Last updated: 6 February 2023
Mercadante S, Grassi Y, Cascio AL, Restivo V, Casuccio A. Characteristics of untreated cancer patients admitted to an acute supportive/palliative care unit [epub ahead of print, 2023 Jan 25]. J Pain Symptom Manage. 2023;S0885-3924(23)00045-3.
Keywords: advanced cancer; anticancer treatments; palliative care; supportive care; symptom burden.
Aim: To assess the characteristics of patients who had never received anticancer treatments at admission of an acute supportive palliative care unit (ASPCU).
Methods: From a consecutive sample of 422 advanced cancer patients, 62 patients with no previous anticancer therapy were selected and compared with a random sample of patients who had received anticancer treatments.
Results: Patients without previous anticancer therapy (14.7%) were mainly admitted to ASPCU for a low KPS and high symptom burden, often waiting for or needing a histological diagnosis to make a decision for the next therapeutic steps. This group of patients were older (P<0.0005), more frequently males (P=0.007), and had more comorbidities (P<0.0005) in comparison with treated patients. Twenty-four per cent of these patients started chemotherapy subsequently. Treatment-naive patients had a higher level of symptom burden, which was less responsive to a comprehensive palliative and more frequently died within three months in comparison with treated patients.
Discussion: Treatment-naive patients showed a higher level of symptom burden, which was less responsive to a comprehensive palliative treatment. In addition they more frequently died within three months in comparison with treated patients.
Uehara Y, Matsumoto Y, Kosugi T, et al. Availability of and factors related to interventional procedures for refractory pain in patients with cancer: a nationwide survey. BMC Palliat Care. 2022;21(1):166.
Keywords: Availability; Interventional procedures; Nationwide survey; Refractory cancer pain; Related factors.
Background: Cancer pain may be refractory to standard pharmacological treatment. Interventional procedures are important for quality of analgesia. The aim of the present study was to clarify the availability of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathecal analgesia), the number of procedures performed by specialists, and their associated factors. In addition, we aimed to establish how familiar home hospice physicians and oncologists are with the different interventional procedures available to manage cancer pain.
Methods: A cross-sectional survey using a self-administered questionnaire was conducted. Subjects were certified pain specialists, interventional radiologists, home hospice physicians, and clinical oncologists.
Results: The numbers of valid responses/mails were 545/1,112 for pain specialists, 554/1,087 for interventional radiology specialists, 144/308 for home hospice physicians, and 412/800 for oncologists. Among pain specialists, depending on intervention, 40.9-75.2% indicated that they perform each procedure by themselves, and 47.5-79.8% had not performed any of the procedures in the past 3 years. Pain specialists had performed the four procedures 4,591 times in the past 3 years. Among interventional radiology specialists, 18.1% indicated that they conduct celiac plexus neurolysis/splanchnic nerve neurolysis by themselves. Interventional radiology specialists had performed celiac plexus neurolysis/splanchnic nerve neurolysis 202 times in the past 3 years. Multivariate analysis revealed that the number of patients seen for cancer pain and the perceived difficulty in gaining experience correlated with the implementation of procedures among pain specialists. Among home hospice physicians and oncologists, depending on intervention, 3.5-27.1% responded that they were unfamiliar with each procedure.
Conclusions: Although pain specialists responded that the implementation of each intervention was possible, the actual number of the interventions used was limited. As interventional procedures are well known, it is important to take measures to ensure that pain specialists and interventional radiology physicians are sufficiently utilized to manage refractory cancer pain.
Ge L, Wang Q, He Y, et al. Acupuncture for cancer pain: an evidence-based clinical practice guideline. Chin Med. 2022;17(1):8.
Keywords: Acupuncture; Cancer pain; Evidence-based practice; Practice guideline
Background: This study aims to develop an evidence-based clinical practice guideline of acupuncture in the treatment of patients with moderate and severe cancer pain.
Methods: The development of this guideline was triggered by a systematic review published in JAMA Oncology in 2020. We searched databases and websites for evidence on patient preferences and values, and other resources of using acupuncture for treatment of cancer pain. Recommendations were developed through a Delphi consensus of an international multidisciplinary panel including 13 western medicine oncologists, Chinese medicine/acupuncture clinical practitioners, and two patient representatives. The certainty of evidence, patient preferences and values, resources, and other factors were fully considered in formulating the recommendations. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the certainty of evidence and the strength of recommendations.
