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Cabezón-Gutiérrez L, Álamo-González C, Monge-Martín D, Caballero-Martínez F. Analyzing Differences in Perception between Oncologists and Patients to Adapt Pharmacological Treatment for Breakthrough Cancer Pain: Observational ADAPTATE Study. J Palliat Med 2022; 25:925-931. [DOI: 10.1089/jpm.2021.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luis Cabezón-Gutiérrez
- Medical Oncology Department, University Hospital of Torrejón, Torrejón de Ardoz, Madrid, Spain
| | | | - Diana Monge-Martín
- Research Unit, Faculty of Medicine, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
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Villegas Estévez F, López Alarcón MD, Alonso Babarro A, Olay Gayoso L, de Castro J, Lería-Gelabert M, Melogno-Klinkas M. Breakthrough cancer pain treatment in Spain: physicians' perception of current opioids utilization and prescription. Curr Med Res Opin 2020; 36:1383-1391. [PMID: 32453602 DOI: 10.1080/03007995.2020.1775073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Multiple reasons for suboptimal treatment of breakthrough cancer pain (BTcP) have been reported in the literature. We aimed to ascertain the perception of physicians on the potential inappropriate use and prescription of rapid-onset opioids (ROOs) for breakthrough cancer pain (BTcP) and the causes thereof.Methods: Observational study based on an online survey addressed to doctors from different specialties (radiation oncology, medical oncology, anesthesia, palliative care and general practitioners) with experience in the management of BTcP in the Spanish public health setting.Results: A total of 114 eligible specialists mainly from radiation oncology (37.7%), medical oncology (24.6%) and pain units (18.4%) participated in the study. Most agreed on important aspects of BTcP management, such as their preference for ROOs or the need for early follow-up after treatment initiation. However, their answers revealed a lack of standardization of BTcP diagnosis. Half of respondents believed that their BTcP patients might misuse ROOs. Physicians polled believed that lack of training in pain management (71.9%) and inadequate BTcP diagnosis and evaluation (66.7%) were the greatest obstacles for prescribing opioids. Specialists also thought that they do not provide the necessary information to patients (51.8%) and caregivers (57.9%) to guarantee the correct use of these drugs.Conclusions: These results are of utmost importance as they highlight the need to increase physicians' awareness of BTcP and its management and the need to improve communication with patients and their caregivers. Our findings also indicate the need for future research on the possible misuse of opioids in BTcP patients and its causes.
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Affiliation(s)
| | | | | | - Luis Olay Gayoso
- Radiation Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier de Castro
- Medical Oncology Department, Hospital Universitario la Paz, Madrid, Spain
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Camps Herrero C, Batista N, Díaz Fernández N, Escobar Álvarez Y, Gonzalo Gómez A, Isla Casado D, Salud A, Terrasa Pons J, Guillem Porta V. Breakthrough cancer pain: review and calls to action to improve its management. Clin Transl Oncol 2020; 22:1216-1226. [DOI: 10.1007/s12094-019-02268-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/08/2019] [Indexed: 02/04/2023]
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Camps Herrero C, Antón Torres A, Cruz-Hernández JJ, Carrato A, Constenla M, Díaz-Rubio E, Feyjoo Saus M, Garcia-Foncillas J, Gascón P, Guillem V. Working towards a consensus on the oncological approach of breakthrough pain: a Delphi survey of Spanish experts. J Pain Res 2019; 12:2349-2358. [PMID: 31534359 PMCID: PMC6681159 DOI: 10.2147/jpr.s203903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose There is a lack of standards for the diagnosis, assessment and management of breakthrough cancer pain (BTcP). La Fundación ECO (the Foundation for Excellence and Quality in Oncology) commissioned a study to establish a consensus and lay the foundations for the appropriate management of BTcP in oncology patients. Patients and methods A modified Delphi survey comprising two rounds was used to gather and analyze data, which was conducted over the Internet. Each statement that reached a consensus with the respondents was defined as a median consensus score (MED) of ≥7, and agreement among panelists as an interquartile range (IQR) of ≤3. Results In total, 69 medical oncologists responded, with a broad consensus that BTcP implied exacerbations of high-intensity pain, as opposed to moderate pain. Furthermore, they concurred that appropriate diagnostic equipment is needed, and that rapid-onset fentanyl formulations should be the preferred treatment for BTcP management. The panelists agreed that a lack of appropriate information and training to attend to patients, as well as limited patient visitation rights, were barriers to effective BTcP management. Regarding gaps in detected knowledge, the panelists were unsure of the measures necessary to assess the burden of the disease on the patient’s quality of life and associated medication costs. Alongside this, there was a lack of awareness of the technical specifics of the different formulations of rapid-onset fentanyl. Conclusion These results represent the current status of BTcP management. They may inform recommendations and provide a framework for future research.
