Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart

Thronæs, Morten; Raj, Sunil Xavier; Brunelli, Cinzia; Almberg, Sigrun Saur; Vagnildhaug, Ola Magne; Bruheim, Susanna; Helgheim, Birgit; Kaasa, Stein; Knudsen, Anne Kari

doi:10.1007/s00520-015-3064-3

Cited by 15 publications

(11 citation statements)

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“…In our study, 56% of the patients reported pain (47% with local and 65% with advanced disease) compared to a Norwegian study, where the prevalence of pain among inpatients with either local or advanced cancer varied between 53% and 55% and among outpatients between 35% and 39% (26). In the present study, moderate or severe pain was reported by 5% of patients with local disease and 16% of patients with advanced disease.…”

Section: Discussioncontrasting

confidence: 60%

“…Our findings are partly in line with a Norwegian study describing pain intensity in cancer patients treated at a tertiary cancer unit. The authors had concluded that no significant change occurred in experienced pain from 2008 to 2014 (26). There are several possible explanations for the lack of improvement in HRQoL and symptom control in our study.…”

Section: Discussioncontrasting

confidence: 57%

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Cancer Patients' Symptom Burden and Health-related Quality of Life (HRQoL) at Tertiary Cancer Center from 2006 to 2013: A Cross-sectional Study

et al. 2018

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Background/Aim: To observe changes in symptoms and health-related quality of life (HRQoL) over 7 years among cancer patients at different stages of the disease. Patients and Methods: This prospective crosssectional study at the Helsinki University Hospital Cancer Center, was carried out in 2006 and repeated in 2013. All participants filled in the EORTC-QLQ-C30 questionnaire. Results: Altogether, 581 patients responded (49% in 2006 and 54% in 2013). The disease was local in 51% and advanced in 49% of patients. The HRQoL was significantly lower, except for emotional and cognitive functions, and the symptom burden more severe in advanced cancer. The most prevalent symptoms were fatigue (93% and 85%; moderate/severe 22% and 9%), pain (65% and 47%; moderate/severe 16% and 5%), and insomnia (64% and 60%; moderate/severe 20 and 21%), respectively. No changes in HRQoL or symptoms were found at 7 years. Conclusion: There is a need for early integrated palliative care to improve HRQoL during cancer treatments.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussioncontrasting

confidence: 57%

Cancer Patients' Symptom Burden and Health-related Quality of Life (HRQoL) at Tertiary Cancer Center from 2006 to 2013: A Cross-sectional Study

et al. 2018

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“…Despite huge resources allocated for research, teaching, and treatment, pain is still prevalent among patients with cancer (1)(2)(3). Barriers to improved cancer pain management are identified (4,5), strategies to overcome the barriers are demonstrated (6,7), and guidelines for treatment of cancer pain are published (8).…”

Section: Introductionmentioning

confidence: 99%

Pain management index (PMI)—does it reflect cancer patients’ wish for focus on pain?

