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Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R. Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:148-156. [PMID: 38087705 DOI: 10.1016/j.clon.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - S Baker
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - G Arbour
- University of British Columbia, British Columbia, Canada
| | - K Stefanyk
- University of British Columbia, British Columbia, Canada
| | - W Jiang
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, British Columbia, Canada; BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Ho
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada.
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Alhajri N, Boudreau SA, Mouraux A, Graven-Nielsen T. Pain-free default mode network connectivity contributes to tonic experimental pain intensity beyond the role of negative mood and other pain-related factors. Eur J Pain 2023; 27:995-1005. [PMID: 37255228 DOI: 10.1002/ejp.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Alterations in the default mode network (DMN) connectivity across pain stages suggest a possible DMN involvement in the transition to persistent pain. AIM This study examined whether pain-free DMN connectivity at lower alpha oscillations (8-10 Hz) accounts for a unique variation in experimental peak pain intensity beyond the contribution of factors known to influence pain intensity. METHODS Pain-free DMN connectivity was measured with electroencephalography prior to 1 h of capsaicin-evoked pain using a topical capsaicin patch on the right forearm. Pain intensity was assessed on a (0-10) numerical rating scale and the association between peak pain intensity and baseline measurements was examined using hierarchical multiple regression in 52 healthy volunteers (26 women). The baseline measurements consisted of catastrophizing (helplessness, rumination, magnification), vigilance, depression, negative and positive affect, sex, age, sleep, fatigue, thermal and mechanical pain thresholds and DMN connectivity (medial prefrontal cortex [mPFC]-posterior cingulate cortex [PCC], mPFC-right angular gyrus [rAG], mPFC-left Angular gyrus [lAG], rAG-mPFC and rAG-PCC). RESULTS Pain-free DMN connectivity increased the explained variance in peak pain intensity beyond the contribution of other factors (ΔR2 = 0.10, p = 0.003), with the final model explaining 66% of the variation (R2 = 0.66, ANOVA: p < 0.001). In this model, negative affect (β = 0.51, p < 0.001), helplessness (β = 0.49, p = 0.007), pain-free mPFC-lAG connectivity (β = 0.36, p = 0.003) and depression (β = -0.39, p = 0.009) correlated significantly with peak pain intensity. Interestingly, negative affect and depression, albeit both being negative mood indices, showed opposing relationships with peak pain intensity. CONCLUSIONS This work suggests that pain-free mPFC-lAG connectivity (at lower alpha) may contribute to individual variations in pain-related vulnerability. SIGNIFICANCE These findings could potentially lead the way for investigations in which DMN connectivity is used in identifying individuals more likely to develop chronic pain.
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Affiliation(s)
- Najah Alhajri
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Shellie Ann Boudreau
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - André Mouraux
- Institute of Neuroscience (IONS), Université catholique de Louvain, Brussels, Belgium
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Hasan SB, Gendra R, James J, Morris D, Orenstein LAV, Ingram JR. Pain measurement in painful skin conditions and rheumatoid arthritis randomized controlled trials: a scoping review to inform pain measurement in hidradenitis suppurativa. Br J Dermatol 2022; 187:846-854. [PMID: 35962565 PMCID: PMC10087046 DOI: 10.1111/bjd.21821] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pain is the most common and bothersome symptom experienced by people with hidradenitis suppurativa (HS) and has been prioritized as an outcome domain by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). OBJECTIVES To perform a scoping review of pain measurement in randomized control trials (RCTs) of painful skin conditions (PSCs) and use of the pain numerical rating scale (NRS) and visual analogue scale (VAS) in rheumatoid arthritis RCTs, to inform the efforts of HISTORIC to reach consensus on how to measure pain intensity in HS trials. METHODS A search was conducted on several publication databases. Inclusion criteria were RCTs with a minimum of 10 participants that measured pain intensity. RESULTS Pain NRS and VAS were used in 68% of PSC trials. Respectively, 77% and 87% of PSC and rheumatoid arthritis RCTs did not specify the recall window. The commonest recall window in PSCs when specified was 24 h. In total, 33% of PSC trials assessed maximum pain intensity and 3% average pain intensity, while 87% of rheumatoid arthritis trials did not provide details. Pain data were reported as mean difference by 76% of PSC trials and 75% of rheumatoid arthritis trials. Respectively, 10% and 11% of PSC and rheumatoid arthritis studies reported pain as the percentage of patients reaching a desirable state and only 1% and 2% reported number needed to treat. CONCLUSIONS While pain NRS and VAS are standard methods to measure pain intensity in PSCs, key details such as the recall window are often omitted and there is no consensus on how to report pain NRS data. What is already known about this topic? Pain is the most burdensome symptom experienced by patients with hidradenitis suppurativa and has been prioritized as an outcome domain by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). What does this study add? Our review shows substantial variation in how pain numerical rating scale (NRS) and visual analogue scale are utilized in clinical trials. This variation restricts meta-analysis of pain intensity results. There is a need for consensus regarding the recall window for pain NRS and maximum vs. average pain, and whether current pain should be measured.
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Affiliation(s)
- Samar B Hasan
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Riham Gendra
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | | | - Delyth Morris
- University Library Service, Cardiff University, Cardiff, UK
| | | | - John R Ingram
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
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Jacobson G, Fluss R, Dany-BenShushan A, Golan T, Meron T, Zimmermann C, Dawson LA, Barry A, Miszczyk M, Buckstein M, Diaz Pardo D, Aguiar A, Hammer L, Dicker AP, Ben-Ailan M, Morag O, Hausner D, Symon Z, Lawrence YR. Coeliac plexus radiosurgery for pain management in patients with advanced cancer : study protocol for a phase II clinical trial. BMJ Open 2022; 12:e050169. [PMID: 35332036 PMCID: PMC8948399 DOI: 10.1136/bmjopen-2021-050169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pancreatic cancer is characterised by severe mid-back and epigastric pain caused by tumour invasion of the coeliac nerve plexus. This pain is often poorly managed with standard treatments. This clinical trial investigates a novel approach in which high-dose radiation (radiosurgery) is targeted to the retroperitoneal coeliac plexus nerve bundle. Preliminary results from a single institution pilot trial are promising: pain relief is substantial and side effects minimal. The goals of this study are to validate these findings in an international multisetting, and investigate the impact on quality of life and functional status among patients with terminal cancer. METHODS AND ANALYSIS A single-arm prospective phase II clinical trial. Eligible patients are required to have severe coeliac pain of at least five on the 11-point BPI average pain scale and Eastern Cooperative Oncology Group performance status of two or better. Non-pancreatic cancers invading the coeliac plexus are also eligible. The intervention involves irradiating the coeliac plexus using a single fraction of 25 Gy. The primary endpoint is the complete or partial pain response at 3 weeks. Secondary endpoints include pain at 6 weeks, analgesic use, hope, qualitative of life, caregiver burden and functional outcomes, all measured using validated instruments. The protocol is expected to open at a number of cancer centres across the globe, and a quality assurance programme is included. The protocol requires that 90 evaluable patients" be accrued, based upon the assumption that a third of patients are non-evaluable (e.g. due to death prior to 3-weeks post-treatment assessment, or spontaneous improvement of pain pre-treatment), it is estimated that a total of 120 patients will need to be accrued. Supported by Gateway for Cancer Research and the Israel Cancer Association. ETHICS AND DISSEMINATION Ethic approval for this study has been obtained at eight academic medical centres located across the Middle East, North America and Europe. Results will be disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03323489.
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Affiliation(s)
- Galia Jacobson
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ronen Fluss
- Gertner Institute, Sheba Mediacal Center, Tel Hashomer, Tel Aviv, Israel
| | - Amira Dany-BenShushan
- Israeli Center for Cardiovascular Research, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Talia Golan
- Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Sackler School of Medicine, Tel aviv University, Tel Aviv, Israel
| | - Tikva Meron
- Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura A Dawson
- Radiation Oncology, Princess Margaret Hospital Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aisling Barry
- Radiation Oncology, Princess Margaret Hospital Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dayssy Diaz Pardo
- Department of Radiation Oncology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Artur Aguiar
- Radiation Oncology, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Liat Hammer
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Radiatin Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam P Dicker
- Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maoz Ben-Ailan
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Ofir Morag
- Cancer Pain Unit, Institute of Oncology, Sheba Medical Center, Tel Aviv, Israel
| | - David Hausner
- Cancer Center, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Zvi Symon
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Sackler School of Medicine, Tel aviv University, Tel Aviv, Israel
| | - Yaacov R Lawrence
- Radiation Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Sackler School of Medicine, Tel aviv University, Tel Aviv, Israel
- Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Pain Experiences and Coping Strategies in Rural Older Adults With Chronic Musculoskeletal Pain in Mountainous Areas of Taiwan. Pain Manag Nurs 2021; 23:524-531. [PMID: 34538729 DOI: 10.1016/j.pmn.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although rural communities are home to a higher proportion of older residents, they provide fewer healthcare services than do urban core communities. Chronic musculoskeletal (MSK) pain is often associated with reduced daily activity and quality of life in older adults, particularly those in rural areas. AIMS This study investigated the pain experiences and coping strategies in rural older adults with MSK pain in Taiwan. METHODS A structured questionnaire was used to collect data from rural older adults with chronic MSK pain in mountainous areas of Taiwan. RESULTS In total, 55 rural older adults were enrolled in this study. The most common pain sites were the low back and knees. The main cause of pain was osteoarthritis. Three quarters of the participants suffered from moderate to severe chronic MSK pain on average. The results revealed that behavioral strategies were used more often than cognitive strategies. Regarding behavioral strategies, the most common non-pharmacologic and pharmacologic pain coping strategies were to rest and to take Chinese medicine, respectively. The most common cognitive strategy for pain coping was to talk to others. CONCLUSIONS The findings suggested that pain management for chronic MSK pain in rural older adults was inadequate in mountainous areas of Taiwan. Most rural older adults used multiple coping strategies to deal with their pain, and behavioral strategies were favored over cognitive strategies.
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Hoffman HG, Patterson DR, Rodriguez RA, Peña R, Beck W, Meyer WJ. Virtual Reality Analgesia for Children With Large Severe Burn Wounds During Burn Wound Debridement. FRONTIERS IN VIRTUAL REALITY 2020; 1:602299. [PMID: 33585833 PMCID: PMC7880045 DOI: 10.3389/frvir.2020.602299] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The objective of this study was to compare the effect of adjunctive virtual reality vs. standard analgesic pain medications during burn wound cleaning/debridement. Participants were predominantly Hispanic children aged 6-17 years of age, with large severe burn injuries (TBSA = 44%) reporting moderate or higher baseline pain during burn wound care. Using a randomized between-groups design, participants were randomly assigned to one of two groups, (a) the Control Group = pain medications only or (b) the VR Group = pain medications + virtual reality. A total of 50 children (88% Hispanic) with large severe burns (mean TBSA > 10%) received severe burn wound cleaning sessions. For the primary outcome measure of worst pain (intensity) on Study Day 1, using a between groups ANOVA, burn injured children in the group that received virtual reality during wound care showed significantly less pain intensity than the No VR control group, [mean worst pain ratings for the No VR group = 7.46 (SD = 2.93) vs. 5.54 (SD = 3.56), F (1,48) = 4.29, <0.05, MSE = 46.00]. Similarly, one of the secondary pain measures, "lowest pain during wound care" was significantly lower in the VR group, No VR = 4.29 (SD = 3.75) vs. 1.68 (2.04) for the VR group, F(147) = 9.29, < 0.005, MSE = 83.52 for Study Day 1. The other secondary pain measures showed the predicted pattern on Study Day 1, but were non-significant. Regarding whether VR reduced pain beyond Study Day 1, absolute change in pain intensity (analgesia = baseline pain minus the mean of the worst pain scores on Study days 1-10) was significantly greater for the VR group, F (148) = 4.88, p < 0.05, MSE = 34.26, partial eta squared = 0.09, but contrary to predictions, absolute change scores were non-significant for all secondary measures.