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Affiliation(s)
- Carlos Camps Herrero
- Jefe de Servicio de Oncología Médica, Consorcio Hospital General Universitario, Valencia, Spain
| | - Antonio Antón Torres
- Jefe del Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Alfredo Carrato
- Jefe del Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Manuel Constenla
- Jefe de Servicio de Oncología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Eduardo Díaz-Rubio
- Jefe del Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Jesus Garcia-Foncillas
- Jefe de Servicio de Oncología Médica, Hospital Universitario "Fundación Jiménez Díaz", Madrid, Spain
| | - Pere Gascón
- Jefe del Servicio de Oncología Médica, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Vicente Guillem
- Jefe del Servicio de Oncología Médica, Instituto Valenciano de Oncología, Valencia, Spain
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García-Mata J, Álamo C, de Castro J, Contreras J, Gálvez R, Jara C, Llombart A, Pérez C, Sánchez P, Traseira S, Cruz JJ. A survey of perceptions, attitudes, knowledge and practices of medical oncologists about cancer pain management in Spain. Clin Transl Oncol 2018; 20:1061-1071. [PMID: 29721765 DOI: 10.1007/s12094-017-1826-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/23/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To monitor oncologists' perspective on cancer pain management. METHODS An anonymized survey was conducted in two waves. First, over a convenience sample of oncologists known to be particularly concerned with the management of pain. Second, using a random sample of oncologists. RESULTS In total, 73 and 82 oncologists participated in the first and second wave, respectively. Many oncologists reported to have good knowledge of analgesic drugs (95.9%), the mechanism of action of opioids (79.5%), and good skills to manage opioid-related bowel dysfunction (76.7%). Appropriate adjustment of background medication to manage breakthrough pain was reported by 95.5% of oncologists. Additionally, 87.7% (68.3% in the second wave, p = 0.035) of oncologists reported suitable opioid titration practices, and 90.4% reported to use co-adjuvant medications for neuropathic pain confidently. On the other hand, just 9.6% of oncologists participated in multidisciplinary pain management teams, and merely 30.3 and 27.1% reported to routinely collaborate with the Pain Clinics or involve other staff, respectively. Only 26.4% of the oncologists of the second wave gave priority to pain pathophysiology to decide therapies, and up to 75.6% reported difficulties in treating neuropathic pain. Significantly less oncologists of the second wave (82.9 vs. 94.5%, p = 0.001) used opioid rotation routinely. CONCLUSIONS Unlike in previous surveys, medical oncologists reported in general good knowledge and few perceived limitations and barriers for pain management. However, multi-disciplinary management and collaboration with other specialists are still uncommon. Oncologists' commitment to optimize pain management seems important to improve and maintain good practices.
