Multicentre study of cancer pain and its treatment in France

Larue, François; Colleau, Sophie M.; Brasseur, L.; Cleeland, Charles S.

doi:10.1136/bmj.310.6986.1034

Cited by 300 publications

(211 citation statements)

References 7 publications

Supporting

Mentioning

177

Contrasting

Unclassified

Order By: Relevance

“…If this is implemented consistently and proper palliative approaches are maximised, it has been claimed that effective pain control may be achieved in 80% of cancer patients (Perron and Schonwetter, 2001). However, despite the widespread acceptance of this strategy, more than 40% of prostate cancer patients in routine practice settings report the presence of pain (Greenwald et al, 1987;Portenoy, 1989;Larue et al, 1995;Sandblom et al, 2001).Health-related quality of life in the final year of life in terminally ill patients, including men with prostate cancer, has been studied previously (Liao et al, 2000;Litwin et al, 2001;Melmed et al, 2002). However, in order to reach a full understanding of how healthrelated quality of life is affected by approaching death, all patients in a population-based sample must be studied.…”

mentioning

confidence: 99%

A population-based study of pain and quality of life during the year before death in men with prostate cancer

et al. 2004

View full text Add to dashboard Cite

In order to explore how health-related quality of life changes towards the end of life, a questionnaire including the EuroQOl form and the Brief Pain Inventory form was sent to all men with prostate cancer in the county of Ö stergö tland, Sweden, in September 1999. Responders who had died prior to 1 January 2001 were later identified retrospectively. Of the 1442 men who received the questionnaire, 1243 responded (86.2%). In the group of responders, 167 had died within the study period, 66 of prostate cancer. In multivariate analysis, pain as well as death within the period of study were found to predict decreased quality of life significantly. Of those who died of prostate cancer, 29.0% had rated their worst pain the previous week as severe. The same figure for those still alive was 10.5%. On a visual analogue scale (range 0 -100), the mean rating of quality of life for those who subsequently died of prostate cancer was 54.0 (95% confidence interval 75.2) and those still alive was 70.0 (71.2). In conclusion, health-related quality of life gradually declines during the last year of life in men with prostate cancer. This decline may partly be avoided by an optimised pain management. (2004) In recent years, health-related quality of life has become one of the most important end points for studies on men with prostate cancer, especially men with cancer at an advanced stage. Caring for cancer patients in the last years of life requires a good understanding of how health-related quality of life can be improved when efforts to prolong life become increasingly futile. Adequate pain and symptom management, avoidance of inappropriate prolongation of the dying process, achievement of a sense of control, relief of burdens, and the strengthening of relations with loved ones have been found to be the most important domains from the patient's perspective of palliative treatment (Singer et al, 1999). Of all factors affecting health-related quality of life, however, pain is usually considered the most prominent factor for patients approaching death (Elliott, 1997). British Journal of CancerAlthough pain management is fundamental in terminal care (Steinhauser et al, 2000;Wrede-Seaman, 2001), it is often undertreated (Perron and Schonwetter, 2001). According to the World Health Organisation's guidelines for the stepwise management of pain in cancer, the potency of the analgesia provided, ranging from non-opioids and opioids for moderate pain (e.g. dextropropoxyphene, codeine and tramadol) to opioids for severe pain (e.g. morphine, cetobemidone and fentanyl), should be adjusted to the patient's experienced level of pain (WHO, 1986). If this is implemented consistently and proper palliative approaches are maximised, it has been claimed that effective pain control may be achieved in 80% of cancer patients (Perron and Schonwetter, 2001). However, despite the widespread acceptance of this strategy, more than 40% of prostate cancer patients in routine practice settings report the presence of pain (Greenwald et al, 1987;Portenoy, 1989;L...