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Affiliation(s)
- Hunter G. Hoffman
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, WA, United States
- Department of Psychology, University of Washington, Washington, ME, United States
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - David R. Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Robert A. Rodriguez
- University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Shriners Hospitals for Children Galveston, Galveston, TX, United States
| | - Raquel Peña
- University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Shriners Hospitals for Children Galveston, Galveston, TX, United States
| | - Wanda Beck
- Shriners Hospitals for Children Galveston, Galveston, TX, United States
| | - Walter J. Meyer
- Department of Radiology, University of Washington, Seattle, WA, United States
- University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Shriners Hospitals for Children Galveston, Galveston, TX, United States
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Schneider S, Junghaenel DU, Broderick JE, Ono M, May M, Stone AA. II. Indices of Pain Intensity Derived From Ecological Momentary Assessments and Their Relationships With Patient Functioning: An Individual Patient Data Meta-analysis. THE JOURNAL OF PAIN 2020; 22:371-385. [PMID: 33203516 DOI: 10.1016/j.jpain.2020.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pain intensity is a complex and dynamic experience. A focus on assessing patients' average pain levels may miss important aspects of pain that impact functioning in daily life. In this second of 3 articles investigating alternative indices of pain intensity derived from Ecological Momentary Assessments (EMA), we examine the indices' associations with physical and psychosocial functioning. EMA data from 10 studies (2,660 patients) were reanalyzed to construct indices of Average Pain, Maximum Pain, Minimum Pain, Pain Variability, Time in High Pain, Time in Low Pain, Pain after Wake-up. Three sets of individual patient data meta-analyses examined 1) the test-retest reliability of the pain indices, 2) their convergent validity in relation to physical functioning, fatigue, depression, mental health, and social functioning, and 3) the incremental validity of alternative indices above Average Pain. Reliabilities approaching or exceeding a level of .7 were observed for all indices, and most correlated significantly with all functioning domains, with small to medium effect sizes. Controlling for Average Pain, Maximum Pain and Pain Variability uniquely predicted all functioning measures, and Time in High Pain predicted physical and social functioning. We suggest that alternative pain indices can provide new perspectives for understanding functioning in chronic pain. PERSPECTIVE: Alternative summary measures of pain intensity derived from EMA have the potential to help better understand patients' pain experience. Utilizing EMA for the assessment of Maximum Pain, Pain Variability, and Time in High Pain may provide an enhanced window into the relationships between pain and patients' physical and psychosocial functioning.
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Affiliation(s)
- Stefan Schneider
- Dornsife Center for Self-Report Science, University of Southern California, California.
| | - Doerte U Junghaenel
- Dornsife Center for Self-Report Science, University of Southern California, California
| | - Joan E Broderick
- Dornsife Center for Self-Report Science, University of Southern California, California
| | - Masakatsu Ono
- Dornsife Center for Self-Report Science, University of Southern California, California
| | - Marcella May
- Dornsife Center for Self-Report Science, University of Southern California, California
| | - Arthur A Stone
- Dornsife Center for Self-Report Science, University of Southern California, California; Deparment of Psychology, University of Southern California, California
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Saito T, Nakamura N, Murotani K, Shikama N, Takahashi T, Yorozu A, Heianna J, Kubota H, Tomitaka E, Toya R, Yamaguchi K, Oya N. Index and Nonindex Pain Endpoints in Radiation Therapy for Painful Tumors: A Secondary Analysis of a Prospective Observational Study. Adv Radiat Oncol 2020; 5:1118-1125. [PMID: 33305072 PMCID: PMC7718541 DOI: 10.1016/j.adro.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose Improving pain interference in daily activities, rather than mere pain reduction, is a desirable endpoint for palliative radiation therapy. The association between pain response and pain interference has been studied almost exclusively in patients with painful bone metastases (PBMs), whereas nonindex pain has scarcely been explored in palliative radiation therapy. We investigated whether index and nonindex pain endpoints are associated with pain interference changes in patients with both PBMs and painful non-bone-metastasis tumors (PNTs). Methods and Materials Brief pain inventory data collected at baseline and at 2 months post-treatment were used to calculate differences in pain interference scores. Pain response in terms of the index pain was assessed using the international consensus endpoint. Patients were diagnosed with predominance of other pain (POP) if nonindex pain of malignant or unknown origin was present and had a greater pain score than the index pain. Results Of 302 patients, 127 (42%) had PBMs and 175 (58%) had PNTs. The median pain interference score, which is based on the mean of the 7 subscale items, decreased to a greater extent among responders than among nonresponders (PBM group: –3.43 vs –0.57 [P = .005]; PNT group: –2.43 vs –0.29 [P < .001]). Moreover, patients without POP experienced a greater reduction in their median pain interference score than did those with POP (PBM group: –2.71 vs +0.43 [P = .004]; PNT group: –2.00 vs +1.57 [P = .007]). The Jonckheere-Terpstra test showed a significant trend across 4 pain response categories in patients with PBMs and those with PNTs (P < .001 for both). Conclusions The index and nonindex pain endpoints were positively and negatively associated with improvement in pain interference, respectively. There was no apparent difference between patients with PBMs and PNTs in terms of the associations of these endpoints with pain interference.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
- Department of Radiation Oncology, Hitoyoshi Medical Center, Hitoyoshi, Japan
- Graduate School of Medicine, Kurume University, Fukuoka, Japan
- Corresponding author: Tetsuo Saito, MD, PhD
| | - Naoki Nakamura
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Joichi Heianna
- Department of Radiology, Graduate School of Medical Science University of The Ryukyus, Okinawa, Japan
| | - Hikaru Kubota
- Department of Radiation Oncology, Kobe University Hospital, Hyogo, Japan
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Kohsei Yamaguchi
- Department of Radiology, Amakusa Central Hospital, Amakusa, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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9
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McGrath C, Chang L, Dennis K. Exploring the nausea experience among female patients with breast cancer; A pilot interview study. Tech Innov Patient Support Radiat Oncol 2020; 15:22-28. [PMID: 32904172 PMCID: PMC7451752 DOI: 10.1016/j.tipsro.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 02/08/2023] Open
Abstract
Nausea is a complicated symptom to report and measure in clinical trials. Better understanding the nausea experience will improve clinical trial designs. Patients have preferences for symptom definitions and nausea grading scales. Patients experience different intensities of nausea. Describing nausea sub-features like duration, timing and character is difficult.
Introduction Nausea is a difficult symptom to report and measure in clinical trials. We conducted a pilot interview study to improve our understanding of the nausea experience. Materials and methods Female patients with breast cancer that had experienced nausea during radiation therapy and/or chemotherapy underwent semi-structured interviews that focused on patient-defined and standard definitions, preferences for nausea grading scales, and nausea sub-features: intensity, location, timing/duration, character, associated symptoms, precipitating/alleviating factors, impact on quality of life. Results 10 patients were interviewed. Patients defined nausea more variably than vomiting and retching/dry heaving. An ordinal grading scale with a 0–10 intensity range was preferred over visual-analogue and qualitative scales. Patients had experienced different intensities of nausea and deemed reporting their worst, average and least intensities feasible. High-intensity episodes were deemed more problematic than low-intensity episodes regardless of their duration. The duration and character of nausea were difficult to describe. A range of associated symptoms, precipitating and alleviating factors were documented. Nausea had a detrimental impact on quality of life. Conclusions Nausea has a range of subjective and objective features. Our pilot study provided valuable information that will inform the design of a planned larger survey study. Creating an operational clinical trial definition for nausea appears feasible.
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Affiliation(s)
- Clare McGrath
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | - Lynn Chang
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
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10
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Saito T, Shikama N, Yorozu A, Kubota H, Murotani K, Yamaguchi K, Oya N, Nakamura N. Inconsistencies in assessment of pain endpoints in radiotherapy for painful tumors: Analysis of original articles in the Green and Red Journals. Clin Transl Radiat Oncol 2020; 24:111-115. [PMID: 32760815 PMCID: PMC7393456 DOI: 10.1016/j.ctro.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/05/2022] Open
Abstract
The frequency of use of the ICT has risen in research for PBMs. The frequency of the ICT use has been considerably limited for PNTs. None of the journal articles had investigated non-index pain.
Background and purpose Consistent assessment of the pain response is essential for adequately comparing treatment efficacy between studies. We studied the assessment of pain endpoints in radiotherapy for painful bone metastases (PBMs) and painful non-bone-metastasis tumors (PNTs). Material and methods We performed a literature search in the Green (Radiotherapy and Oncology) and Red (International Journal of Radiation Oncology * Biology * Physics) Journals for full-length original articles published between 2009 and 2018. We only included articles that assessed palliation of tumor-related pain after radiotherapy. The data obtained included the definitions of pain response and assessment of non-index pain (pain other than that related to the irradiated tumors). Results Among the 1812 articles identified using the journals’ search function, 60 were included in the analysis. Thirty percent of the PBM articles and approximately half of the PNT articles did not report on analgesic use. Among the prospective studies, 68% of the articles on PBMs and 10% of the articles on PNTs used the International Consensus Endpoint. The PBM articles published in 2014–2018 utilized the International Consensus Endpoint more frequently than those published in 2009–2013 (p = 0.049). No articles reported information on non-index pain. Conclusions After the initial publication of the International Consensus Endpoint, the frequency of its use appears to have risen in PBM research; however, its use in PNT studies has been considerably limited. The International Consensus Endpoint should be consistently utilized in future studies on radiotherapy for painful tumors. Since none of the journal articles had investigated non-index pain, this issue may also needs to be addressed.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.,Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hikaru Kubota
- Department of Radiation Oncology, Kobe University Hospital, Hyogo, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Kohsei Yamaguchi
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Naoki Nakamura
- Department of Radiology, St. Marianna University Hospital, Kawasaki, Japan
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11
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MacLeod K, Laird BJA, Carragher NO, Hoskin P, Fallon MT, Sande TA. Predicting Response to Radiotherapy in Cancer-Induced Bone Pain: Cytokines as a Potential Biomarker? Clin Oncol (R Coll Radiol) 2020; 32:e203-e208. [PMID: 32284199 DOI: 10.1016/j.clon.2020.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 11/27/2022]
Abstract
AIMS Radiotherapy (XRT) for cancer-induced bone pain (CIBP) has varying levels of efficacy. A biomarker that predicts likely efficacy could stratify XRT to those most likely to benefit. No biomarker is used in clinical practice, but potential candidate cytokines have been identified. The aim of the present study was to examine the relationship between candidate cytokines and analgesic response after XRT. MATERIALS AND METHODS An exploratory analysis was undertaken on biobank data from patients who had received single fraction (8 Gy) XRT for CIBP. The biobank data were prospectively collected from multiple centres in the UK as part of a larger clinical trial, which had institutional review board approval and all patients provided written informed consent for the use of their data in future research. Phenotypic data, pain assessments as well as plasma samples were collected at baseline (within the 24 h before the XRT) and at follow-up (4 weeks after XRT). Baseline and follow-up samples were analysed and levels of 16 pre-identified cytokines were compared in patients classified as XRT 'responders' or 'non-responders'. RESULTS Data from 60 patients were analysed. Insulin-like growth factor binding protein 9 (NOV/CCN3/IGFBP-9) and interleukin-1ß (IL-1ß) were identified as potential predictors of response to XRT. A significant relationship was shown between the response to XRT and the ratio of the median level of NOV/CCN3/IGFBP-9 at baseline:follow-up (P = 0.024). Furthermore, for the patients up to 64 years of age, the median level of NOV/CCN3/IGFBP-9 was significantly different between responders and non-responders (P = 0.047). For IL-1ß, the median level was significantly different between responders and non-responders in patients with breast cancer (P = 0.006). CONCLUSION Although the present findings do not identify robust biomarkers, this is the first such study to examine the role of cytokines in predicting response to XRT in patients with CIBP, and studies that build on these findings are encouraged.
