Internet-delivered management of pain among cancer treatment survivors (IMPACTS WF-1901)

TPS12151

Background: Pain is a common symptom among cancer patients and often is inadequately treated. Treatment guidelines recommend patients have access to behavioral interventions that educate about pain and pain management. Pain coping skills training (PCST) accomplishes these goals through teaching cognitive and behavioral coping skills shown to reduce pain. When delivered in in-person, PCST can substantially improve chronic pain conditions. Yet, these interventions are underused due to myriad barriers (high costs, shortage of therapists, travel needs). There is a critical need for improved options to help reduce cancer-related pain and related impairment that should include evidence-based PCST interventions capable of overcoming access barriers. To address this need, we developed a web-based PCST program using a novel expert systems approach that retains critical features of in-person PCST in an automated program that requires no therapist. PainTRAINER, is an 8-week, interactive PCST program using tailoring algorithms, a knowledge database, and a virtual coach to guide development of essential skills for coping with chronic pain. Methods: With funding from the NIH HEAL Initiative, we have undertaken a randomized, prospective, comparative effectiveness trial through the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base to determine the impact of painTRAINER on pain outcomes when compared to Enhanced Usual Care (EUC). Participants have a documented diagnosis of invasive cancer who are undergoing anticancer therapy or within 5 years of completing all cancer therapy. Participants must report cancer-related pain most days of the week of 4 or greater on the PROMIS Pain Intensity Scale; with pain of new onset or significantly exacerbated since cancer diagnosis. All participants receive usual care provided by their physician along with pain education materials. PainTRAINER arm participants have access to the painTRAINER program and a tutorial on how to use the program, and complete the painTRAINER modules on their own (1 session/week for 8 weeks). To enhance study access, patients without internet availability are provided a WiFi/cellular-enabled tablet during the intervention period. This trial examines short- and long-term outcomes measured immediately post-intervention and 3- and 6- months post-intervention. Primary outcomes are: pre- to post-intervention change in pain interference/severity. Secondary outcomes are: pain severity/interference at 3- and 6-month follow-up, opioid/analgesic use, health-related quality of life, and pain management self-efficacy. Qualitative interviews are conducted with a random sample of diverse participants who have completed the painTRAINER, and all who exit the study early, to subjectively assess experiences with pain and the clinical trial. Enrollment for this trial has begun (n = 36 of 456 patients enrolled) and is ongoing at 12 sites. Clinical trial information: NCT04462302.

Abnormal serum lipid patterns in primary renal allograft recipients

The blood lipids profile was determined in 59 patients with successful primary renal allografts, who were followed for an average period of 31.8 months (range, 6 to 80 months). Elevated levels of cholesterol (greater than 250 mg/100 ml) were found in 51% of the patients, elevated levels of triglycerides were found in 56%, and elevated levels of phospholipids in all but one of the patients who were studied (45 of 46). Correlation analysis revealed significant relationships among the systolic blood pressure with total cholesterol (r equals 0.36, P less than 0.01), triglycerides (r equals 0.56, p is less than 0.001), and phospholipids (r equals 0.40, P is less than 0.001). No significant correlations were found between the lipid levels and daily prednisone dosage or with the duration of the period following transplantation. The most significant finding in our study was an elevation of serum phospholipid level--a pattern unreported previously in transplant recipients but which has been reported to be associated with hepatic derangement in nontransplant population. Of 32 patients who had elevated levels of serum phospholipids, the liver function tests were abnormal in 22 patients (69%).