Results: The guideline proposed three recommendations: (1) a strong recommendation for the treatment of acupuncture rather than no treatment to relieve pain in patients with moderate to severe cancer pain; (2) a weak recommendation for the combination treatments with acupuncture/acupressure to reduce pain intensity, decrease the opioid dose, and alleviate opioid-related side effects in moderate to severe cancer pain patients who are using analgesics; and (3) a strong recommendation for acupuncture in breast cancer patients to relieve their aromatase inhibitor-induced arthralgia.
Conclusion: This proposed guideline provides recommendations for the management of patients with cancer pain. The small sample sizes of evidence limit the strength of the recommendations and highlights the need for additional research.
Ozdemir S, Lee JJ, Yang GM, et al. Awareness and utilization of palliative care among advanced cancer patients in Asia [epub ahead of print, 2022 Jun 12]. J Pain Symptom Manage. 2022;S0885-3924(22)00759-X
Keywords: Asia; advanced cancer; awareness; end-of-life; low- and middle-income countries; palliative care; utilization.
Context: To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia.
Objectives: This study aimed to investigate PC awareness and its predictors, utilization of PC services, and perceived utilization barriers among advanced cancer patients from select hospitals in Asian LMICs.
Methods: This cross-sectional study analysed data of 759 advanced cancer patients at major hospitals of four LMICs in Asia (i.e., Bangladesh, Philippines, Sri Lanka, and Vietnam). The predictors of PC awareness were investigated using multivariable logistic regression.
Results: Overall PC awareness was 30.8% (n=234). Patients with higher education (OR=1.0; CI=1.0,1.1), from upper-middle or high-income households (compared to low-income) (OR=2.0; CI=1.2,3.3), awareness of disease severity (OR=1.5; CI=1.0,2.2), and higher pain severity (OR=1.1; CI=1.0,1.2) had higher odds of PC awareness. Compared to patients who perceived themselves as being very informed about disease trajectory, those who were unsure (OR=0.5; CI=0.3,0.8) or uninformed (OR=0.5; CI=0.3,0.9) had lower odds of PC awareness. The PC utilization rate was 35.0% (n=82) among those with PC awareness, and 47.8% (n=66) among patients recommended PC by a healthcare professional (n=138). The most cited PC utilization barriers were currently receiving anti-cancer treatment (n=43; 33.9%), and having insufficient information about PC (n=41; 32.3%).
Conclusion: The low awareness of PC services in these major hospitals in Asian LMICs highlights that more effort may be required to promote the awareness of PC in this region. The efforts should especially focus on those from disadvantaged groups to reduce the gap in PC awareness.
Di Franco R, Cascella M, Fusco M, et al. Management of Metastatic Disease in Campania (MAMETIC): An Observational Multicenter Retrospective and Prospective Trial on Palliative Radiotherapy in an Italian Region. Study Protocol. J Pain Res. 2022;15:1003-101
Keywords: breakthrough cancer pain; cancer pain; metastatic disease; palliative care; quality of life; radiotherapy
Background: In the Italian Campania Region, 30.517 new cases of solid cancer have been diagnosed, in 2019. Of those, patients with metastatic disease are up to 20%. This class of patients is extremely diversified and copious, and the offer of radiotherapy may vary in different geographical areas within the same region. The aim of this observational multicenter retrospective and prospective trial is to evaluate the occurrence of metastatic metastatic cancer patients candidates for palliative radiotherapy in several areas of a great Italian region, the management of the disease through RT approaches, and its impact on cancer-related pain and overall HRQoL.
Methods: This is a multicenter, retrospective and prospective observational investigation. The retrospective part of the study concerns all patients enrolled with a diagnosis of metastatic disease and treated in RT centers within the Campania Region between January 2019 and July 2020. The prospective phase is going to involve all the metastatic patients with an indication of palliative RT. Considering regional epidemiological data, we expect an enrollment of 12.500-21.000 patients in 5 years.
Conclusion: The MAMETIC Trial in an observational study designed for investigating on the use of radiotherapy in patients with advanced disease within a regional area, and for evaluating the local response to the patient's request. It can be a unique opportunity, not only to highlight possible geographic differences but also to regularly collect and share data to standardize the therapeutic offer within the regional area. ClinicalTrials.gov ID NCT04595032, retrospectively registered.
Somogyi AA, Musolino ST, Barratt DT. New pharmacological perspectives and therapeutic options for opioids: Differences matter [epub ahead of print, 2022 Feb 3]. Anaesth Intensive Care.
