779608231197008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/21/2023] [Accepted: 07/29/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Cancer incidence and mortality are increasing worldwide, and pain is the most common symptom patients experience. Despite developments in cancer pain management and guidelines, the pain often remains undertreated. Effective pain management ultimately involves overcoming several complex institutional, patient, and healthcare provider-related barriers. Objective The objective of the study was to explore and describe healthcare providers' perceptions of the cancer pain management barriers at a hospital in Zambia. Method A descriptive qualitative study was conducted. Data were collected from 10 purposively sampled medical doctors and registered nurses using prepiloted semistructured individual interviews. Interviews were audio recorded and transcribed verbatim. Thematic analysis was done, and trustworthiness was enhanced based on the criteria described by Lincoln and Guba. Ethical principles, as outlined in the Declaration of Helsinki, were adhered to. Results Three themes emerged, namely patient-related barriers (biographic characteristics, patient knowledge and perceptions), healthcare provider-related barriers (knowledge and perceptions and language barriers), and institution-related barriers (resource limitations and lack of standards and guidelines). Healthcare providers' views that cultural beliefs about cancer being caused by witchcraft and the use of traditional medicine and services are barriers to cancer pain management were unique to this study. Conclusion Cancer pain management requires a total pain management approach that addresses the barriers to pain management strategies from a patient, healthcare provider, and institutional perspective. The knowledge deficit among patients and healthcare providers is a barrier to cancer pain management and one of the most common challenges reported in the literature. This study further points toward a need to develop culturally competent healthcare providers.
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Affiliation(s)
- Jennipher Kombe Mulonda
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
| | - Yolanda Havenga
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
| | - Martjie de Villiers
- Adelaide Tambo School of Nursing Science, Tshwane University of Technology, Pretoria, South Africa
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Fernández A, Rodríguez Cardona X, Cardenas Rey CJ, Moreno-Quijano C, Rodriguez Martínez CH. Using a multimodal approach to manage difficult visceral cancer pain: A case study. SAGE Open Med Case Rep 2023; 11:2050313X231157483. [PMID: 36890802 PMCID: PMC9986897 DOI: 10.1177/2050313x231157483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 03/07/2023] Open
Abstract
Difficult visceral cancer pain is defined as pain that does not improve with conventional non-pharmacological and pharmacological strategies, including opioids and adjuvants, and occurs in up to 15% of patients with cancer. In oncological practice, we must be prepared to establish strategies for dealing with such complex cases. Different analgesic strategies have been described in the literature, including managing refractory pain through palliative sedation; however, this might become a dilemma from a clinical and bioethical point of view in end-of-life situations. We present the case of a young male patient with moderately differentiated intestinal-type adenocarcinoma of the left colon, with intra-abdominal sepsis, and for whom despite the multimodal treatment for difficult visceral cancer pain, the pain was refractory leading to palliative sedation. Difficult visceral cancer pain is a pathology that affects the quality of life of patients and is a challenge for pain specialists, for both pharmacological and non-pharmacological management.
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Affiliation(s)
- Angélica Fernández
- Pain Medicine and Palliative Care, Instituto Nacional de Cancerología, Universidad de la Sabana, Bogotá, Colombia
| | - Ximena Rodríguez Cardona
- Pain Medicine and Palliative Care, Instituto Nacional de Cancerología, Universidad de la Sabana, Bogotá, Colombia
| | - Claudia Jimena Cardenas Rey
- Pain Medicine and Palliative Care, Instituto Nacional de Cancerología, Universidad de la Sabana, Bogotá, Colombia
| | - Catalina Moreno-Quijano
- Universidad Industrial de Santander, Bucaramanga, Colombia.,Instituto Nacional de Cancerología, Universidad Militar Nueva Granada, Bogotá, Colombia
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4
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LeBaron VT, Horton BJ, Adhikari A, Chapagain S, Dhakal M, Gongal R, Kattel R, Koirala G, Kutcher A, Hass B, Maurer M, Munday D, Neupane B, Sharma K, Shilpakar R, Shrestha A, Shrestha S, Thapa U, Dillingham R, Paudel BD. A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal. FRONTIERS IN PAIN RESEARCH 2022; 3:910995. [PMID: 35965597 PMCID: PMC9366104 DOI: 10.3389/fpain.2022.910995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionQuality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets.MethodsBuilding on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application (“app”) was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted.ResultsNinety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) “agreed” or “strongly agreed” that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030).ConclusionThe NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context.