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Affiliation(s)
- K MacLeod
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - B J A Laird
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - N O Carragher
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - P Hoskin
- Department of Oncology, Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, UK
| | - M T Fallon
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - T A Sande
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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12
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Suso-Ribera C, Martínez-Borba V, Martín-Brufau R, Suso-Vergara S, García-Palacios A. Individual differences and health in chronic pain: are sex-differences relevant? Health Qual Life Outcomes 2019; 17:128. [PMID: 31331336 PMCID: PMC6647055 DOI: 10.1186/s12955-019-1182-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background Because psychological variables are known to intercorrelate, the goal of this investigation was to compare the unique association between several well-established psychological constructs in pain research and pain-related outcomes. Sex differences are considered because pain is experienced differently across sex groups. Methods Participants were 456 consecutive chronic pain patients attending a tertiary pain clinic (mean age = 58.4 years, SD = 14.8, 63.6% women). The study design was cross-sectional. Psychological constructs included personality (NEO-Five Factor Inventory), irrational thinking (General Attitudes and Beliefs Scale), and coping (Social Problem Solving Inventory). Outcomes were pain severity and interference (Brief Pain Inventory) and physical, general, and mental health status (Short Form-36). To decide whether the bivariate analyses and the two-block, multivariate linear regressions for each study outcome (block 1 = age, sex, and pain severity; block 2 = psychological variables) should be conducted with the whole sample or split by sex, we first explored whether sex moderated the relationship between psychological variables and outcomes. An alpha level of 0.001 was set to reduce the risk of type I errors due to multiple comparisons. Results The moderation analyses indicated no sex differences in the association between psychological variables and study outcomes (all interaction terms p > .05). Thus, further analyses were calculated with the whole sample. Specifically, the bivariate analyses revealed that psychological constructs were intercorrelated in the expected direction and mostly correlated with mental health and overall perceived health status. In the regressions, when controlling for age, sex, and pain severity, psychological factors as a block significantly increased the explained variance of physical functioning (ΔR2 = .037, p < .001), general health (ΔR2 = .138, p < .001), and mental health (ΔR2 = .362, p < .001). However, unique associations were only obtained for mental health and neuroticism (β = − 0.30, p < .001) and a negative problem orientation (β = − 0.26, p < .001). Conclusions There is redundancy in the relationship between psychological variables and pain-related outcomes and the strength of this association is highest for mental health status. The association between psychological characteristics and health outcomes was comparable for men and women, which suggests that the same therapeutic targets could be selected in psychological interventions of pain patients irrespective of sex.
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Affiliation(s)
- C Suso-Ribera
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain.
| | - V Martínez-Borba
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain
| | | | | | - A García-Palacios
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain.,CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03, Instituto de Salud Carlos III, Barcelona, Spain
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13
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Knoerl R, Chornoby Z, Smith EML. Estimating the Frequency, Severity, and Clustering of SPADE Symptoms in Chronic Painful Chemotherapy-Induced Peripheral Neuropathy. Pain Manag Nurs 2019; 19:354-365. [PMID: 29503217 DOI: 10.1016/j.pmn.2018.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients undergoing treatment for cancer commonly experience symptoms such as sleep disturbance, pain, anxiety, depression, and low energy/fatigue (SPADE), subsequently altering physical function and complicating effective symptom management. However, little is known about the frequency, severity, and clustering of SPADE symptoms in individuals with chronic painful chemotherapy-induced peripheral neuropathy (CIPN). Aims/Design: The purpose of this cross-sectional, secondary analysis was to describe the frequency, severity, and clustering of SPADE symptoms and their association with physical function in individuals with chronic painful CIPN. Participants/Subjects: Sixty individuals with chronic painful CIPN were recruited from five academic and community oncology outpatient center to participate in a randomized controlled pilot trial designed to test the efficacy of a cognitive behavioral therapy-based pain management program. METHODS Participants completed the 0-10 Average CIPN Pain Numerical Rating Scale and Patient-Reported Outcome Measurement Information System measures for sleep-related impairment, anxiety, depression, fatigue, and pain interference via tablet before being randomly assigned to a study arm. The frequency, severity, and clustering of SPADE symptoms were calculated via descriptive statistics and Partitioning Around Medoids cluster analysis. Spearman rank correlation was performed to determine the association between number of SPADE symptoms and pain interference severity. RESULTS AND CONCLUSIONS Participants (n = 59) experienced numerous SPADE symptoms. 66.1% of participants experienced at least two SPADE symptoms concurrently. The cluster analysis revealed high (n = 36) and low (n = 23) severity subgroups. There was a moderate correlation (r = 0.48) between the number of SPADE symptoms and pain interference severity. Determining the clustering of SPADE symptoms in individuals with chronic painful CIPN may lead to targeted multifaceted interventions to improve physical function.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Zach Chornoby
- University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Ellen M L Smith
- University of Michigan School of Nursing, Ann Arbor, Michigan
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14
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Saito T, Toya R, Tomitaka E, Matsuyama T, Ninomura S, Oya N. Predictors of Pain Palliation After Radiation Therapy for Painful Tumors: A Prospective Observational Study. Int J Radiat Oncol Biol Phys 2018; 101:1061-1068. [PMID: 29885995 DOI: 10.1016/j.ijrobp.2018.04.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/20/2018] [Accepted: 04/23/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Although radiation therapy (RT) is an important part of treatment for cancer pain, prediction of the patient's pain response remains difficult. We evaluated the characteristics of patients, their tumors, and their pain to identify the predictors of pain palliation after RT for painful tumors. METHODS Our 3-center prospective observational study included patients scheduled for palliative or curative RT for painful tumors. Brief Pain Inventory data were collected at the start of RT and 1, 2, and 3 months thereafter. The pain response was assessed using the International Consensus Endpoint. The Mann-Whitney U-test was used to compare responders and nonresponders based on changes in the BPI scores. Predictors of the pain response were evaluated using the Fine-Gray model, in which death without a pain response was recorded as a competing risk. The independent variables were 11 a priori selected potential predictors with clinical relevance. RESULTS Of 302 analyzable patients, 262 (87%) had solid and 40 (13%) had hematologic tumors. The median total radiation dose was 30 Gy (range, 6-70.4 Gy). The pain response rate was 52% for 264 (87%) evaluable patients at 1-, 57% for 228 (75%) such patients at 2-, and 58% for 182 (60%) evaluable patients at 3-month follow-up. At 2-month follow-up, responders experienced a greater decrease in all 7 pain interference subscales of the Brief Pain Inventory compared to nonresponders. Multivariable analysis demonstrated that hematologic tumors (hazard ratio [HR], 1.85; 95% confidence interval [CI], 1.15-2.98), a neuropathic component of the index pain (HR, 1.50; 95% CI, 1.05-2.14), and opioid analgesic use before RT (HR, 0.65; 95% CI, 0.47-0.91) were independent significant predictors of pain response. CONCLUSIONS Patients with hematologic tumors, a neuropathic component of the index pain, and no treatment with opioid analgesics before RT were more likely to experience pain palliation after RT.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan; Department of Radiation Oncology, Hitoyoshi Medical Center, Kumamoto, Japan.
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Etsushi Tomitaka
- Department of Radiation Oncology, Kumamoto Medical Center, Kumamoto, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Satoshi Ninomura
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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15
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Fallon M, Walker J, Colvin L, Rodriguez A, Murray G, Sharpe M. Pain Management in Cancer Center Inpatients: A Cluster Randomized Trial to Evaluate a Systematic Integrated Approach-The Edinburgh Pain Assessment and Management Tool. J Clin Oncol 2018; 36:1284-1290. [PMID: 29543567 PMCID: PMC5929219 DOI: 10.1200/jco.2017.76.1825] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose Pain is suboptimally managed in patients with cancer. We aimed to compare the effect of a policy of adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and management Tool [EPAT]) to usual care (UC) versus UC alone on pain outcomes. Patients and Methods In a two-arm, parallel group, cluster randomized (1:1) trial, we observed pain outcomes in 19 cancer centers in the United Kingdom and then randomly assigned the centers to either implement EPAT or to continue UC. The primary outcome was change in the percentage of study participants in each center with a clinically significant (≥ 2 point) improvement in worst pain (using the Brief Pain Inventory Short Form) from admission to 3 to 5 days after admission. Secondary outcomes included quality of analgesic prescribing and opioid-related adverse effects. Results Ten centers were randomly assigned to EPAT, and nine were assigned to UC. We enrolled 1,921 patients and obtained outcome data from 93% (n = 1,795). Participants (mean age, 60 years; 49% women) had a variety of cancer types. For centers randomly assigned to EPAT, the percentage of participants with a clinically significant improvement in worst pain increased from 47.7% to 54.1%, and for those randomly assigned to continue UC, this percentage decreased from 50.6% to 46.4%. The absolute difference was 10.7% (95% CI, 0.2% to 21.1%; P = .046) and it increased to 15.4% (95% CI, 5.8% to 25.0%; P = .004) when two centers that failed to implement EPAT were excluded. EPAT centers had greater improvements in prescribing practice and in the Brief Pain Inventory Short Form pain subscale score. Other pain and distress outcomes and opioid adverse effects did not differ between EPAT and UC. Conclusion A systematic integrated approach improves pain outcomes for inpatients in cancer centers without increasing opioid adverse effects.
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Affiliation(s)
- Marie Fallon
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Jane Walker
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Lesley Colvin
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Aryelly Rodriguez
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Gordon Murray
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Michael Sharpe
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - for the Edinburgh Pain Assessment and Management Tool Study Group
- Marie Fallon and Lesley Colvin, University of Edinburgh, Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre; Aryelly Rodriguez and Gordon Murray, University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh; and Jane Walker and Michael Sharpe, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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16
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Knoerl R, Smith EM, Barton DL, Williams DA, Holden JE, Krauss JC, LaVasseur B. Self-Guided Online Cognitive Behavioral Strategies for Chemotherapy-Induced Peripheral Neuropathy: A Multicenter, Pilot, Randomized, Wait-List Controlled Trial. THE JOURNAL OF PAIN 2018; 19:382-394. [DOI: 10.1016/j.jpain.2017.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/07/2017] [Accepted: 11/27/2017] [Indexed: 11/25/2022]
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17
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Gelhorn HL, Eremenco S, Skalicky AM, Balantac Z, Cimms T, Halling K, Sexton C. Content validity and ePRO usability of the BPI-sf and "worst pain" item with pleural and peritoneal mesothelioma. J Patient Rep Outcomes 2018; 2:16. [PMID: 29749970 PMCID: PMC5934933 DOI: 10.1186/s41687-018-0039-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Brief Pain Inventory-short form (BPI-sf) is widely used in self-reported pain assessment, incorporates pain numeric rating scales (NRS) and is commonly utilized in electronic format in clinical trials, however, there is no published information about its usability as an electronic patient-reported outcome (ePRO) measure. The objective of this qualitative study was threefold: 1) to better understand pain experiences among patients with pleural or peritoneal mesothelioma; 2) to assess the interpretability of the instructions, item stem, recall period, and response option of the "worst pain" item of the BPI-sf; and 3) to examine the usability of the TrialMax Touch™ (CRF Health, Inc., Plymouth Meeting, PA) screen-based handheld device and the electronic format of the BPI-sf in a sub-sample of pleural mesothelioma patients. Methods A cross-sectional qualitative study was conducted among participants with pleural and peritoneal mesothelioma recruited from 4 clinical sites in the US. Semi-structured telephone or in-person interviews were conducted consisting of concept elicitation, cognitive interviewing of the 11-item BPI-sf, and in-person interview evaluation of ePRO assessment usability in pleural mesothelioma patients. Results Twenty-one participants recruited from 4 clinical sites in the US were interviewed in-person (n = 9) and by telephone (n = 12); 71% male; mean age 68.7 ± 13.6 years. Pleural and peritoneal patients described pain as ranging from discomfort to intense pain and reported being able to distinguish tumor pain from treatment pain. The BPI-sf "worst pain" item was relevant to, and easily understood by, study participants with pleural and peritoneal mesothelioma. The ePRO version was found to be easy to use, but readability of small font may be an issue. Participants reported minimal differences between their responses on the paper and ePRO version for all of the pain severity and pain interference items. Conclusions Results support the relevance and ease of understanding of the "worst pain" item and provide support for its content validity in patients with pleural and peritoneal mesothelioma. Usability of the ePRO format of the BPI-sf was confirmed for use in clinical trials among patients with pleural mesothelioma.
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Affiliation(s)
- Heather L Gelhorn
- Evidera - Evidence, Value & Access by PPD, 7101 Wisconsin Ave, Suite 1400, Bethesda, MD 20814 USA
| | - Sonya Eremenco
- Evidera - Evidence, Value & Access by PPD, 7101 Wisconsin Ave, Suite 1400, Bethesda, MD 20814 USA
| | - Anne M Skalicky
- Evidera - Evidence, Value & Access by PPD, 7101 Wisconsin Ave, Suite 1400, Bethesda, MD 20814 USA
| | - Zaneta Balantac
- Evidera - Evidence, Value & Access by PPD, 7101 Wisconsin Ave, Suite 1400, Bethesda, MD 20814 USA
| | | | | | - Chris Sexton
- Evidera - Evidence, Value & Access by PPD, 7101 Wisconsin Ave, Suite 1400, Bethesda, MD 20814 USA
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18
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Currow D, Watts GJ, Johnson M, McDonald CF, Miners JO, Somogyi AA, Denehy L, McCaffrey N, Eckert DJ, McCloud P, Louw S, Lam L, Greene A, Fazekas B, Clark KC, Fong K, Agar MR, Joshi R, Kilbreath S, Ferreira D, Ekström M. A pragmatic, phase III, multisite, double-blind, placebo-controlled, parallel-arm, dose increment randomised trial of regular, low-dose extended-release morphine for chronic breathlessness: Breathlessness, Exertion And Morphine Sulfate (BEAMS) study protocol. BMJ Open 2017; 7:e018100. [PMID: 28716797 PMCID: PMC5726102 DOI: 10.1136/bmjopen-2017-018100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD. METHODS AND ANALYSIS The primary question is what effect regular ER morphine has on worst breathlessness, measured daily on a 0-10 numerical rating scale. Uniquely, the coprimary outcome will use a FitBit to measure habitual physical activity. Secondary questions include safety and, whether upward titration after initial benefit delivers greater net symptom reduction. Substudies include longitudinal driving simulation, sleep, caregiver, health economic and pharmacogenetic studies. Seventeen centres will recruit 171 participants from respiratory and palliative care. The study has five phases including three randomisation phases to increasing doses of ER morphine. All participants will receive placebo or active laxatives as appropriate. Appropriate statistical analysis of primary and secondary outcomes will be used. ETHICS AND DISSEMINATION Ethics approval has been obtained. Results of the study will be submitted for publication in peer-reviewed journals, findings presented at relevant conferences and potentially used to inform registration of ER morphine for chronic breathlessness. TRIAL REGISTRATION NUMBER NCT02720822; Pre-results.