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Affiliation(s)
- Jesús García-Mata
- Medical Oncology Department, Santa María Nai Hospital, Orense, Spain
| | - Cecilio Álamo
- Department of Pharmacology, University of Alcalá de Henares, Madrid, Spain
| | | | - Jorge Contreras
- Radiotherapeutic Oncology Department, Carlos Haya Hospital, Málaga, Spain
| | - Rafael Gálvez
- Pain Clinic and Palliative Care Unit, Virgen de las Nieves Hospital, Granada, Spain
| | - Carlos Jara
- Medical Oncology Department, Alcorcón Hospital, Madrid, Spain
| | - Antonio Llombart
- Medical Oncology Department, Arnau de Vilanova Hospital, Valencia, Spain
| | | | - Pedro Sánchez
- Medical Oncology Department, Specialty Hospital, Jaén, Spain
| | - Susana Traseira
- Medical Department, Mundipharma Pharmaceuticals, Madrid, Spain
| | - Juan-Jesús Cruz
- Hospital Universitario de Salamanca-Universidad de Salamanca (USAL), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
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Butow P, Sharpe L. The impact of communication on adherence in pain management. Pain 2013; 154 Suppl 1:S101-S107. [DOI: 10.1016/j.pain.2013.07.048] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 07/19/2013] [Accepted: 07/25/2013] [Indexed: 11/15/2022]
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Muñoz Fernández S, Lázaro y De Mercado P, Alegre López J, Almodóvar González R, Alonso Ruiz A, Ballina García FJ, Bilbao Cantarero AM, Cabañas Sáenz M, García-Vicuña R, Mínguez Vega M, Padró Blanch I, Román Ivorra JA, Roncal Marqueta E. Quality of care standards for nursing clinics in rheumatology. ACTA ACUST UNITED AC 2013; 9:206-15. [PMID: 23688844 DOI: 10.1016/j.reuma.2012.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/10/2012] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing clinics in rheumatology (NCR) are organizational models in the field of nursing care. There are various NCR models, but there is no consensus on its operational definition. Our objective is to develop quality standards to define and characterize a NCR. METHOD Two-round Delphi method. The panel consisted of 67 experts: Rheumatologists and nurses of the nursing working group of the Spanish Society of Rheumatology (SSR). The Delphi questionnaire was developed after a literature and experience review from previous SSR projects. The questionnaire consists of 7 sections: general considerations, standards of structure, process, treatment and monitoring, health education, training and research and quality of care. Each item was scored from 1 (least important) to 9 (most important) or by assigning a number (e.g., waiting days). The degree of agreement among the experts was categorized according to the coefficient of variation (CoV) between very high (CoV≤25%) and very low (CoV>100%). RESULTS The second round questionnaire (182 items) was answered by 46 panelists (34 rheumatologists and 12 nurses). A very important agreement was reached on the general standards of structure, process, treatment and monitoring, health education and quality of care. Less agreement was observed on standards related to training time, number of recommended nurses' research projects and publications. CONCLUSION The standards developed in this study would be useful for establishing desirable quality standards of structure and process, and criteria for clinical work, research and teaching that can be used to develop and evaluate the NCRs.
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Margarit C, Juliá J, López R, Anton A, Escobar Y, Casas A, Cruz JJ, Galvez R, Mañas A, Zaragozá F. Breakthrough cancer pain - still a challenge. J Pain Res 2012. [PMID: 23204865 PMCID: PMC3508660 DOI: 10.2147/jpr.s36428] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Breakthrough cancer pain is defined as transient pain exacerbation in patients with stable and controlled basal pain. Although variable, the prevalence of breakthrough cancer pain is high (33%–95%). According to the American Pain Foundation, breakthrough pain is observed in 50%–90% of all hospitalized cancer patients, in 89% of all patients admitted to homes for the elderly and terminal-patient care centers, and in 35% of all ambulatory care cancer patients. The management of breakthrough cancer pain should involve an interdisciplinary and multimodal approach. The introduction of new fentanyl formulations has represented a great advance and has notably improved treatment. Among these, the pectin-based intranasal formulation adjusts very well to the profile of breakthrough pain attacks, is effective, has a good toxicity profile, and allows for convenient dosing – affording rapid and effective analgesia with the added advantage of being easily administered by caregivers when patients are unable to collaborate.