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Affiliation(s)
- Virginia T. LeBaron
- University of Virginia School of Nursing, Charlottesville, VA, United States
- *Correspondence: Virginia T. LeBaron
| | - Bethany J. Horton
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Sandhya Chapagain
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Manita Dhakal
- B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal
| | | | - Regina Kattel
- Nepal Cancer Hospital & Research Center, Lalitpur, Nepal
| | | | - Anna Kutcher
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Ben Hass
- Hass Software Consulting, Brooklyn, NY, United States
| | - Martha Maurer
- Sonderegger Research Center, University of Wisconsin School of Pharmacy, Madison, WI, United States
| | - Daniel Munday
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Bijay Neupane
- B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal
| | | | - Ramila Shilpakar
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Amuna Shrestha
- Nepal Cancer Hospital & Research Center, Lalitpur, Nepal
| | - Sudip Shrestha
- Nepal Cancer Hospital & Research Center, Lalitpur, Nepal
| | - Usha Thapa
- B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal
| | - Rebecca Dillingham
- University of Virginia School of Medicine, Charlottesville, VA, United States
- University of Virginia Center for Global Health Equity, Charlottesville, VA, United States
| | - Bishnu D. Paudel
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Zhang L, Ren XY, Huang HX, Huang YM, Huang L, Chen XP, Chen Y, Wang C, Xiao J. Development of the Practice of Pharmaceutical Care for Cancer Pain Management in Outpatient Clinics Using the Delphi Method. Front Pharmacol 2022; 13:840560. [PMID: 35721109 PMCID: PMC9201566 DOI: 10.3389/fphar.2022.840560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: There exists no broad agreement of experts on the practice of pharmaceutical care for cancer pain management in outpatient clinics. Objectives: This study aimed to use the Delphi consensus process to provide expert recommendations on the practice of cancer pain management in outpatient clinics from the point of view of pharmaceutical care in clinical practice and future clinical trials. Methods: A comprehensive literature review was conducted to draft the initial practice. In this process, 30-40 senior experts from various provinces in China were invited to rank the items of practice during the two Delphi consultations. The definitions of consensus included a combination with an average score of ≥4, the percentage of experts rating the scores at >4 points, and the coefficient of variation of the scores. Results: The expert panel comprised 18 pharmacists, 3 anesthesiologists, 6 oncologists, and 9 nurses. As a result of a comprehensive review, 33 items were initially formed. Among them, the consensus was reached for 27 items after the first Delphi round. The other six items and a total of five items for supplementation entered the second round, among which consensus was reached for eight items and three items were excluded. Expert consensus was achieved on 35 items after two rounds of consultation, which involved the collection of patient basic information, comprehensive pain assessment, breakthrough or neuropathic pain assessment, analgesic treatment evaluation, out-of-hospital follow-up, medical records, and evidence-based documents for reference. Conclusion: The final list of 35 items could be used to develop the practice of pharmaceutical care for cancer pain management in outpatient clinics in China. The practice may aid in the standardization of pharmaceutical care for pain, relieve pain to the greatest extent possible, and enhance the level of pain management in China.
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Affiliation(s)
- Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xia-Yang Ren
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hang-Xing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ya-Min Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ling Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Ping Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Yao Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Chen Wang
- Department of Pharmacy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Palat G, Algotsson C, Rayala S, Gebre-Medhin M, Brun E, Segerlantz M. The Introduction and Experiences of Methadone for Treatment of Cancer Pain at a Low-resource Governmental Cancer Center in India. Indian J Palliat Care 2021; 27:382-404. [PMID: 34898933 PMCID: PMC8655673 DOI: 10.25259/ijpc_383_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/04/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives This study aimed to describe the clinical experience of the health-care professionals (HCPs) responsible for the introduction of methadone, for the treatment of complex cancer pain, at a low-resource hospital in India in a patient-group, burdened by illiteracy, and low socio-economic status. Materials and Methods Ten HCPs: Four medical doctors, four nurses, one pharmacist, and one hospital administrator were interviewed. The interviews are examined using a qualitative conventional content analysis. Results The interviews showed a confidence amongst the HCPs, responsible for the safe introduction of methadone in a stressful and low-resource surrounding, to patients with cancer pain and the different aspects of methadone, as initiation, titration, and maintenance of treatment. Conclusion Introduction of methadone for cancer pain management is safe and feasible although low resources in a challenging hospital setting and care environment.