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Affiliation(s)
- David Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Gareth John Watts
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - Christine F McDonald
- Department of Austin Health, Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Australia
| | - John O Miners
- Clinical Pharmacology School of Medicine, Flinders University, Adelaide, Australia
| | - Andrew A Somogyi
- Department of Clinical Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Linda Denehy
- School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nicola McCaffrey
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeRA) Randwick, New South Wales, Australia
| | - Philip McCloud
- MCloud Consulting Group, Belrose, New South Wales, Australia
| | - Sandra Louw
- MCloud Consulting Group, Belrose, New South Wales, Australia
| | - Lawrence Lam
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Aine Greene
- Southern Adelaide Palliative Services, Adelaide, South Australia, Australia
| | - Belinda Fazekas
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Katherine C Clark
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
- School of Medicine and Public Health, The University if Newcastle, Newcastle, New South Wales, Australia
| | - Kwun Fong
- Thoracic Research Centre, The Prince Charles Hospital School of Medicine, University of Queensland, Australia
| | - Meera R Agar
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Faculty of Health, University of Technology Sydney, Sydney, Australia
- Clinical Trials, Ingham Institute of Applied Medical Research, Sydney, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Rohit Joshi
- Department of Medical Oncology, University of Adelaide Lyell MEwin Hospital, Adelaide, Australia
| | - Sharon Kilbreath
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Diana Ferreira
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Magnus Ekström
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Sweden
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Jatoi A, Grudem ME, Dockter TJ, Block MS, Villasboas JC, Tan A, Deering E, Kasi PM, Mansfield AS, Botero JP, Okuno SH, Smith DR, Fields AP. A proof-of-concept trial of protein kinase C iota inhibition with auranofin for the paclitaxel-induced acute pain syndrome. Support Care Cancer 2016; 25:833-838. [PMID: 27838777 DOI: 10.1007/s00520-016-3467-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Paclitaxel causes the paclitaxel-induced acute pain (PIAP) syndrome. Based on preclinical data, we hypothesized that the protein kinase C (PKC) iota inhibitor, auranofin (a gold salt used for other pain conditions), palliates this pain. METHODS In a randomized, double-blinded manner, patients who had suffered this syndrome were assigned a one-time dose of auranofin 6 mg orally on day #2 of the chemotherapy cycle (post-paclitaxel) versus placebo. Patients completed the Brief Pain Inventory and a pain diary on days 2 through 8 and at the end of the cycle. The primary endpoint was pain scores, as calculated by area under the curve, in response to "Please rate your pain by circling the one number that best describes your pain at its worse in the last 24 hours." RESULTS Thirty patients were enrolled. For the primary endpoint, mean area under the curve of 55 units (standard deviation 19) and 61 units (standard deviation 22) were observed in auranofin-treated and placebo-exposed patients, respectively (p = 0.44). On day 8 and at the end of the cycle, pain scores in auranofin-treated patients were more favorable, although differences were not statistically significant. CONCLUSIONS In the dose schedule studied, auranofin did not palliate the PIAP syndrome, but delayed beneficial trends suggest further study for this indication.
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Affiliation(s)
- Aminah Jatoi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Megan E Grudem
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Travis J Dockter
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew S Block
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jose C Villasboas
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Angelina Tan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Erin Deering
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Pashtoon M Kasi
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aaron S Mansfield
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Juliana Perez Botero
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Scott H Okuno
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Deanne R Smith
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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20
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Gater A, Nelsen L, Fleming S, Lundy JJ, Bonner N, Hall R, Marshall C, Staunton H, Krishnan JA, Stoloff S, Schatz M, Haughney J. Assessing Asthma Symptoms in Adolescents and Adults: Qualitative Research Supporting Development of the Asthma Daily Symptom Diary. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:440-450. [PMID: 27325336 DOI: 10.1016/j.jval.2016.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/08/2015] [Accepted: 01/17/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite the widespread availability of patient-reported asthma questionnaires, instruments developed in accordance with present regulatory expectations are lacking. To address this gap, the Patient-Reported Outcome (PRO) Consortium's Asthma Working Group has developed a patient-reported asthma daily symptom diary (ADSD) for use in clinical research to assess outcomes and support medical product labeling claims in adults and adolescents with asthma. OBJECTIVES To summarize the qualitative research conducted to inform the initial development of the ADSD and to provide evidence for content validity of the instrument in accordance with the Food and Drug Administration's PRO Guidance. METHODS Research informing the initial development and confirming the content validity of the ADSD is summarized. This comprised a review of published qualitative research, semi-structured concept elicitation interviews (n = 55), and cognitive interviews (n = 65) with a diverse and representative sample of adults and adolescents with a clinician-confirmed diagnosis of asthma in the United States to understand the asthma symptom experience and to assess the relevance and understanding of the newly developed ADSD. RESULTS From the qualitative literature review and concept elicitation interviews, eight core asthma symptoms emerged. These were broadly categorized as breathing symptoms (difficulty breathing, shortness of breath, and wheezing), chest symptoms (chest tightness, chest pain, and pressure/weight on chest), and cough symptoms (cough and the presence of mucus/phlegm). Conceptual saturation was achieved and differences in the experience of participants according to socio-demographic or clinical characteristics were not observed. Subsequent testing of the ADSD confirmed participant relevance and understanding. CONCLUSIONS The ADSD is a new patient-reported asthma symptom diary developed in accordance with the Food and Drug Administration's PRO Guidance. Evidence to date supports the content validity of the instrument. Item performance, reliability, and construct validity will be assessed in future quantitative research.
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Affiliation(s)
- Adam Gater
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK.
| | | | | | | | - Nicola Bonner
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | - Rebecca Hall
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | - Chris Marshall
- Adelphi Values Ltd., Adelphi Mill, Bollington, Cheshire, UK
| | | | - Jerry A Krishnan
- University of Illinois Hospital and Health Sciences System, Medical Center Administration, Chicago, IL, USA
| | | | - Michael Schatz
- Kaiser Permanente Medical Center/Kaiser Foundation Hospital, San Diego, CA, USA
| | - John Haughney
- University of Aberdeen, King's College, Aberdeen, UK
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21
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There’s More Than Catastrophizing in Chronic Pain: Low Frustration Tolerance and Self-Downing Also Predict Mental Health in Chronic Pain Patients. J Clin Psychol Med Settings 2016; 23:192-206. [DOI: 10.1007/s10880-016-9454-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Fallon M, Hoskin PJ, Colvin LA, Fleetwood-Walker SM, Adamson D, Byrne A, Murray GD, Laird BJA. Randomized Double-Blind Trial of Pregabalin Versus Placebo in Conjunction With Palliative Radiotherapy for Cancer-Induced Bone Pain. J Clin Oncol 2016; 34:550-6. [PMID: 26644535 PMCID: PMC5098845 DOI: 10.1200/jco.2015.63.8221] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer-induced bone pain (CIBP) affects one third of patients with cancer. Radiotherapy remains the gold-standard treatment; however, laboratory and clinical work suggest that pregabalin may be useful in treating CIBP. The aim of this study was to examine pregabalin in patients with CIBP receiving radiotherapy. PATIENTS AND METHODS A multicenter, double-blind randomized trial of pregabalin versus placebo was conducted. Eligible patients were age ≥ 18 years, had radiologically proven bone metastases, were scheduled to receive radiotherapy, and had pain scores ≥ 4 of 10 (on 0-to-10 numeric rating scale). Before radiotherapy, baseline assessments were completed, followed by random assignment. Doses of pregabalin and placebo were increased over 4 weeks. The primary end point was treatment response, defined as a reduction of ≥ 2 points in worst pain by week 4, accompanied by a stable or reduced opioid dose, compared with baseline. Secondary end points assessed average pain, interference of pain with activity, breakthrough pain, mood, quality of life, and adverse events. RESULTS A total of 233 patients were randomly assigned: 117 to placebo and 116 to pregabalin. The most common cancers were prostate (n = 88; 38%), breast (n = 77; 33%), and lung (n = 42; 18%). In the pregabalin arm, 45 patients (38.8%) achieved the primary end point, compared with 47 (40.2%) in the placebo arm (adjusted odds ratio, 1.07; 95% CI, 0.63 to 1.81; P = .816). There were no statistically significant differences in average pain, pain interference, or quality of life between arms. There were differences in mood (P = .031) and breakthrough pain duration (P = .037) between arms. Outcomes were compared at 4 weeks. CONCLUSION Our findings do not support the role of pregabalin in patients with CIBP receiving radiotherapy. The role of pregabalin in CIBP with a clinical neuropathic pain component is unknown.