Thronæs

Balstad

Brunelli

et al. 2019

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Background: The Pain Management Index (PMI) was developed to combine information about the prescribed analgesics and the self-reported pain intensity in order to assess physicians' response to patients` pain. However, PMI has been used to explore undertreatment of cancer pain. The present study explores prevalence of negative PMI and its associations to clinical variables, including the patient-perceived wish for more attention to pain. Methods: A single-centre, cross-sectional observational study of cancer patients was conducted. Data on demographics and clinical variables, as well as patient-perceived wish for more attention to pain, were registered. PMI was calculated. Negative PMI indicates that the analgesics prescribed might not be appropriate to the pain intensity reported by the patient and associations to negative PMI were explored by logistic regression models. Results: 187 patients were included, 53% had a negative PMI score. Negative PMI scores were more frequent among patients with breast cancer (OR=4.2, 95% CI 1.3, 13.5), in a follow-up setting (OR 12.1, 95% CI 1.4, 101.4), and was inversely associated to low performance status (OR 0.14, 95% CI 0.03, 0.65). Twenty-two percent of patients with negative PMI scores reported that they wanted more focus on pain management versus 13 % among patients with a non-negative PMI score; the difference was not statistically significant. Conclusion: A high prevalence of negative PMI was observed, but only 1/5 of patients with a negative PMI wanted more attention to pain by their physician. Our findings challenge the use of PMI as a measure of undertreatment of cancer pain. Methods Study design This is a secondary analysis of a cross-sectional study among cancer in-patients and outpatients conducted in Mid-Norway in 2013-14 (1). Patients included in the study were admitted to St. Olavs Hospital, Trondheim University Hospital, a 800-bed referral centre. In general, cancer patients are treated at the Departments of Oncology, Surgery, Internal Medicine, and Gynaecology. All eligible cancer in-patients admitted to these departments were included at predefined days in the autumn of 2013. Outpatients were included from the Department of Oncology at predefined days in January 2014. Patients Inclusion criteria for the cross-sectional study were: adult cancer patients (age ≤ 18 years), no cognitive impairment (judged by the physician), and able to understand Norwegian language. Patients who had undergone surgical procedures the last 24 hours were excluded to minimize registration of transient symptoms related to surgery and anaesthesia. In the present secondary analysis, only patients who reported pain and /or were using analgesics were eligible. Data collection and assessment Data on primary cancer disease, metastatic pattern, comorbidity, Karnofsky Performance Status (KPS) (25), and current pain medications were collected by health care providers. The patients completed a questionnaire with information on gender, age, marital status, education, symptoms, and wishes for fo...

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“…Pain prevalence and pain control may have changed during the following years [ 36 ]. However, a recent study found no improvement in cancer pain management in a 5-year perspective from 2008 [ 37 ]. Furthermore, the study population is patients with advanced cancer, limiting the generalizability of the conclusions.…”

Section: Discussionmentioning

confidence: 99%

Pain Intensity Factors Changing Breakthrough Pain Prevalence in Patients with Advanced Cancer: A Secondary Analysis of a Cross-Sectional Observational International Study

et al. 2018

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IntroductionDifferent definitions of breakthrough pain (BTP) influence the observed BTP prevalence. This study examined BTP prevalence variability due to use of different cutoffs for controlled background pain, different assessment periods for background pain, and difference between worst and average pain intensity (PI).MethodsCancer patients from the EPCRC-CSA study who reported flare-ups of pain past 24 h were potential BTP cases. BTP prevalence was calculated for different cutoffs for background PI on numeric rating scales (NRS 0–10) for the past week, past 48 and past 24 h period. Furthermore, BTP cases were categorized based on the difference between maximum and average PI past 24 h (range, 0 to > 2 points, NRS 0–10).ResultsOf 696 respondents, 302 patients (43.4%) reported pain flares the past 24 h. The BTP prevalence when using a defined background PI ≤ 4 for the past week was 19.8%. This number varied for different defined cutoffs for background PI. Actual background PI and BTP prevalence also varied between the assessment periods “past week”, “past 48 h”, and “past 24 h” (PI 4.0, 3.6, and 3.4; BTP prevalence 19.8, 22.7, and 24.9% for background PI ≤ 4). For patients with background PI ≤ 4 past week, 105 had a difference between maximum and average PI ≥ one point and 48 had a difference > two points.ConclusionsThe reported BTP prevalence is dependent on the cutoff for background PI in the BTP definition, population background PI during the assessment period, and defined cutoff for the difference between worst and average PI.FundingNTNU, Norwegian University of Science and Technology.

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Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart

Cited by 15 publications

References 38 publications

Cancer Patients' Symptom Burden and Health-related Quality of Life (HRQoL) at Tertiary Cancer Center from 2006 to 2013: A Cross-sectional Study

Cancer Patients' Symptom Burden and Health-related Quality of Life (HRQoL) at Tertiary Cancer Center from 2006 to 2013: A Cross-sectional Study

Pain management index (PMI)—does it reflect cancer patients’ wish for focus on pain?

Pain Intensity Factors Changing Breakthrough Pain Prevalence in Patients with Advanced Cancer: A Secondary Analysis of a Cross-Sectional Observational International Study

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