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Affiliation(s)
- Gayatri Palat
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India.,Department of Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India.,Two-Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada
| | | | - Spandana Rayala
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India.,Department of Pain Relief and Palliative Care Society, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Maria Gebre-Medhin
- Department of Clinical Sciences, Oncology, Lund University, Sweden.,Department of Radiotherapy and Radiophysics, Skane University Hospital, Lund, Sweden
| | - Eva Brun
- Department of Clinical Sciences, Oncology, Lund University, Sweden.,Department of Radiotherapy and Radiophysics, Skane University Hospital, Lund, Sweden
| | - Mikael Segerlantz
- Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane, Lund, Sweden.,Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Lund University, Lund, Sweden
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7
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LeBaron V, Adhikari A, Bennett R, Chapagain Acharya S, Dhakal M, Elmore CE, Fitzgibbon K, Gongal R, Kattel R, Koirala G, Maurer M, Munday D, Neupane B, Sagar Sharma K, Shilpakar R, Shrestha S, Thapa U, Zhang H, Dillingham R, Dutta Paudel B. A survey of cancer care institutions in Nepal to inform design of a pain management mobile application. BMC Palliat Care 2021; 20:171. [PMID: 34740339 PMCID: PMC8570036 DOI: 10.1186/s12904-021-00824-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs. OBJECTIVES This research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application ('app') to scale-up implementation of existing locally developed PMG. METHODS We conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app. FINDINGS Surveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39). CONCLUSIONS Smart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | | | - Rachel Bennett
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | | | - Manita Dhakal
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | - Catherine E. Elmore
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | - Kara Fitzgibbon
- University of Virginia Center for Survey Research, Charlottesville, VA USA
| | | | - Regina Kattel
- Nepal Cancer Hospital & Research Center, Kathmandu, Nepal
| | | | - Martha Maurer
- University of Wisconsin School of Pharmacy, Sonderegger Research Center, Madison, WI USA
| | - Daniel Munday
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bijay Neupane
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | | | - Ramila Shilpakar
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Sudip Shrestha
- Nepal Cancer Hospital & Research Center, Kathmandu, Nepal
| | - Usha Thapa
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | - Hexuan Zhang
- University of Virginia Center for Survey Research, Charlottesville, VA USA
| | - Rebecca Dillingham
- University of Virginia Center for Global Health Equity, Charlottesville, VA USA
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Liu Y, Zhang Z, Gong Q, Yang G, Wu Z, Yang Z, Zhao X. Analysis of primary nursing intervention for elderly patients with cancer pain on the improvement of potential risk and pain degree. Am J Transl Res 2021; 13:11890-11898. [PMID: 34786119 PMCID: PMC8581872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/21/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To analyze the effect of primary nursing on the improvement of potential risk and pain degree in elderly patients with cancer pain. METHODS Altogether 187 patients with cancer pain from June 2018 to November 2019 were selected as the research participants and grouped into two groups according to different nursing intervention methods, including 102 cases in the research group (RG) and 85 cases in the control group (CG). The pain relief and medication compliance were evaluated. General Self-efficacy Scale (GSES) and Exercise of Self-Care Agency (ESCA) were used to evaluate the self-efficacy and self-care ability. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to evaluate the anxiety and depression. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. SF-36 Quality of Life Scale was used to evaluate the quality of life. Self-made nursing satisfaction questionnaire was used to evaluate the nursing satisfaction. RESULTS The improvement of pain relief in the RG was evidently higher than that in the CG. The scores of SAS and SDS in the RG after intervention were evidently lower than those in the CG. GSES and ESCA scores of patients in the RG after intervention were evidently higher than those in the CG. The compliance of patients in the RG after intervention was evidently higher than that in the CG. The PSQI scores of patients in the RG after intervention were evidently better than those in the CG. The scores of SF-36 and nursing satisfaction in the RG were evidently higher than those in the CG. CONCLUSION The implementation of primary nursing intervention for elderly patients with cancer pain can effectively relieve their pain and improve their bad psychological state and medication compliance, thus improving patients' quality of life.
