The need for a multidisciplinary approach to pain management in advanced cancer: A clinical case

Didwaniya, Neha; Tanco, Kimberson; Cruz, Maxine Grace De La; Bruera, Éduardo

doi:10.1017/s1478951514000108

“…This information has been reported before by our team [13,17]. It is probably related to the interdisciplinary management of the patients, with careful titration ofopioidsandavoidanceofdose escalation.Ourgroup has found previously that at the initial visit, CAGE-positive patients arrived with higher opioid dose, but follow-up with the palliative care team successfully controlled opioid escalation [9,[17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…We also reviewed the medical records of the patients to evaluate documentation of chemical coping by the physicians and to collect demographic and clinical variables that may have had any correlation with diagnosing chemical coping. Chemical coping has been diagnosed regularly by our team of highly experienced, board-certified palliative medicine specialists and has been the subject of multiple publications [4,9,13,[15][16][17][18][19].…”

Section: Study Participants and Proceduresmentioning

confidence: 99%

Frequency, Predictors, and Medical Record Documentation of Chemical Coping Among Advanced Cancer Patients

Kwon

¹

,

Tanco

²

,

Park

³

et al. 2015

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Background. In this prospective study, we determined the frequency of opioid-related chemical coping among advanced cancer patients, as diagnosed by palliative medicine specialists. We also determined predictors for chemical coping and the concordance between the physician's diagnosis and documentation in the medical records. Patients and Methods. Palliative medicine specialists evaluated and diagnosed consecutive patients seen for chemical coping. The proportion of patients identified as chemically coping was compared with the proportion documented in the medical records. Demographic data; cancer diagnosis; history of smoking; substance abuse; psychiatric disease; morphine equivalent daily dosage; Cut-down, Annoyed, Guilty, and Eyeopener (CAGE) questionnaire scores; and Edmonton Symptom Assessment System scores were also collected. Results. A total of 432 patients were evaluated. Overall, 76 patients (18%; 95% confidence interval [CI]: 14%-21%) were

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“…This information has been reported before by our team [13,17]. It is probably related to the interdisciplinary management of the patients, with careful titration ofopioidsandavoidanceofdose escalation.Ourgroup has found previously that at the initial visit, CAGE-positive patients arrived with higher opioid dose, but follow-up with the palliative care team successfully controlled opioid escalation [9,[17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…We also reviewed the medical records of the patients to evaluate documentation of chemical coping by the physicians and to collect demographic and clinical variables that may have had any correlation with diagnosing chemical coping. Chemical coping has been diagnosed regularly by our team of highly experienced, board-certified palliative medicine specialists and has been the subject of multiple publications [4,9,13,[15][16][17][18][19].…”

Section: Study Participants and Proceduresmentioning

confidence: 99%

Frequency, predictors and medical record documentation of chemical coping among advanced cancer patients.

Tanco

¹

,

Kwon

²

,

Park

³

et al. 2015

JCO

Self Cite

View full text Add to dashboard Cite

Background. In this prospective study, we determined the frequency of opioid-related chemical coping among advanced cancer patients, as diagnosed by palliative medicine specialists. We also determined predictors for chemical coping and the concordance between the physician's diagnosis and documentation in the medical records. Patients and Methods. Palliative medicine specialists evaluated and diagnosed consecutive patients seen for chemical coping. The proportion of patients identified as chemically coping was compared with the proportion documented in the medical records. Demographic data; cancer diagnosis; history of smoking; substance abuse; psychiatric disease; morphine equivalent daily dosage; Cut-down, Annoyed, Guilty, and Eyeopener (CAGE) questionnaire scores; and Edmonton Symptom Assessment System scores were also collected. Results. A total of 432 patients were evaluated. Overall, 76 patients (18%; 95% confidence interval [CI]: 14%-21%) were diagnosed as chemically coping. Documentation of chemical coping in the medical records was reported for only 15 patients (4%; 95% CI: 2%-6%). CAGE positivity (odds ratio [OR]: 2.89), younger age (OR: 0.97 per year), better performance status (OR: 0.68 per point), pain (OR: 1.20 per point), and well-being (OR: 1.28 per point) were found to be significant predictors of chemical coping by protocol definition. After recursive partitioning, 21 of 50 patients (42%) who were CAGE positive and had an Eastern Cooperative Oncology Group performance status #2 were diagnosed as chemically coping. Conclusion. Approximately 18% of palliative care patients seen were diagnosed as chemically coping by palliative medicine specialists. The frequency of documentation in the medical records was significantly lower. Better and safer ways for physicians to assess and report chemical coping are needed.

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“…Cancer pain may correspond to nociceptive pain, generally relieved by the administration of opioid analgesics, neuropathic pain, requiring the use of specific medications such as anticonvulsants or antidepressants, and often mixed pain. [4–6] …”

Section: Introductionmentioning

confidence: 99%

Successful treatment of refractory cancer pain with morphine and ropivacaine

Li

¹

,

Yang²,

Guo³

et al. 2017

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Rationale:Pain is one of the most common and distressing symptoms experienced by cancer patients. Cancer pain is a complex phenomenon with physical, psychological, social, and cognitive domains. Although opioids remain a cornerstone of cancer pain management, they are not effective in all patients. This case highlights the successful treatment of an opioid-refractory severe cancer pain crisis with ropivacaine infusion and subsequent rapid tapering of opioid dose.Patient concerns:This report illustrates the use of ropivacaine for cancer pain. A 62-year-old man with metastatic lung cancer was admitted to the hospital with uncontrolled chest-back and abdominal pain.Diagnoses:The patient was diagnosed as refractory cancer pain.Interventions:Successful treatment with morphine and ropivacaine was performed to obtain longer opioid refractory severe cancer pain.Outcomes:At 1, 3, and 6 months postoperative review, 70-75% relief of pain was achieved with overall activity was improved. The analgesic effect was stable during the 6-month follow-up period. No complications were reported during the follow-up period.Lessons:Our report demonstrates that ropivacaine is successful treatment for cancer pain in this case. It will supply us a novel navigation in cancer pain treatments. Meanwhile, this finding still needs additional study for confirmation.

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The need for a multidisciplinary approach to pain management in advanced cancer: A clinical case

Cited by 13 publications

References 26 publications

Frequency, Predictors, and Medical Record Documentation of Chemical Coping Among Advanced Cancer Patients

Frequency, Predictors, and Medical Record Documentation of Chemical Coping Among Advanced Cancer Patients

Frequency, predictors and medical record documentation of chemical coping among advanced cancer patients.

Successful treatment of refractory cancer pain with morphine and ropivacaine

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