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Affiliation(s)
- Marie Fallon
- Marie Fallon and Barry J.A. Laird, Edinburgh Cancer Research Centre, University of Edinburgh; Lesley A. Colvin, Western General Hospital and University of Edinburgh; Susan M. Fleetwood-Walker, School of Biomedical Sciences, University of Edinburgh; Gordon D. Murray, Centre for Population Health Sciences, University of Edinburgh, Edinburgh; Peter J. Hoskin, Mount Vernon Hospital Cancer Centre, Middlesex, and University College London; Douglas Adamson, Princess Alexandra Centre, Ninewells Hospital, Dundee; Anthony Byrne, Marie Curie Palliative Care Research Centre, Institute of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom; and Barry J.A. Laird, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Peter J Hoskin
- Marie Fallon and Barry J.A. Laird, Edinburgh Cancer Research Centre, University of Edinburgh; Lesley A. Colvin, Western General Hospital and University of Edinburgh; Susan M. Fleetwood-Walker, School of Biomedical Sciences, University of Edinburgh; Gordon D. Murray, Centre for Population Health Sciences, University of Edinburgh, Edinburgh; Peter J. Hoskin, Mount Vernon Hospital Cancer Centre, Middlesex, and University College London; Douglas Adamson, Princess Alexandra Centre, Ninewells Hospital, Dundee; Anthony Byrne, Marie Curie Palliative Care Research Centre, Institute of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom; and Barry J.A. Laird, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lesley A Colvin
- Marie Fallon and Barry J.A. Laird, Edinburgh Cancer Research Centre, University of Edinburgh; Lesley A. Colvin, Western General Hospital and University of Edinburgh; Susan M. Fleetwood-Walker, School of Biomedical Sciences, University of Edinburgh; Gordon D. Murray, Centre for Population Health Sciences, University of Edinburgh, Edinburgh; Peter J. Hoskin, Mount Vernon Hospital Cancer Centre, Middlesex, and University College London; Douglas Adamson, Princess Alexandra Centre, Ninewells Hospital, Dundee; Anthony Byrne, Marie Curie Palliative Care Research Centre, Institute of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom; and Barry J.A. Laird, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Susan M Fleetwood-Walker
- Marie Fallon and Barry J.A. Laird, Edinburgh Cancer Research Centre, University of Edinburgh; Lesley A. Colvin, Western General Hospital and University of Edinburgh; Susan M. Fleetwood-Walker, School of Biomedical Sciences, University of Edinburgh; Gordon D. Murray, Centre for Population Health Sciences, University of Edinburgh, Edinburgh; Peter J. Hoskin, Mount Vernon Hospital Cancer Centre, Middlesex, and University College London; Douglas Adamson, Princess Alexandra Centre, Ninewells Hospital, Dundee; Anthony Byrne, Marie Curie Palliative Care Research Centre, Institute of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom; and Barry J.A. Laird, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Douglas Adamson
- Marie Fallon and Barry J.A. Laird, Edinburgh Cancer Research Centre, University of Edinburgh; Lesley A. Colvin, Western General Hospital and University of Edinburgh; Susan M. Fleetwood-Walker, School of Biomedical Sciences, University of Edinburgh; Gordon D. Murray, Centre for Population Health Sciences, University of Edinburgh, Edinburgh; Peter J. Hoskin, Mount Vernon Hospital Cancer Centre, Middlesex, and University College London; Douglas Adamson, Princess Alexandra Centre, Ninewells Hospital, Dundee; Anthony Byrne, Marie Curie Palliative Care Research Centre, Institute of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom; and Barry J.A. Laird, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anthony Byrne
- Marie Fallon and Barry J.A. Laird, Edinburgh Cancer Research Centre, University of Edinburgh; Lesley A. Colvin, Western General Hospital and University of Edinburgh; Susan M. Fleetwood-Walker, School of Biomedical Sciences, University of Edinburgh; Gordon D. Murray, Centre for Population Health Sciences, University of Edinburgh, Edinburgh; Peter J. Hoskin, Mount Vernon Hospital Cancer Centre, Middlesex, and University College London; Douglas Adamson, Princess Alexandra Centre, Ninewells Hospital, Dundee; Anthony Byrne, Marie Curie Palliative Care Research Centre, Institute of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom; and Barry J.A. Laird, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gordon D Murray
- Marie Fallon and Barry J.A. Laird, Edinburgh Cancer Research Centre, University of Edinburgh; Lesley A. Colvin, Western General Hospital and University of Edinburgh; Susan M. Fleetwood-Walker, School of Biomedical Sciences, University of Edinburgh; Gordon D. Murray, Centre for Population Health Sciences, University of Edinburgh, Edinburgh; Peter J. Hoskin, Mount Vernon Hospital Cancer Centre, Middlesex, and University College London; Douglas Adamson, Princess Alexandra Centre, Ninewells Hospital, Dundee; Anthony Byrne, Marie Curie Palliative Care Research Centre, Institute of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom; and Barry J.A. Laird, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - Barry J A Laird
- Marie Fallon and Barry J.A. Laird, Edinburgh Cancer Research Centre, University of Edinburgh; Lesley A. Colvin, Western General Hospital and University of Edinburgh; Susan M. Fleetwood-Walker, School of Biomedical Sciences, University of Edinburgh; Gordon D. Murray, Centre for Population Health Sciences, University of Edinburgh, Edinburgh; Peter J. Hoskin, Mount Vernon Hospital Cancer Centre, Middlesex, and University College London; Douglas Adamson, Princess Alexandra Centre, Ninewells Hospital, Dundee; Anthony Byrne, Marie Curie Palliative Care Research Centre, Institute of Cancer and Genetics, Cardiff University, Cardiff, United Kingdom; and Barry J.A. Laird, European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
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23
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Chiu N, Zhang L, Gallo-Hershberg D, Dent R, Chiu L, Pasetka M, van Draanen J, Chow R, Lam H, Verma S, Stinson J, Stacey E, Chow E, DeAngelis C. Which pain intensity scale from the Brief Pain Inventory correlates most highly with functional interference scores in patients experiencing taxane-induced arthralgia and myalgia? Support Care Cancer 2016; 24:2979-88. [PMID: 26868953 DOI: 10.1007/s00520-016-3106-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to assess which pain intensity dimension scale (worst, least, average, or current pain) from the Brief Pain Inventory (BPI) correlates most highly with functional interference scores in patients experiencing taxane-induced arthralgia and myalgia. METHODS Breast cancer patients scheduled to receive docetaxel, paclitaxel, or albumin-bound paclitaxel (nab-paclitaxel) were enrolled in the study. Patients completed an initial baseline questionnaire and subsequently filled out a diary based on the BPI on days 1-7, 14, and 21 for three consecutive treatment cycles. Pain scores for worst, least, average, and current pain intensity dimensions as well as pain interference scores were recorded in the diaries and questionnaires using the BPI. Worst, least, average, and current pain scores were correlated with functional pain interference scores using Spearman's rank correlation coefficients. A general linear mixed model of each functional interference measure was performed over time for cycles 1-3 with each pain intensity dimension scale. RESULTS Among worst, average, least, and current joint pain dimensions, average joint pain scores correlated best with all BPI interference responses while average muscle pain scores correlated best with all BPI interference responses except for sleeping probability and normal work. CONCLUSION We recommend the BPI scale measuring average pain for future studies evaluating pain scores in patients experiencing taxane-induced arthralgia and myalgia.
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Affiliation(s)
- Nicholas Chiu
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Liying Zhang
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Rebecca Dent
- National Cancer Centre, Singapore, Singapore, Singapore
| | - Leonard Chiu
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Pasetka
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jenna van Draanen
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Ronald Chow
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Henry Lam
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Sunil Verma
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jordan Stinson
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Erica Stacey
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Edward Chow
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Carlo DeAngelis
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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24
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Jacobs C, Kuchuk I, Bouganim N, Smith S, Mazzarello S, Vandermeer L, Dranitsaris G, Dent S, Gertler S, Verma S, Song X, Simos S, Cella D, Clemons M. A randomized, double-blind, phase II, exploratory trial evaluating the palliative benefit of either continuing pamidronate or switching to zoledronic acid in patients with high-risk bone metastases from breast cancer. Breast Cancer Res Treat 2015; 155:77-84. [PMID: 26643085 DOI: 10.1007/s10549-015-3646-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Abstract
Previous studies suggest switching from pamidronate to a more potent bone-targeted agent is associated with biomarker and palliative response in breast cancer patients with bone metastases. Until now, this has not been addressed in a double-blind, randomized trial. Breast cancer patients with high-risk bone metastases, despite >3 months of pamidronate, were randomized to either continue pamidronate or switch to zoledronic acid every 4 weeks for 12 weeks. Primary outcome was the proportion of patients achieving a fall in serum C-telopeptide (sCTx) at 12 weeks. Secondary outcomes included difference in mean sCTx, pain scores, quality of life, toxicity, and skeletal-related events (SREs). Seventy-three patients entered the study; median age 61 years (range 37-87). Proportion of patients achieving a fall in sCTx over the 12-week evaluation period was 26/32 (81 %) with zoledronic acid and 18/29 (62 %) with pamidronate (p = 0.095). Mean decrease in sCTx (mean difference between groups = 50 ng/L, 95 % CI 18-84; p = 0.003) was significantly greater in patients who received zoledronic acid. Quality of life, pain scores, toxicity, and frequency of new SREs were comparable between the two arms. While a switch from pamidronate to zoledronic acid resulted in reduction in mean sCTx, there were no significant differences between the arms for proportion of patients achieving a reduction in sCTx, quality of life, pain scores, toxicity or SREs. Given the lack of palliative improvement, the current data do not support a switching strategy.
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Affiliation(s)
- C Jacobs
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - I Kuchuk
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - N Bouganim
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - S Smith
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - S Mazzarello
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - L Vandermeer
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - G Dranitsaris
- Statistical Consultant, 283 Danforth Ave, Suite 448, Toronto, ON, M4K 1N2, Canada
| | - S Dent
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - S Gertler
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - S Verma
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - X Song
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - S Simos
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - D Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M Clemons
- Division of Medical Oncology and Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. .,The Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Box 900, Ottawa, ON, K1H8L6, Canada.
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25
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Hoskin P, Sundar S, Reczko K, Forsyth S, Mithal N, Sizer B, Bloomfield D, Upadhyay S, Wilson P, Kirkwood A, Stratford M, Jitlal M, Hackshaw A. A Multicenter Randomized Trial of Ibandronate Compared With Single-Dose Radiotherapy for Localized Metastatic Bone Pain in Prostate Cancer. J Natl Cancer Inst 2015; 107:djv197. [PMID: 26242893 DOI: 10.1093/jnci/djv197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 06/23/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The radiotherapy or ibandronate (RIB) trial was a randomized multicenter nonblind two-arm trial to compare intravenous ibandronate given as a single infusion with single-dose radiotherapy for metastatic bone pain. METHODS Four hundred seventy prostate cancer patients with metastatic bone pain who were suitable for local radiotherapy were randomly assigned to radiotherapy (single dose, 8 Gy) or intravenous infusion of ibandronate (6mg) in a noninferiority trial. Pain was measured using the Brief Pain Inventory at baseline and four, eight, 12, 26, and 52 weeks. Pain response was assessed using World Health Organization (WHO) criteria and the Effective Analgesic Score (EAS); the maximum allowable difference was ±15%. Patients failing to respond at four weeks were offered retreatment with the alternative treatment. Quality of life (QoL) was assessed at baseline and four and 12 weeks. Because the trial was designed with a 5% one-sided test, we provide 90% confidence intervals (two-sided) for differences in pain response. RESULTS Overall, pain response was not statistically different at four or 12 weeks (WHO: -3.7%, 90% confidence interval [CI] = -12.4% to 5.0%; and 6.7%, 90% CI = -2.6 to 16.0%, respectively). Corresponding differences using the EAS were -7.5% and -3.5%. However, a more rapid initial response with radiotherapy was observed. There was no overall difference in toxicity, although each treatment had different side effects. QoL was similar at four and 12 weeks. Overall survival was similar between the two groups but was better among patients having retreatment than those who did not. CONCLUSIONS A single infusion of ibandronate had outcomes similar to a single dose of radiotherapy for metastatic prostate bone pain. Ibandronate could be considered when radiotherapy is not available.
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Affiliation(s)
- Peter Hoskin
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS).
| | - Santhanam Sundar
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Krystyna Reczko
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Sharon Forsyth
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Natasha Mithal
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Bruce Sizer
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - David Bloomfield
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Sunil Upadhyay
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Paula Wilson
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Amy Kirkwood
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Michael Stratford
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Mark Jitlal
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Allan Hackshaw
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
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Schmid S, Omlin A, Blum D, Strasser F, Gillessen S, Rothermundt C. Assessment of anticancer-treatment outcome in patients with metastatic castration-resistant prostate cancer-going beyond PSA and imaging, a systematic literature review. Ann Oncol 2015. [PMID: 26216388 DOI: 10.1093/annonc/mdv326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In the past years, there has been significant progress in anticancer drug development for patients with metastatic castration-resistant prostate cancer (CRPC). However, the current instruments to assess clinical treatment response have limitations and may not sufficiently reflect patient benefit. Our objective was to systematically identify tools to evaluate both patient benefit and clinical anticancer-treatment response as basis for an international consensus process and development of a specific pragmatic instrument for men with CRPC. METHODS PubMed, Embase and CINAHL were searched to identify currently available tools to assess anticancer-treatment benefit, other than standard imaging procedures and prostate-specific antigen measurements, namely quality of life (QoL), detailed pain assessment, physical function and objective measures of other complex cancer-related syndromes in patients with CRPC. Additionally, all CRPC phase III trials published in the last 5 years were reviewed as well as studies using physical function tools in a general cancer population. The PRIMSA statement was followed for the systematic review process. RESULTS The search generated 1096 hits, 185 full-text papers were screened and finally 73 publications were included. Additional 89 publications were included by hand-search. We identified a total of 98 tools used in CRPC trials and grouped these into three categories: 22 tools assessing QoL domains and subgroups, 47 tools for pain assessment and 29 tools for objective measures, mainly physical function and assessment of skeletal disease burden. CONCLUSION A wide variety of assessment tools and also efforts to standardize and harmonize patient-reported outcomes and pain assessment were identified. However, the specific needs of the increasing CRPC population living longer with their incurable cancer are insufficiently captured and objective physical outcome measures are under-represented. In the age of new anticancer drug targets and principles, new methods to monitor patient relevant outcomes of antineoplastic therapy are of utmost importance.