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Affiliation(s)
- Cesar Margarit
- Pain Unit, Alicante University General Hospital, Alicante, Spain
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Antón A, Montalar J, Carulla J, Jara C, Batista N, Camps C, Cassinello J, Sanz-Ortiz J, Díaz-Rubio E, Martínez C, Ledesma F, Zubillaga E. Pain in clinical oncology: patient satisfaction with management of cancer pain. Eur J Pain 2011; 16:381-9. [PMID: 22337158 DOI: 10.1002/j.1532-2149.2011.00036.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite effective analgesic therapy, inadequate pain control is frequently perceived by patients and caregivers. AIMS To assess satisfaction with management of pain in cancer patients. METHODS Between January and May 2007, a cross-sectional multicentre study was conducted in 64 Medical Oncology Departments throughout Spain. A total of 525 outpatients with oncological diseases completed a questionnaire with demographic data, characteristics and intensity of pain, and perceptions and attitudes towards pain management at the time of a routine clinical visit. Physicians also completed a questionnaire with tumour-related and treatment-related data. Cluster analysis was used to classify patients into three groups (satisfied, neither satisfied nor dissatisfied or neutral, dissatisfied) according to pain intensity and satisfaction with treatment. RESULTS Patients satisfied with their analgesic treatment (33%) had lower pain intensities and, when regularly asked about their pain, considered their physicians to be more involved in their treatment. Neither satisfied nor dissatisfied patients (neutral) (44%) had higher mean pain intensities. Two-thirds of them achieved marked relief of their pain and also thought that physicians were aware of their situation. Dissatisfied patients (23%) had moderate to severe pain intensities, and said that they were asked less frequently about their pain, and thought that their physicians were less involved in their analgesic treatment. CONCLUSION Physician-patient communication and information provided to patients are essential aspects of patient perceptions and attitudes towards control of cancer-related pain. Pain is seen as a condition that may be controlled but affects the capacity to lead a normal life.
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Affiliation(s)
- A Antón
- Service of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Professional survey on knowledge and clinical patterns of pain management in Spanish medical oncology. Clin Transl Oncol 2010; 12:819-24. [PMID: 21156412 DOI: 10.1007/s12094-010-0603-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Cancer pain is still not treated adequately. The barriers impeding its appropriate treatment include lack of knowledge, erroneous beliefs and inappropriate attitudes with regard to pain, which are sustained by some or all of those involved in the problem. The present study shows the results of an exploratory survey using a large sample of specialists in clinical oncology. Its main objective is to evaluate daily analgesic practices and compliance with clinical guidelines in order to identify areas that should be improved in this particular therapeutic field. Information collection from the responders was in the form of a self-administered written questionnaire, structured in three thematic areas: clinical patterns and resources used in pain treatment in clinical practice, pain and pain-relief therapy, and theoretical knowledge and decision-making in clinical practice. The study identified those skills that most need improvement in the treatment of pain (scientific and technical knowledge and clinical decision-making capacity of professionals) in order to reduce the unjustified variability in current clinical practice.
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Kwekkeboom KL, Hau H, Wanta B, Bumpus M. Patients' perceptions of the effectiveness of guided imagery and progressive muscle relaxation interventions used for cancer pain. Complement Ther Clin Pract 2008; 14:185-94. [PMID: 18640630 DOI: 10.1016/j.ctcp.2008.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Relaxation and guided imagery are useful strategies for cancer pain; however, their effects vary from patient to patient. Patients' perceptions of these treatments and factors that contribute to their effectiveness have not previously been described. Data from interviews conducted after a trial of guided imagery and progressive muscle relaxation (PMR) interventions were analyzed to compare patients' perceptions of treatment effects with observed changes in pain scores, and to explore patients' ideas about factors that contributed to the effectiveness of each intervention. Post-study interviews were conducted with 26 hospitalized patients with cancer pain who had completed trials of guided imagery and PMR. In most cases, participants' perceptions of treatment effects matched observed changes in pain scores. Participants described treatment and patient characteristics that influenced effectiveness of the interventions such as active involvement in the intervention, guided instructions, providing a source of distraction, stimulating relaxation, individual abilities and preferences, and pain qualities.
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Affiliation(s)
- Kristine L Kwekkeboom
- University of Wisconsin-Madison, School of Nursing, K6/336 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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