show abstract

mentioning

confidence: 99%

A population-based study of pain and quality of life during the year before death in men with prostate cancer

et al. 2004

View full text Add to dashboard Cite

show abstract

“…First, each component was Cancer treated as a separate variable (Model 3-1); then, a composite score for the ''adequacy of human resources'' was treated as a single variable (Model 3-2). Independent variables that were included in the multivariate analysis were selected based on a literature review, 8,15,16,[22][23][24] expert opinion, and statistical significance from the bivariate analyses. Likelihood ratio tests were performed to examine model fits.…”

Section: Discussionmentioning

confidence: 99%

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Shin

Hwang

et al. 2012

Cancer

View full text Add to dashboard Cite

BACKGROUND:The assessment of pain management outcomes is important for the quality assurance of palliative care. The objective of this study was to determine whether there are significant variations in pain management outcomes among palliative care centers and whether they are affected by organizational factors. METHODS: Data used in this investigation were from the 2009 Korean Terminal Cancer Patient Information System and administrative records of the 34 inpatient palliative care centers designated by the Korean Ministry of Health and Welfare in 2009. Self-reported pain scores (range, from 0 to 10) at admission and 1 week after admission were prospectively collected. Multilevel mixed-effect regression models were used to analyze the variations and the impact of organizational-level factors on 2 pain management outcomes (ie, reduction in average pain score and achievement of adequate pain control at 1 week after admission). RESULTS: In total, 1711 patients with terminal cancer were included in the analyses. The mean reduction in the pain score was 0.69 to 1.91 after 1 week, and most patients (82.8%) achieved adequate pain control. There were significant variations in pain management outcomes among palliative care centers. Higher composite scores for human resources adequacy were associated significantly with a greater reduction in pain score (b, 0.11; 95% confidence interval, 0.01-0.21), and achievement of adequate pain control (adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.45). CONCLUSIONS: There were significant variations in pain management outcomes among inpatient palliative care centers, and they were affected by organizational factors, such as human resources adequacy. Cancer 2012;118:5688-97.

show abstract

“…1 ' Among patients with cancer (unselected population) 460% suffer from chronic pain. [2][3][4] Pain treatment frequently fails even when the circumstances of care delivery are optimal, such as attentive, well-trained physicians; ready access to opioids; use of adjuvant analgesics; availability of patient-controlled analgesia; and evidence-based use of procedures like nerve blocks and IT pumps. Studies report rates of failure to control pain in cancer patients of 12-66%.…”

Section: Prevalence Of Chronic Painmentioning

confidence: 99%

AAV for pain: steps towards clinical translation

Beutler

Reinhardt

2009

Gene Ther

View full text Add to dashboard Cite

Recombinant adeno-associated virus (rAAV) vectors consisting of self-complementary genomes and packaged in certain capsids can target primary sensory neurons efficiently and can control neuropathic pain long term by expressing opioid or non-opioid analgesic genes. This review examines the therapeutic potential of the approach in five sections: Pain control in oncology (including a discussion of cancer centers as translational pain research environment); vector biology; safety considerations and immunological lessons learned from rAAV clinical trials of other disorders; development of intrathecal rAAV therapy in rodent models of pain; and preclinical steps towards clinical translation of rAAV for pain. In the field of analgesic drug development, clinical validation of new approaches identified in rodents is currently a critical limiting step. Small-molecule therapeutics suitable as conventional drugs to probe novel targets in clinical trials are often unavailable. In this context, gene therapy could fill an important gap in the drug development process facilitating first-into-human trials of untested targeted treatments, each instantiated as a therapeutic gene.

show abstract

Multicentre study of cancer pain and its treatment in France

Abstract: In the light of the high prevalence and the severity of pain among patients with cancer, the assessment and treatment of cancer pain in France remain inadequate, emphasising the need for changes in patient care.

Cited by 300 publications

References 7 publications

A population-based study of pain and quality of life during the year before death in men with prostate cancer

A population-based study of pain and quality of life during the year before death in men with prostate cancer

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

AAV for pain: steps towards clinical translation

Contact Info

Product

Resources

About