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Affiliation(s)
- S Schmid
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - A Omlin
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - D Blum
- Division of Oncological Palliative Medicine, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - F Strasser
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland Division of Oncological Palliative Medicine, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - S Gillessen
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
| | - C Rothermundt
- Division of Oncology and Haematology, Division of Oncology and Palliative Centre, Cantonal Hospital St Gallen, St Gallen,Switzerland
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McDonald R, Chow E, Rowbottom L, Bedard G, Lam H, Wong E, Popovic M, Pulenzas N, Tsao M. Quality of life after palliative radiotherapy in bone metastases: A literature review. J Bone Oncol 2014; 4:24-31. [PMID: 26579481 PMCID: PMC4620945 DOI: 10.1016/j.jbo.2014.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/06/2014] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the quality of life (QOL) following palliative radiotherapy for painful bone metastases. Methods A literature search was conducted in OvidSP Medline (1946–Jan Week 4 2014), Embase (1947–Week 5 2014), and the Cochrane Central Register of Controlled Trials (Dec 2013) databases. The search was limited to English. Subject headings and keywords included ‘palliative radiation’, ‘cancer palliative therapy’, ‘bone metastases’, ‘quality of life’, and ‘pain’. All studies (prospective or retrospective) reporting change in QOL before and after palliative radiotherapy for painful bone metastases were included. Results Eighteen articles were selected from a total of 1730. The most commonly used tool to evaluate QOL was the Brief Pain Inventory. Seventeen studies collected data prospectively. An improvement in symptoms and functional interference scores following radiotherapy was observed in all studies. The difference in changes in QOL between responders and non responders was inconsistently reported. Conclusion QOL improves in patients who respond to palliative radiotherapy for painful bone metastases.
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Affiliation(s)
- Rachel McDonald
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leigha Rowbottom
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Bedard
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lam
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin Wong
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marko Popovic
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Pulenzas
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - May Tsao
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Addison CL, Pond GR, Zhao H, Mazzarello S, Vandermeer L, Goldstein R, Amir E, Clemons M. Effects of de-escalated bisphosphonate therapy on bone turnover biomarkers in breast cancer patients with bone metastases. SPRINGERPLUS 2014; 3:577. [PMID: 25332877 PMCID: PMC4194305 DOI: 10.1186/2193-1801-3-577] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 01/10/2023]
Abstract
While de-escalation of bisphosphonates from 4 to 12-weekly dosing has been shown to be clinically non-inferior to standard dosing, there is evidence the de-escalation is associated with increased bone turnover biomarkers. Here we evaluated the effect of de-escalated dosing on a panel of biomarkers and determined their association with incidence of skeletal related events (SREs) in breast cancer patients with ‘low risk’ bone metastases. As part of a pilot randomized trial, women with baseline C-telopeptide levels <600 ng/L after >3 months of 3–4 weekly pamidronate were randomized to continue pamidronate every 4 weeks or de-escalation to 12-weekly treatment. Serum was analysed for bone biomarkers (C-telopeptide, N-telopeptide, bone-specific alkaline phosphatase, transforming growth factor-β, procollagen type 1 N-propeptide, activinA and bone sialoprotein) using ELISA. The associations between changes in biomarkers, pain scores and SREs were assessed by univariable logistic regression. Numerical increases in all biomarkers were observed between baseline and 12 weeks but were of higher magnitude in the de-escalated arm. Pain scores in the de-escalated treatment arm showed a greater magnitude of pain reduction from baseline to 12 weeks. Neither baseline levels nor changes in biomarkers from baseline to 12 weeks on treatment were associated with on study SREs. Baseline pain as measured by the FACT-BP was associated with increased risk of SRE. In conclusion, biomarkers of bone activity do not appear to predict for SREs in ‘low risk’ cohorts. However, baseline bone pain appears to be associated with SRE occurrence, a finding which warrants evaluation in larger cohorts.
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Affiliation(s)
- Christina L Addison
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON Canada ; Department of Medicine, University of Ottawa, Ottawa, ON Canada ; Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, Canada
| | - Huijun Zhao
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Sasha Mazzarello
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Lisa Vandermeer
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | | | - Eitan Amir
- Princess Margaret Hospital, Toronto, ON Canada
| | - Mark Clemons
- Program for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, ON Canada ; Department of Medicine, University of Ottawa, Ottawa, ON Canada
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A phase II, multicentre trial evaluating the efficacy of de-escalated bisphosphonate therapy in metastatic breast cancer patients at low-risk of skeletal-related events. Breast Cancer Res Treat 2014; 144:615-24. [PMID: 24638849 PMCID: PMC3962742 DOI: 10.1007/s10549-014-2906-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/03/2014] [Indexed: 11/27/2022]
Abstract
The optimal frequency of intravenous (IV) bisphosphonate administration is unclear. We thus performed a study evaluating the effects of switching from 3–4 to 12 weekly therapy in patients with biochemically defined low-risk bone metastases. Patients with serum C-telopeptide (CTx) levels ≤600 ng/L after ≥3 months of 3–4 weekly IV pamidronate were switched to 12 weekly therapy for 48 weeks. Primary endpoint was the proportion of patients maintaining CTx levels in the lower-risk range. All endpoints (serum CTx and bone-specific alkaline phosphatase (BSAP), skeletal-related events (SREs) and self-reported pain) were measured at baseline, 6, 12, 24, 36 and 48 weeks. Treatment failure was defined as biochemical failure (CTx > 600 ng/L) or a SRE. Exploratory biomarkers including; serum TGF-β, activin-A, bone sialoprotein (BSP), procollagen type 1 N-terminal propeptide and urinary N-telopeptide (NTx) were assessed at baseline as predictors for failure to complete treatment. Seventy-one patients accrued and 43 (61 %) completed 48 weeks of de-escalated therapy. Reasons for failure to complete treatment included; biochemical failure (CTx > 600 ng/L) (n = 10, 14.1 %), on-study SRE (n = 9, 12.7 %), disease progression (n = 7, 9.9 % including death from disease [n = 1, 1.4 %]) or patient choice (n = 2, 2.8 %). Elevated baseline levels of CTx, BSAP, NTx and BSP were associated with treatment failure. The majority of patients in this biochemically defined low-risk population could switch from 3–4 weekly to 12 weekly bisphosphonate therapy with no effect on CTx levels or SREs during the 48 week study. Larger trials are required to assess the roles of biomarkers as predictors of adequacy of de-escalated therapy.
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Basch E, Trentacosti AM, Burke LB, Kwitkowski V, Kane RC, Autio KA, Papadopoulos E, Stansbury JP, Kluetz PG, Smith H, Justice R, Pazdur R. Pain palliation measurement in cancer clinical trials: the US Food and Drug Administration perspective. Cancer 2013; 120:761-7. [PMID: 24375398 DOI: 10.1002/cncr.28470] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/06/2013] [Accepted: 09/13/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pain palliation resulting from antitumor therapy provides direct evidence of treatment benefit when combined with evidence of antitumor activity. The US Food and Drug Administration (FDA) previously issued guidance regarding the use of patient-reported outcome (PRO) measures to support labeling claims. The purpose of this article is to identify common challenges and key design strategies when measuring pain palliation in antitumor therapy clinical trials that are consistent with PRO Guidance principles. METHODS Antitumor clinical protocols submitted to the FDA between 1995 and 2012 that included pain palliation as a primary or secondary endpoint were reviewed. Challenges in critical trial design components were identified. Design strategies consistent with PRO Guidance principles are proposed. RESULTS The challenges identified were measurement of pain intensity and analgesic use, enrollment eligibility criteria, data collection methods, responder definitions, missing data, and blinding. Strategies included the use of well-defined, reliable, PRO assessments of pain intensity and analgesics; ensuring that enrollment criteria define patients with clinically significant pain attributable to cancer on an optimal analgesic regimen; defining responders using both pain and analgesic use criteria; incorporating an analysis of tumor response to support evidence of pain response; and minimizing missing data and inadvertent unblinding. CONCLUSIONS Improvement in cancer-related pain resulting from antitumor therapy is an important treatment benefit that can support drug approval and labeling claims when adequately measured if study results demonstrate statistically and clinically significant findings. Sponsors are encouraged to discuss pain palliation assessment methods with the FDA early in and throughout product development.
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Affiliation(s)
- Ethan Basch
- Cancer Outcomes Research Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sande TA, Scott AC, Laird BJA, Wan HI, Fleetwood-Walker SM, Kaasa S, Klepstad P, Mitchell R, Murray GD, Colvin LA, Fallon MT. The characteristics of physical activity and gait in patients receiving radiotherapy in cancer induced bone pain. Radiother Oncol 2013; 111:18-24. [PMID: 24231246 DOI: 10.1016/j.radonc.2013.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/15/2013] [Accepted: 10/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE An objective measure of pain relief may add important information to patients' self assessment, particularly after a treatment. The study aims were to determine whether measures of physical activity and/or gait can be used in characterizing cancer-induced bone pain (CIBP) and whether these biomarkers are sensitive to treatment response, in patients receiving radiotherapy (XRT) for CIBP. MATERIALS AND METHODS Patients were assessed before (baseline) and 6-8weeks after XRT (follow up). The following assessments were done: Brief Pain Inventory (BPI), activPAL™ activity meter, and GAITRite® electronic walkway (measure of gait). Wilcoxon, Mann-Whitney and Pearson statistical analyses were done. RESULTS Sixty patients were assessed at baseline; median worst pain was 7 and walking interference was 5. At follow up 42 patients were assessed. BPI worst pain, average pain, walking interference and total functional interference all improved (p<0.001). An improvement in functional interference correlated with aspects of physical activity (daily hours standing r=0.469, p=0.002) and gait (cadence r=0.341, p=0.03). The activPAL and GAITRite parameters did not change following XRT (p>0.05). In responder analyses there were no differences in activPAL and GAITRite parameters (p>0.05). CONCLUSION Assessment of physical activity and gait allow a characterization of the functional aspects of CIBP, but not in the evaluation of XRT.
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Affiliation(s)
- Tonje A Sande
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Technology and Science (NTNU), Trondheim, Norway.
| | - Angela C Scott
- University of Edinburgh, Edinburgh Cancer Research Centre, United Kingdom
| | - Barry J A Laird
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Technology and Science (NTNU), Trondheim, Norway; University of Edinburgh, Edinburgh Cancer Research Centre, United Kingdom
| | - Hong I Wan
- Pfizer Biotherapeutics, Translational Medicine and Molecular Medicine Clinical Research, Collegeville, United States
| | | | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Technology and Science (NTNU), Trondheim, Norway; Cancer Clinic, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Pål Klepstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Technology and Science (NTNU), Trondheim, Norway; St. Olavs Hospital, University Hospital of Trondheim, Department of Anaesthesiology and Emergency Medicine, Trondheim, Norway
| | - Rory Mitchell
- University of Edinburgh, Centre for Integrative Physiology,Edinburgh, United Kingdom
| | - Gordon D Murray
- University of Edinburgh, Centre for Population Health Sciences, Edinburgh, United Kingdom
| | - Lesley A Colvin
- University of Edinburgh, Department of Anaesthesia and Pain Medicine, Western General Hospital, Edinburgh, United Kingdom
| | - Marie T Fallon
- University of Edinburgh, Edinburgh Cancer Research Centre, United Kingdom
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Wang Y, Huang H, Zeng Y, Wu J, Wang R, Ren B, Xu F. Pharmacist-led medication education in cancer pain control: A multicentre randomized controlled study in Guangzhou, China. J Int Med Res 2013; 41:1462-72. [PMID: 23975860 DOI: 10.1177/0300060513491170] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate clinical pharmacist-led pain-medication education in patients with cancer. Methods A controlled study was conducted prospectively at six tertiary hospitals in China. In-patients with cancer were randomized to receive conventional treatment plus medication education or no education (controls). Education consisted of access to information booklets and eight 30-min face-to-face counselling sessions given by clinical pharmacists over 4 weeks. Patients completed pain- and analgesic-knowledge assessments and a Brief Pain Inventory, pre- and post-study. Results A total of 123 and 114 patients in the education and control groups, respectively, completed follow-up. At the end of the study, patient knowledge regarding cancer pain and pain control was significantly increased in both groups; pain and analgesic knowledge scores were significantly higher in the education group compared with controls. In the control group, the increase in total pain-related knowledge was significantly greater in analgesic-naïve patients compared with those who were using/had used analgesics. Pain intensity scores and pain interference of daily activities were significantly reduced in the education group compared with controls. Conclusions Clinical pharmacist-led medication education resulted in improved pain control in patients with cancer.