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Affiliation(s)
- Ying Liu
- Department of Oncology, Chongqing Hospital of Traditional Chinese MedicineChongqing 400021, China
| | - Ziqi Zhang
- Department of Oncology, Chongqing Hospital of Traditional Chinese MedicineChongqing 400021, China
| | - Qingxia Gong
- Department of Oncology, Chongqing Hospital of Traditional Chinese MedicineChongqing 400021, China
| | - Guangjing Yang
- Department of Nursing, Chongqing Hospital of Traditional Chinese MedicineChongqing 400021, China
| | - Zaimin Wu
- Department of Oncology, Chongqing Hospital of Traditional Chinese MedicineChongqing 400021, China
| | - Zhiyi Yang
- Department of Oncology, Chongqing Hospital of Traditional Chinese MedicineChongqing 400021, China
| | - Xiwei Zhao
- Department of Oncology, Chongqing Hospital of Traditional Chinese MedicineChongqing 400021, China
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9
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Palat G, Algotsson C, Rayala S, Haridass V, Nethagani J, Ahmed M, Rapelli V, Medhin MG, Brun E, Segerlantz M. The Use of Methadone in Adult Patients with Cancer Pain at a Governmental Cancer Center in India. Indian J Palliat Care 2021; 27:139-145. [PMID: 34035632 PMCID: PMC8121220 DOI: 10.4103/ijpc.ijpc_275_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Management of cancer-related pain relies on the access to opioids. When regular opioids as morphine are not tolerated or are insufficient, adjuvant opioids as methadone are an affordable and effective analgesic. Aim: The aim of the project was to describe the pattern of use and clinical experiences of methadone in patients with cancer-related pain at a low-resource hospital in Hyderabad, one of few Indian cancer centers with permission to prescribe methadone. Methods: Medical records of all patients who had been prescribed methadone, September 9, 2017 and November 19, 2019 were studied retrospectively. Data on analgesic treatment and opioid side effects were analyzed. Results: A total of 93 adult cancer patients were included in the study. A majority of patients (79%) were prescribed opioid analgesic, mainly morphine, before methadone introduction. The initial daily dose of methadone ranged between 5 and 22.5 years and in the vast majority of the patients 5 mg, divided in two daily administrations. A good analgesic effect, with decreased pain, was reported in 60% of the patients. No severe side effects were reported. Conclusions: In this study, methadone as a primary opioid was used with a good analgesic effect for cancer pain in a low-resource setting. Indication for methadone was mainly uncontrolled pain with a regular opioid treatment. No severe adverse effects were reported. Further research and prospective studies are needed on methadone treatment in low-resource settings to establish the robust guidelines to support prescribing physicians.
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Affiliation(s)
- Gayatri Palat
- Palliative Access (PAX) Program, MNJ Institute of Oncology and Regional Cancer Centre, Vancouver, British Columbia, Canada.,Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Vancouver, British Columbia, Canada.,Department of Two Worlds Cancer Collaboration-INCTR, Vancouver, British Columbia, Canada
| | | | - Spandana Rayala
- Department of Pediatric Palliative Care, MNJ Institute of Oncology and Regional Cancer Centre, Vancouver, British Columbia, Canada.,Department of Pain Relief and Palliative Care Society, MNJ Institute of Oncology and Regional Cancer Centre, Vancouver, British Columbia, Canada
| | - Vikranth Haridass
- Department of Pain Relief and Palliative Care Society, MNJ Institute of Oncology and Regional Cancer Centre, Vancouver, British Columbia, Canada
| | - Jayalatha Nethagani
- Department of Radiology, MNJ Institute of Oncology and Regional Cancer Centre, Vancouver, British Columbia, Canada
| | - Mustafa Ahmed
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Vancouver, British Columbia, Canada
| | - Vineela Rapelli
- Department of Pain Relief and Palliative Care Society, MNJ Institute of Oncology and Regional Cancer Centre, Vancouver, British Columbia, Canada
| | - Maria Gebre Medhin
- Department of Clinical Sciences, Oncology and Pathology, Faculty of Medicine, Lund UniversitY, Lund, Sweden.,Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Eva Brun
- Department of Clinical Sciences, Oncology and Pathology, Faculty of Medicine, Lund UniversitY, Lund, Sweden.,Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Mikael Segerlantz
- Department of Clinical Sciences, Oncology and Pathology, Institute for Palliative Care, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skane, Region Skane, Lund, Sweden
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Hadzibegovic S, Sikorski P, Potthoff SK, Springer J, Lena A, Anker MS. Clinical problems of patients with cachexia due to chronic illness: a congress report. ESC Heart Fail 2020; 7:3414-3420. [PMID: 33012131 PMCID: PMC7754899 DOI: 10.1002/ehf2.13052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sara Hadzibegovic
