Inadequate pain management in cancer patients attending an outpatient palliative radiotherapy clinic

Banipal

2017

JGO

PurposeThe objective of this cross-sectional, noninterventional, 6-month observational study was to assess the adequacy of pain management in patients with cancer admitted to the Oncology Department of Guru Gobind Singh Medical College in Faridkot, India.Methods and MaterialsA total of 348 patients with cancer were recruited for evaluation of the prevalence of inadequate cancer pain management using the Brief Pain Inventory Pain Management Index.ResultsThe current study included 127 males (36.5%) and 221 females (63.5%). The most prevalent cancer type was genitourinary; 268 patients (77%) had inadequately managed pain. A significant correlation was observed between poorly managed pain and age groups, analgesic used, and body mass index.ConclusionOur observation of inadequate pain management among 77% of patients indicates that pain management was insufficient in three quarters of the patients in this study. Accumulating data regarding the inadequacy of cancer pain management is crucial to improve symptom management. Better management of pain not only alleviates pain symptoms but also increases the quality of life for patients with cancer.

Section: Discussionmentioning

confidence: 99%

Assessment of Adequacy of Pain Management and Analgesic Use in Patients With Advanced Cancer Using the Brief Pain Inventory and Pain Management Index Calculation

Banipal

2017

JGO

“…Radiation oncologists often treat patients with palliative radiotherapy for painful metastatic and advanced cancers, and patients' pain must be well controlled if they are to tolerate their radiation treatments and optimize quality of life until palliative radiation reaches its full efficacy, a process that can take 2 to 3 weeks. 19 Studies have shown that patients referred for palliative radiotherapy for symptomatic bone metastases are often not taking analgesics or are receiving weak opioids or non-opioids, 20,21 thus making opioid management a critical skill set for radiation oncologists. This skill set is necessarily one that allows flexibility in prescribing between alternative routes and potencies to achieve analgesia across a broad range of clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on National Membership Survey by the American Society for Radiation Oncology (ASTRO).

Wei

Mattes

et al. 2016

JCO

Purpose-Radiation oncologists are frequently involved in providing palliative and supportive care (PSC) for patients with advanced cancers through delivery of palliative radiation. Whether they are confident in their ability to assess and initiate treatments for pain, nonpain, and psychosocial distress is unknown. The American Society for Radiation Oncology surveyed its practicing members in the United States on self-assessment of their primary PSC skills and access to continuing medical education on PSC. Methods HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptResults-The survey was e-mailed to 4093 American Society for Radiation Oncology members, and 649 responses were received (response rate 16%). The majority (91%) of radiation oncologists surveyed believe PSC is an important competency for radiation oncologists. Most radiation oncologists reported that they are moderately confident in their ability to assess and manage pain and gastrointestinal symptoms, but less confident in their ability to manage anorexia, anxiety, and depression. Despite areas of decreased confidence, a large number (42%) of radiation oncologists do not receive any additional PSC education beyond their residency training. Lastly, a perceived fear of upsetting referring medical oncologists and lack of clinic time are concerns for radiation oncologists who may want to initiate goals of care/advance care planning discussions with patients and their families.Conclusion-Radiation oncologists are more confident in their ability to assess and manage pain than in their ability to manage depression, anxiety, anorexia, and fatigue. There is a need for increasing continuing medical educational efforts in PSC for practicing radiation oncologists, and strengthening PSC training in residency programs.

International Journal of Pharmacy Practice

“…Despite the improvement recorded in pain management after using this strategy, evidence indicates that patients living with cancer still experience high levels of pain in situations where it is possible to reduce their suffering . It has been reported that around 25–33% of patients living with cancer are receiving insufficient pain management . In addition, two systematic reviews that assessed the quality of pain management in adult patients with cancer revealed modest improvements in pain management, but stated that one‐third of patients who experience pain continue to be under‐treated …”

Section: Introductionmentioning

confidence: 99%

Pharmacist educational interventions for cancer pain manaaement: a systematic review and meta-analvsis

Edwards

Ziegler

Craigs

et al. 2019

Objectives Educational interventions by pharmacists for patients with cancer pain aim to improve pain management, but little is known about the different components of interventions and their effectiveness. Our aim was to assess the benefit of pharmacist delivered educational interventions for patients with cancer pain. A systematic review and meta‐analysis of experimental trials testing pharmacist delivered educational interventions for cancer pain was carried out to identify the components of interventions and effectiveness at improving pain‐related outcomes for patients with cancer. A literature review was conducted in EMBASE, MEDLINE, CINAHL, PsycINFO, ASSIA, Web of Science and CENTRAL from inception until January 2018 searching for educational interventions involving a pharmacist for patients with cancer pain. Four studies were included involving 944 patients. Meta‐analysis was carried out where possible. Key findings Meta‐analysis of three of the four studies found that mean pain intensity in the intervention group was reduced by 0.76 on a 0–10 scale (95% confidence interval), although only two of the studies used validated measures of pain. Improvements in knowledge, side effects and patient satisfaction were seen although with less reliable measures. Summary Pharmacist educational interventions for patients with cancer pain have been found to show promise in reducing pain intensity. Studies were few and of varying quality. Further, good quality studies should be carried out in this area and these should be comprehensively reported. Trials measuring patient self‐efficacy and patient satisfaction are needed before the impact of the pharmacist delivered interventions on these outcomes can be established.