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Affiliation(s)
- Yan Wang
- Department of Pharmacy, Sixth People’s Hospital South Campus, Shanghai Jiaotong University, Shanghai, China
- Department of Pharmacy, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hongbing Huang
- Department of Pharmacy, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Yingtong Zeng
- Department of Pharmacy, Guangdong General Hospital, Guangzhou, China
| | - Junyan Wu
- Department of Pharmacy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruolun Wang
- Department of Pharmacy, Second Affiliated Hospital, Guangzhou Medical College, Guangzhou, China
| | - Bin Ren
- Department of Pharmacy, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng Xu
- Department of Pharmacy, Sixth People’s Hospital South Campus, Shanghai Jiaotong University, Shanghai, China
- Department of Pharmacy, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Ponsford JL, Parcell DL, Sinclair KL, Roper M, Rajaratnam SMW. Changes in sleep patterns following traumatic brain injury: a controlled study. Neurorehabil Neural Repair 2013; 27:613-21. [PMID: 23549523 DOI: 10.1177/1545968313481283] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sleep changes are frequently reported following traumatic brain injury (TBI) and have an impact on rehabilitation and quality of life following injury. Potential causes include injury to brain regions associated with sleep regulation, as well as secondary factors, including depression, anxiety, and pain. Understanding the nature and causes of sleep changes following TBI represents a vital step in developing effective treatments. OBJECTIVE The study aimed to investigate subjective sleep changes in a community-based sample of individuals with TBI in comparison with noninjured age- and sex-matched controls and to explore the impact of secondary factors (pain, anxiety, depression, employment) on these self-reported sleep changes. METHODS A total of 153 participants with mild to severe TBI and 128 noninjured controls completed self-report measures relating to their sleep quality, daytime sleepiness, mood, fatigue, and pain and completed a sleep diary each day for 7 days. RESULTS Compared with the noninjured controls, participants with TBI reported significantly poorer sleep quality and higher levels of daytime sleepiness; sleep diaries revealed longer sleep onset latency, poorer sleep efficiency, longer sleep duration, and more frequent daytime napping in the TBI group, as well as earlier bedtimes and greater total sleep duration. Anxiety, depression, and pain were associated with poorer sleep quality. Greater injury severity was also associated with a need for longer sleep time. CONCLUSION These findings highlight the importance of assessing and addressing pain, anxiety, and depression as part of the process of treating TBI-related sleep disturbances.
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Affiliation(s)
- Jennie L Ponsford
- School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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Truntzer P, Atlani D, Pop M, Clavier JB, Guihard S, Schumacher C, Noel G. Early evaluation predicts pain relief of irradiated bone metastases: a single-center prospective study. BMC Palliat Care 2013; 12:12. [PMID: 23496823 PMCID: PMC3600038 DOI: 10.1186/1472-684x-12-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 02/14/2013] [Indexed: 11/10/2022] Open
Abstract
Background Radiation therapy is a well-recognized, effective modality used for palliative care. Most studies completed to date have endpoints of one month or greater after treatment completion. This study analyzed the response rates at different time points during the first month after treatment. Methods From May 2010 to November 2011, 61 patients treated for 74 metastases were included in the study. The end points were defined as the completion of treatment (CT) and d8, d15 and d30 after the completion of treatment. The response rate was measured by the worst pain in the last 24 hours and the administered opioid dose. Patient assessment was performed during consultations and phone appointments. Results The overall response rate significantly improved from the CT (38%) to d8 (53.8%), d15 (53.8%) and d30 (57.1%) (respectively p < 0.001; p < 0.001 and p = 0.001). The improvement peaked at d8. Patients responding to the treatment at d8 had a significative longer pain relapse free survival (PRFS) compared to patients not responding (3.38 weeks vs 0.3 weeks; p < 0.001). From the beginning of treatment to the CT and at d8 , d15 and d30, oral morphine equivalent dose (OMED) did not significantly differ. However, the pain decrease did not result in a performance status improvement, which declined over time (p < 0.001). Conclusion Radiation therapy is an efficient treatment method for providing pain relief. This relief peaked at d8 after treatment, and the response at d8 is predictive of the response at 4 weeks. Pain management alone is not enough to improve performance status; further studies are needed to evaluate a more global supportive care approach.
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Affiliation(s)
- Pierre Truntzer
- Radiation department, against cancer center Paul Strauss, 3, rue de la porte de l'hôpital BP42, Strasbourg cedex, 67065, France.
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Jho HJ, Myung SK, Chang YJ, Kim DH, Ko DH. Efficacy of pain education in cancer patients: a meta-analysis of randomized controlled trials. Support Care Cancer 2013; 21:1963-71. [PMID: 23430013 DOI: 10.1007/s00520-013-1756-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/04/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE Patient education has been considered as one of the important strategies to improve cancer pain control. However, randomized controlled trials (RCTs) have reported inconsistent findings on this issue. This study aims to evaluate the overall efficacy of pain education on improving pain management in cancer patients by using a meta-analysis of RCTs. METHODS We searched PubMed, EMBASE, and the Cochrane Library in February 2012. Two evaluators independently reviewed and selected trials based on the predetermined selection criteria. Out of 213 articles meeting initial criteria, 12 RCTs involving 2,169 participants (1,069 intervention group and 1,100 control group), were included in the final analysis. RESULTS In the meta-analysis of all 12 RCTs, compared with the control group, the intervention group showed a small significant lower pain intensity (standardized mean difference [SMD], -0.11; 95 % confidence interval [CI], -0.20 to -0.02). In the subgroup meta-analysis by various factors, a beneficial effect of pain education was observed for patients with an estimated prognosis of at least 3 months, a follow-up within 2 weeks after pain education, multiple sessions, measured worst pain, tailored education, general pain management, education by medical staff, and usual care for a control group. However, in the subgroup meta-analyses of trials using attention control as a control group and high-quality trials, there was no significant effect of pain education. CONCLUSIONS Further large, high-quality RCTs using a placebo control such as attention control are required to investigate whether pain education has a true efficacy on pain control or is a placebo effect.
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Affiliation(s)
- Hyun Jung Jho
- Department of Family Medicine, Hospital, National Cancer Center, Goyang, South Korea
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36
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Ripamonti CI, Santini D, Maranzano E, Berti M, Roila F. Management of cancer pain: ESMO Clinical Practice Guidelines. Ann Oncol 2013; 23 Suppl 7:vii139-54. [PMID: 22997447 DOI: 10.1093/annonc/mds233] [Citation(s) in RCA: 297] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- C I Ripamonti
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
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Eriksson K, Wikström L, Lindblad-Fridh M, Broström A. Using mode and maximum values from the Numeric Rating Scale when evaluating postoperative pain management and recovery. J Clin Nurs 2012; 22:638-47. [DOI: 10.1111/j.1365-2702.2012.04225.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quantitative Sensory Testing to assess the sensory characteristics of cancer-induced bone pain after radiotherapy and potential clinical biomarkers of response. Eur J Pain 2012; 16:123-33. [DOI: 10.1016/j.ejpain.2011.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kumar SP. Utilization of brief pain inventory as an assessment tool for pain in patients with cancer: a focused review. Indian J Palliat Care 2011; 17:108-15. [PMID: 21976850 PMCID: PMC3183599 DOI: 10.4103/0973-1075.84531] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The Pain Research Group of the world health organization (WHO) Collaborating Centre for Symptom Evaluation in Cancer Care had developed the Brief Pain Inventory (BPI), a pain assessment tool for use with cancer patients. The BPI measures both the intensity of pain (sensory dimension) and interference of pain in the patient's life (reactive dimension). The objective of this review paper was to provide a detailed update of existing evidence on applicability of BPI in evaluation of patients with cancer pain. The BPI demonstrated good construct and concurrent validity. It was translated and validated into many languages - Brazilian, Chinese, Greek, Hindi, Italian, Japanese, Korean, Malay, Norwegian, Polish, Russian, Spanish, Taiwanese and Thai. The BPI was validated in patient populations such as bone metastases, breast cancer and postoperative cancer patients. The BPI can be used both as a quantitative or a qualitative measure for statistical analysis. The BPI was a powerful tool and, having demonstrated both reliability and validity across cultures and languages, was being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies on the effectiveness of pain treatment. Future studies are warranted on its responsiveness and cross-cultural adaptation into other cancer pain syndromes and into other Indian languages.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College (Manipal University), Mangalore, India
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Gater A, Abetz-Webb L, Battersby C, Parasuraman B, McIntosh S, Nathan F, Piault EC. Pain in castration-resistant prostate cancer with bone metastases: a qualitative study. Health Qual Life Outcomes 2011; 9:88. [PMID: 21992720 PMCID: PMC3222603 DOI: 10.1186/1477-7525-9-88] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 10/12/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bone metastases are a common painful and debilitating consequence of castration-resistant prostate cancer (CPRC). Bone pain may predict patients' prognosis and there is a need to further explore CRPC patients' experiences of bone pain in the overall context of disease pathology. Due to the subjective nature of pain, assessments of pain severity, onset and progression are reliant on patient assessment. Patient reported outcome (PRO) measures, therefore, are commonly used as key endpoints for evaluating the efficacy of CRPC treatments. Evidence of the content validity of leading PRO measures of pain severity used in CRPC clinical trials is, however, limited. METHODS To document patients' experience of CRPC symptoms including pain, and their impact on health-related quality of life (HRQL), semi-structured in-depth qualitative interviews were conducted with 17 patients with CRPC and bone metastases. The content validity of the Present Pain Intensity (PPI) scale from the McGill Pain Questionnaire (MPQ), and the 'Average Pain' and 'Worst Pain' items of the Brief Pain Inventory Short-Form (BPI-SF) was also assessed. RESULTS Patients with CRPC and bone metastases present with a constellation of symptoms that can have a profound effect on HRQL. For patients in this study, bone pain was the most prominent and debilitating symptom associated with their condition. Bone pain was chronic and, despite being generally well-managed by analgesic medication, instances of breakthrough cancer pain (BTcP) were common. Cognitive debriefing of the selected PRO measures of pain severity highlighted difficulties among patients in understanding the verbal response scale (VRS) of the MPQ PPI scale. There were also some inconsistencies in the way in which the BPI-SF 'Average Pain' item was interpreted by patients. In contrast, the BPI-SF 'Worst Pain' item was well understood and interpreted consistently among patients. CONCLUSIONS Study findings support the importance of PRO measures of pain severity as key endpoints for evaluating the efficacy of treatments for CRPC, particularly for patients with bone metastases where episodes of BTcP are common. Qualitative evidence from CRPC patients supports the content validity of the BPI-SF ''Worst Pain' item and promotes use of this item for measuring pain severity in this population.
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Palliation of painful metastatic disease involving bone with imaging-guided treatment: comparison of patients' immediate response to radiofrequency ablation and cryoablation. AJR Am J Roentgenol 2011; 197:510-5. [PMID: 21785102 DOI: 10.2214/ajr.10.6029] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this article was to compare periprocedural analgesic requirements and hospital length of stay for treatment of patients with painful metastatic tumors involving bone using either percutaneous radiofrequency ablation (RFA) or cryoablation. MATERIALS AND METHODS A retrospective review was conducted of patients who underwent either imaging-guided cryoablation or imaging-guided RFA for painful metastatic tumors involving bone. The total analgesic usage for 24 hours after the procedure was expressed as a standard morphine-equivalent dose. Analgesic usage at admission served as a baseline for comparison. Total hospital stay was used as an additional measurement of procedure-related morbidity. RESULTS Fifty-eight patients underwent either cryoablation (n = 36) or RFA (n = 22) for painful metastatic tumors involving bone. Twenty-two primary tumors were treated. The most common treatment site was the pelvis (n = 31). There was no significant difference between the two groups with regard to tumor histologic type (p = 0.52) and location (p = 0.72). The median tumor diameter was 4.4 cm for the cryoablation group and 5.0 cm for the RFA group (p = 0.63). Pretreatment pain scores, measured on a scale of 0 to 10, were not significantly different between the two groups: 6.5 for cryoablation and 6.0 for RFA (p = 0.78). Analgesic use in the 24 hours immediately after the procedure decreased significantly by 24 morphine-equivalent doses after cryoablation, whereas it increased by a median of 22 morphine-equivalent doses after RFA (p = 0.03). Total hospital length of stay for patients undergoing cryoablation was a median of 2.5 days less than that for patients receiving RFA (p = 0.003). CONCLUSION The use of cryoablation compared with RFA is associated with a greater reduction in analgesic dose and shorter hospital stays after the procedure in the perioperative time frame.