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Philipp Sikorski
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Sophia K Potthoff
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Jochen Springer
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Alessia Lena
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité - Campus Virchow Klinikum (CVK), Berlin, Germany.,Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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Laser-photobiomodulation on experimental cancer pain model in Walker Tumor-256. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 210:111979. [PMID: 32738748 DOI: 10.1016/j.jphotobiol.2020.111979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT Cancer Pain is considered a common and significant clinical problem in malignant neoplasms, comprising 20% to 50% of all patients with tumor progression. Laser photobiomodulation (L-PBM) has been used in a multitude of pain events, ranging from acute trauma to chronic articular. However, L-PBM has never been tested in cancer pain. OBJECTIVES Evaluate hyperalgesia, edema, COX-1, COX-2, IL-10, and Bdkrb1 mRNA in low-level laser irradiated Walker-256 tumor-bearing rats. METHODS Rat hind paw injected with Walker Tumor-256 (W-256) and divided into six groups of 6 rats: G1 (control) - W-256 injected, G2- W-256 + Nimesulide, G3- W-256 + 1 J, G4- W-256 + 3 Jand G5- W256 + 6 J. Laser parameters: λ = 660 nm, 3.57 W/cm2, Ø = 0.028 cm2. Mechanical hyperalgesia was evaluated by Randall-Selitto test. Plethysmography measured edema; mRNA levels of COX-1, COX-2, IL-10, and Bdkrb1were analyzed. RESULTS It was found that the W-256 + 1 J group showed a decrease in paw edema, a significant reduction in pain threshold. Higher levels of IL-10 and lower levels of COX-2 and Bdkrb1 were observed. CONCLUSION Results suggest that 1 J L-PBM reduced the expression of COX-2 and Bdkrb1 and increasing IL-10 gene expression, promoting analgesia to close levels to nimesulide.
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Lovo EE, Campos FJ, Caceros VE, Minervini M, Cruz CB, Arias JC, Reyes WA. Automated Stereotactic Gamma Ray Radiosurgery to the Pituitary Gland in Terminally Ill Cancer Patients with Opioid Refractory Pain. Cureus 2019; 11:e4811. [PMID: 31403008 PMCID: PMC6682389 DOI: 10.7759/cureus.4811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction We report our initial series of terminally ill cancer patients treated with radiosurgery to the pituitary gland to alleviate pain. Methods A fully automated rotating gamma ray unit was used to deliver a high dose of radiation (150Gy) using an 8 mm collimator to the neurohypophysis in 11 patients suffering from opioid-refractory pain deriving from cancer. Results From November 2016 to November 2018, 11 patients were treated, and 10 were eligible for follow-up evaluation. Pain from bone metastases was present in 70%; others suffered from neuropathic and visceral pain. The median survival was 119.7 days (range: 32 to 370). The visual analogue scale (VAS) was nine (7-10) and standardized to 10; eight patients (80%) responded. The average VAS at the time of response was three (range: 1-6), and the average time to response was 2.8 days (range: 2-5). In the first week, 40% of the patients categorized the result as 'excellent', 30% deemed the result 'good', and 20% reported the result as 'poor'. One patient (10%) referred to the result as 'regular'. Those who responded were able to reduce their medications by at least 25%. The one-month average VAS score was five (range: 1-6), 60% reported a 'good' effect, 20% reported 'excellent' results, and 20% had no response. Of the study participants, 60% maintained their level of medicine consumption at lower than baseline. At the end of life, five patients (50%) presented substantial pain, two (20%) never had a therapeutic effect, and three (30%) died without substantial pain. There were no clinical complications that could be attributed directly to the treatment. Conclusion Radiosurgery to the pituitary gland is effective and safe and warrants further investigation to understand its potential role in palliative care in cancer patients.
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Affiliation(s)
- Eduardo E Lovo
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Fidel J Campos
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Victor E Caceros
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Mario Minervini
- Neurosurgery, International Cancer Center, San Salvador, SLV
| | - Claudia B Cruz
- Pain Management, International Cancer Center, San Salvador, SLV
| | - Juan C Arias
- Pallative Care, International Cancer Center, San Salvador, SLV
| | - William A Reyes
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
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