Keywords: Anaesthesia; acute; cancer; opioid; pain; pharmacodynamics; pharmacology; reviews
Opioids remain the major drug class for the treatment of acute, chronic and cancer pain, but have major harmful effects such as dependence and opioid-induced ventilatory impairment. Although no new typical opioids have come onto the market in the past almost 50 years, a plethora of new innovative formulations has been developed to meet the clinical need. This review is intended to shed light on new understanding of the molecular pharmacology of opioids, which has arisen largely due to the genomic revolution, and what new drugs may become available in the coming years. Atypical opioids have and are being developed which not only target the mu opioid receptor but other targets in the pain pathway. Biased mu agonists have been developed but remain 'unbiased' clinically. The contribution of drugs targeting non-mu opioid receptors either alone or as heterodimers shows potential promise but remains understudied. That gene splice variants of the mu opioid receptor produce multiple receptor isoforms in different brain regions, and may change with pain chronicity and phenotype, presents new challenges but also opportunities for precision pain medicine. Finally, that opioids also have pro-inflammatory effects not aligned with mu opioid receptor binding affinity implicates a fresh understanding of their role in chronic pain, whether cancer or non-cancer. Hopefully, a new understanding of opioid analgesic drug action may lead to new drug development and better precision medicine in acute and chronic pain relief with less patient harm.
Wu CC, et al. Bibliometric analysis of research on the comorbidity of cancer and pain. J Pain Res. 2021;14:213-228.
Keywords: CiteSpace; Cancer; Global trend; Pain.
Background: Pain is the most common symptom in patients with neoplasm. It is a distressing experience that seriously destructs the quality-of-life of patients, with a high prevalence in clinical observations. However, only a few studies have applied bibliometric methods to analyze systematic works on the comorbidity of cancer and pain.
Purpose: The aim of this work was to conduct a systematic analysis of the scientific studies worldwide on the comorbidity of cancer and pain in 2010-2019.
Methods: The Web of Science databases were searched for publications related to the comorbidity of cancer and pain from 2010 to 2019.
Results: A total of 3,423 papers met the inclusion criteria in this research. The increase in the quantity of papers presented a significant growth from 2010 to 2019 (P<0.001) by linear regression analysis. The research subject categories of the 3,423 papers mainly concentrated on oncology (28.57%), clinical neurology (25.62%), and healthcare science services (15.89%). The US had the highest number of published papers, followed by the People's Republic of China, and England. According to scientific statistics, breast cancer (20.36%) was by far the most predominant topic in the papers related to the comorbidity of cancer and pain.
Conclusion: This bibliometric research provided a framework for visual and quantitative research to management scholars in favor of exploring a potential field related to hot issue and research frontiers.
Kutay Yazici K, Kaya M, Aksu B, Uuml;nver S. The effect of perioperative lidocaine infusion on postoperative pain and postsurgical recovery parameters in gynecologic cancer surgery.Clinical Journal of Pain. 2021 Feb 1;37(2):126-132. doi: 10.1097/AJP.0000000000000900.
Chung M, Kim HK, Abdi S. Update on cannabis and cannabinoids for cancer pain. Current Opinion Anaesthesiology. 2020 Dec;33(6):825-831. doi: 10.1097/ACO.0000000000000934.
De Groef A, Penen F, Dams L, Van der Gucht E, Nijs J, Meeus M. Best-evidence rehabilitation for chronic pain part 2: pain during and after cancer treatment. J Clin Med. 2019 Jul 5;8(7). pii: E979.
Nadler JW, Quinn TD, Bennett-Guerrero E. Can anesthesiologists affect cancer outcomes? Canadian Journal of Anesthesia/Journal Canadien d'Anesthésie. 2019;66(5):491-494.
Datto CJ, Hu Y, Wittbrodt E, Fine PG. Opioid utilization patterns among patients with cancer and non-cancer pain. Journal of Opioid Management. 2019;15(1):11-18.
Ahmedzai SH, Bautista MJ, Bouzid K, et al. Optimizing cancer pain management in resource-limited settings. Supportive Care in Cancer. 2019;27(6):2113-2124.
Bennett MI, Eisenberg E, Ahmedzai SH, et al. Standards for the management of cancer-related pain across Europe-a position paper from the EFIC task force on cancer pain. European Journal of Pain (London, England). 2019;23(4):660-668.
De Laurentis M, Rossana B, Andrea B, Riccardo T, Valentina I. The impact of social-emotional context in chronic cancer pain: patient-caregiver reverberations : social-emotional context in chronic cancer pain. Supportive Care in Cancer. 2019;27(2):705-713.
Forget P, Aguirre JA, Bencic I, et al. How anesthetic, analgesic and other non-surgical techniques during cancer surgery might affect postoperative oncologic outcomes: a summary of current state of evidence. Cancers. 2019;11(5).