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de Bono JS, Logothetis CJ, Molina A, Fizazi K, North S, Chu L, Chi KN, Jones RJ, Goodman OB, Saad F, Staffurth JN, Mainwaring P, Harland S, Flaig TW, Hutson TE, Cheng T, Patterson H, Hainsworth JD, Ryan CJ, Sternberg CN, Ellard SL, Fléchon A, Saleh M, Scholz M, Efstathiou E, Zivi A, Bianchini D, Loriot Y, Chieffo N, Kheoh T, Haqq CM, Scher HI. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med 2011; 364:1995-2005. [PMID: 21612468 PMCID: PMC3471149 DOI: 10.1056/nejmoa1014618] [Citation(s) in RCA: 3191] [Impact Index Per Article: 245.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biosynthesis of extragonadal androgen may contribute to the progression of castration-resistant prostate cancer. We evaluated whether abiraterone acetate, an inhibitor of androgen biosynthesis, prolongs overall survival among patients with metastatic castration-resistant prostate cancer who have received chemotherapy. METHODS We randomly assigned, in a 2:1 ratio, 1195 patients who had previously received docetaxel to receive 5 mg of prednisone twice daily with either 1000 mg of abiraterone acetate (797 patients) or placebo (398 patients). The primary end point was overall survival. The secondary end points included time to prostate-specific antigen (PSA) progression (elevation in the PSA level according to prespecified criteria), progression-free survival according to radiologic findings based on prespecified criteria, and the PSA response rate. RESULTS After a median follow-up of 12.8 months, overall survival was longer in the abiraterone acetate-prednisone group than in the placebo-prednisone group (14.8 months vs. 10.9 months; hazard ratio, 0.65; 95% confidence interval, 0.54 to 0.77; P<0.001). Data were unblinded at the interim analysis, since these results exceeded the preplanned criteria for study termination. All secondary end points, including time to PSA progression (10.2 vs. 6.6 months; P<0.001), progression-free survival (5.6 months vs. 3.6 months; P<0.001), and PSA response rate (29% vs. 6%, P<0.001), favored the treatment group. Mineralocorticoid-related adverse events, including fluid retention, hypertension, and hypokalemia, were more frequently reported in the abiraterone acetate-prednisone group than in the placebo-prednisone group. CONCLUSIONS The inhibition of androgen biosynthesis by abiraterone acetate prolonged overall survival among patients with metastatic castration-resistant prostate cancer who previously received chemotherapy. (Funded by Cougar Biotechnology; COU-AA-301 ClinicalTrials.gov number, NCT00638690.).
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Affiliation(s)
- Johann S de Bono
- Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, United Kingdom.
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Di Staso M, Zugaro L, Gravina GL, Bonfili P, Marampon F, Di Nicola L, Conchiglia A, Ventura L, Franzese P, Gallucci M, Masciocchi C, Tombolini V. A feasibility study of percutaneous radiofrequency ablation followed by radiotherapy in the management of painful osteolytic bone metastases. Eur Radiol 2011; 21:2004-10. [DOI: 10.1007/s00330-011-2133-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/12/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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Chow E, Hoskin P, Mitera G, Zeng L, Lutz S, Roos D, Hahn C, van der Linden Y, Hartsell W, Kumar E. Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Int J Radiat Oncol Biol Phys 2011; 82:1730-7. [PMID: 21489705 DOI: 10.1016/j.ijrobp.2011.02.008] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 01/24/2011] [Accepted: 02/03/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. METHODS AND MATERIALS A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. RESULTS Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. CONCLUSION An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.
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Affiliation(s)
- Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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Zeng L, Chow E, Zhang L, Culleton S, Holden L, Jon F, Khan L, Tsao M, Barnes E, Danjoux C, Sahgal A. Comparison of pain response and functional interference outcomes between spinal and non-spinal bone metastases treated with palliative radiotherapy. Support Care Cancer 2011; 20:633-9. [PMID: 21476118 DOI: 10.1007/s00520-011-1144-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 03/28/2011] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study was to compare functional interference and pain response outcomes using the Brief Pain Inventory (BPI) for patients treated with palliative radiotherapy to spine versus non-spine bones and determine if dose fractionation was associated with each group's respective response. MATERIALS AND METHODS Patients treated for painful bone metastases with palliative radiotherapy during May 2003 to June 2007 were analyzed. The BPI was utilized at baseline and monthly for 6 months post-radiation. Pain response was determined using International Bone Metastases Consensus response definitions. Wilcoxon rank-sum test (for continuous variable), Fisher exact test (for categorical value), and two-way analysis of variance were used for comparisons, and a p value of ≤ 0.05 was considered statistically significant. RESULTS Three hundred eighty-six patients were analyzed, 62% were treated with a single fraction, 38% with multiple fractions. Pain and functional interference scores significantly improved over time in both spine and non-spine sites. At 3 months, 42% of all patients had a partial response, and 25% had a complete response. Location of bone metastases and radiotherapy dose were not predictive factors for pain response nor functional interference following radiation treatment. CONCLUSION Spine and non-spine bone metastases exhibited similar pain and functional interference improvements over a period of 6 months post-radiotherapy. There were, however, high attrition rates as expected with palliative studies, with approximately half the patients remaining in this study by 3 months and a fifth by 6 months. A single 8 Gy resulted in equal benefits in terms of both pain response and improvement in function.
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Affiliation(s)
- Liang Zeng
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Trajectories of pain and analgesics in oncology outpatients with metastatic bone pain during participation in a psychoeducational intervention study to improve pain management. THE JOURNAL OF PAIN 2011; 12:652-66. [PMID: 21429811 DOI: 10.1016/j.jpain.2010.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/27/2010] [Accepted: 12/08/2010] [Indexed: 01/22/2023]
Abstract
UNLABELLED A large number of oncology patients with bone metastasis report significant and often unrelieved pain that is associated with reduced quality of life and impaired functional status. Our research team previously assessed the efficacy of a tailored self-care psychoeducational intervention to improve pain management in these patients. Samplewide analyses demonstrated improvements in pain intensity and analgesic prescriptions. However, substantial interindividual variability was observed within the intervention group. In the current paper, hierarchical linear modeling (HLM) was used to determine factors that contributed to variability in pain intensity and analgesic prescription and intake in the sample of patients who participated in the intervention. Specifically, HLM analyses identified demographic, clinical, and psychological characteristics that predicted variation in pain intensity and analgesic prescription and intake at baseline (intercepts) and over the course of the 6-week study (trajectories). Awareness of these predictors may be particularly useful for the identification of patients who would benefit most from this type of intervention. Furthermore, these findings highlight specific aspects of the intervention that may be modified in order to further improve pain management in these patients. PERSPECTIVE This paper describes the application of HLM to explain interindividual variability in pain and analgesic outcomes among oncology outpatients with metastatic bone pain who participated in a psychoeducational intervention to improve pain management. Findings identify particularly responsive subgroups, areas for improvement to the intervention, and targets for future intervention.
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Nguyen J, Chow E, Zeng L, Zhang L, Culleton S, Holden L, Mitera G, Tsao M, Barnes E, Danjoux C, Sahgal A. Palliative response and functional interference outcomes using the Brief Pain Inventory for spinal bony metastases treated with conventional radiotherapy. Clin Oncol (R Coll Radiol) 2011; 23:485-91. [PMID: 21353506 DOI: 10.1016/j.clon.2011.01.507] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 11/09/2010] [Accepted: 12/14/2010] [Indexed: 01/14/2023]
Abstract
AIMS To report pain and functional interference responses in patients radiated for painful spinal metastases, and to determine if location within the vertebral column or dose fractionation are associated with response. MATERIALS AND METHODS Patients treated with palliative radiotherapy for symptomatic spinal metastases from May 2003 to June 2005 were analysed. All patients completed the Brief Pain Inventory (BPI) assessment tool at 1, 2 and 3 months after radiotherapy. The pain response was determined using the International Bone Metastases Consensus response definitions. Given seven BPI functional interference items, a Bonferroni adjusted P value of less than 0.007 was considered significant. RESULTS One hundred and nine treated patients were assessed. About 50% of patients were treated with a single fraction of 8Gy. All pain scores and functional interference scores significantly decreased over time after radiotherapy. At 3 months, 64% of patients achieved a response. Mood was significantly improved for responders (P=0.003) and a trend in improvement was observed for general activity (P=0.01) and normal work (P=0.04). Breast and prostate primaries were more likely to achieve an early response as compared with a lung primary. Neither location within the vertebral column or radiotherapy dose fractionation independently predicted for pain or functional interference responses. CONCLUSION Conventional radiotherapy with 8Gy in a single fraction for spine metastases resulted in effective palliation of pain at 3 months and had a positive effect on a patient's mood. Location within the spine was not a predictive factor.
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Affiliation(s)
- J Nguyen
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
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Trajectories of pain and analgesics in oncology outpatients with metastatic bone pain. THE JOURNAL OF PAIN 2011; 12:495-507. [PMID: 21310669 DOI: 10.1016/j.jpain.2010.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 09/27/2010] [Accepted: 10/26/2010] [Indexed: 11/20/2022]
Abstract
UNLABELLED A large proportion of oncology outpatients with bone metastasis report unrelieved pain that significantly interferes with daily functioning and quality of life. However, little is known about the longitudinal pattern of pain intensity and analgesic prescriptions or use. Moreover, despite considerable advantages, the use of sophisticated statistical techniques, such as hierarchical linear modeling (HLM) has not been applied to the study of pain and analgesic outcomes. In a prospective longitudinal study, HLM was used to explore predictors of pain intensity and analgesic prescription and intake at the time of enrollment into the study (intercept) and over the course of 6 weeks (trajectory) in a sample of oncology outpatients with bone metastasis who received standard care for pain. In addition to corroborating known predictors of pain intensity, previously unrecognized variables were found that appear to affect both pain and analgesic outcomes. Importantly, some of the predictors of the trajectories of pain intensity and analgesic use (ie, pain-related distress and Pain Management Index (PMI) scores) are particularly amenable to interventions. Findings from this study suggest that sophisticated statistical modeling can be used in pain research to identify individual risk factors and propose novel targets that can be used to improve pain management in oncology outpatients with bone metastasis. PERSPECTIVE Findings from this study suggest that a large amount of inter-individual variability exists in patients' experiences with cancer pain and analgesic use. Future studies need to elucidate the mechanisms that underlie these differences.
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Patterns of pain and functional improvement in patients with bone metastases after conventional external beam radiotherapy and a telephone validation study. PAIN RESEARCH AND TREATMENT 2011; 2011:601720. [PMID: 22110927 PMCID: PMC3197188 DOI: 10.1155/2011/601720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 12/22/2010] [Indexed: 11/17/2022]
Abstract
Patients experiencing lower body pain resulting from bone metastases have greater levels of functional interference than those with upper body pain. The purpose of this study was to assess the levels of interference caused by pain after treatment with conventional radiotherapy using the Brief Pain Inventory (BPI) and to validate this tool for telephone use. After radiotherapy, a total of 159, 129, and 106 patients completed the BPI over the telephone at months 1, 2, and 3, respectively. Cronbach's alpha, confirmatory factor analysis, and discriminant validity tests were performed to assess the validity of the BPI. One-way ANOVA was used to compare BPI scores. There was no statistically significant difference in functional interference among patients after treatment. Internal consistency of the BPI was high. Functional interference may be inherently higher in patients with pain in the lower body. Telephone use of the BPI is reliable and recommended in this population.
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Characterization of cancer-induced bone pain: an exploratory study. Support Care Cancer 2010; 19:1393-401. [PMID: 20680354 DOI: 10.1007/s00520-010-0961-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Cancer-induced bone pain (CIBP) is the commonest cause of pain in patients with cancer. Its association with increased morbidity combined with limitations of currently available therapies makes it a clinical challenge. Clinical characterization of this complex pain syndrome is essential in underpinning clinical management and informing future research. The aim of this exploratory study was to characterise CIBP using self-rating scales. PATIENTS AND METHODS A cross-sectional survey of patients with CIBP was carried out in a regional oncology centre. Patients described their pain over the preceding 24 h using the McGill Pain Questionnaire, Brief Pain Inventory (BPI), and a breakthrough pain questionnaire. Multiple linear regression analyses were conducted. RESULTS Fifty-five patients were recruited. Annoying, gnawing, aching, and nagging were the most commonly used words to describe CIBP. From the BPI, median average pain was 4/10 and worst pain was 7/10 on a 0-10 Numerical Rating Scale. The worst pain score correlated more strongly with BPI interference score (p=0.001). Forty-one patients had breakthrough pain. Patients with breakthrough pain had higher total BPI interference scores than those with no breakthrough pain; median (IQR); 35.0 (2.5-44.7) vs. 18.5 (5.5-26.7), p<0.01. Of the patients, 20/41 (48%) had breakthrough pain of rapid onset (less than 5 min) and short duration (less than 15 min). CONCLUSION In CIBP, worst pain most accurately reflects the characteristics of pain flares and functional impairment. Breakthrough pain is often unpredictable, sudden onset and short duration. Further characterization studies of CIBP in the broader cancer population are needed.
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