Application of Quality Control Circle Activity in Improving Effectiveness of Drug Intervention in Lung Cancer Patients with Moderate to Severe Pain

9012 Background: Cytokines, aberrantly produced by cancer cells, have recently been implicated in the severity of cancer-related symptoms. We hypothesize that functional variations in cytokine genes could explain variability in self-reported pain and depressed mood in lung cancer patients of all stages. Methods: Pain, depressed mood, clinical and demographic variables were assessed at presentation, and prior to initiating any cancer treatment in 514 white patients with non-small cell lung cancer (NSCLC). Using the TaqMan method, we genotyped single nucleotide polymorphisms in interleukin (IL) −6 (−174 G>C), IL-8 (−251 T> A), and tumor necrosis factor-alpha (TNF-; −308 G> A), and determined their associations with pain and depressed mood. Results: Sixteen and 7% of respondents reported severe levels of pain (≥ 7, on a 0–10 scale) and depressed mood most/all of the time, respectively. The severity of pain and depressed mood predictably varied by clinical, sociodemographic, and genotype variables in the univariate analyses. Multivariable logistic regression analyses showed that variant allele in IL8 (OR=2.05;95%CI=1.04–4.06), early age of onset (≤ 50 years) (OR=1.80;95%CI=1.02–3.14), and depressed mood (OR=4.55;95%CI=2.105–9.81) were significant predictors for severe pain. For depressed mood, results showed that variant allele in IL6 (OR=0.49;95%CI=0.24–0.49), severe pain (OR= 3.77;95%CI=1.79–7.95) and a history of stroke (OR=3.50;95%CI=1.03–11.82) as significant predictors. Classification and Regression Tree analyses revealed potential higher order gene-gene interaction for pain (IL1 and IL6) and depressed mood (IL8 and IL6). Conclusions: Variations in individual inflammatory responses could partly explain variability in pain and depressed mood in patients with lung cancer. No significant financial relationships to disclose.

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Patient-related predictors of poor-quality pain care in advanced lung cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6062 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6062-6062

Author(s):

Inga Tolin Lennes ◽

Jennifer S. Temel ◽

Emily R. Gallagher ◽

Joseph A. Greer ◽

William F. Pirl

Keyword(s):

Lung Cancer ◽

Pain Management ◽

Cancer Patients ◽

Severe Pain ◽

Poor Quality ◽

Advanced Lung Cancer ◽

Composite Measure ◽

Related Factors ◽

Lung Cancer Patients ◽

Pain Care

6062 Background: Unrelieved pain remains a major problem for all patients, including those with cancer, despite national standards for pain management. Screening and addressing pain is an integral part of oncology visits and an ASCO QOPI indicator of quality oncology care. The goal of this study was to assess associations between patient-related factors, particularly patient distress, and meeting ASCO quality metrics for appropriate management of pain in patients with advanced lung cancers. Identification of patient related factors could lead to targeted quality improvement efforts. Methods: From 8/07 to 9/10, we recruited consecutive new patients in a multidisciplinary thoracic oncology clinic to participate in a research database for which patients completed self-report instruments for distress, depression (PHQ-9) and anxiety (GAD-7), at their first oncology visit. We then performed a QOPI chart audit for patients with advanced lung cancer who received care at our institution. A composite measure of appropriate pain management was calculated. Components of the composite measure included 1) documentation of pain assessment, and 2) for patients with moderate-severe pain (≥4 on 10 point scale) plan of care documentation. Results: 253 patients completed baseline assessments and had follow up. Pain was assessed in 252 (99%) patients. Over a third (88/253) of newly diagnosed advanced lung cancer patients had at least moderate pain on their first visit to the medical oncologist. Almost half of patients with moderate-severe pain were depressed (40/88). Of the patients with moderate-severe pain, 54/88 (63%) had a plan of care related to pain documented in the oncologist’s note. In total, 219 (87%) patients received appropriate pain assessment and care. In a multivariate model including age, sex, histology, ECOG PS, provider, depression, and anxiety, only depression independently predicted inadequate pain care. Depressed patients were 3 times more likely to receive poor quality pain care (OR 2.75, 95% CI 1.04-7.25, p=0.04). Conclusions: At initial oncology visit, pain is present in over a third of patients with advanced lung cancer. Depression is highly co-morbid with pain and appears to be a risk factor for inadequate pain care.

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Inflammation genes and pain severity in lung cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9618 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9618-9618

Author(s):

C. C. Reyes-Gibby ◽

S. Shete ◽

X. Wu ◽

R. Kurzrock ◽

M. Spitz

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Severe Pain ◽

Complex Trait ◽

Pain Severity ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

Lung Cancer Patients ◽

Younger Age ◽

Numeric Scale

9618 Background: While studies suggest that variants in infammation genes explain individual variation in pain severity, these studies only assessed one or a few candidate genes. Given that pain is a complex trait, multiple genes with relatively small effects are likely to influence vulnerability to pain. In this study, we evaluated a comprehensive panel of 59 single nucleotide polymorphisms (SNP) in 37 inflammation genes in newly diagnosed non-Hispanic Caucasian lung cancer patients (n=667) and assessed their association with pain severity. We also assessed the extent to which clinical and demographic factors explain pain severity in this population. Methods: Patients rated their pain “during the past week” on an 11-point numeric scale, (0= ‘no pain’ and 10= ‘pain as bad as you can imagine’) at presentation, prior to initiating cancer therapy. A score > 7/10 was considered to indicate severe pain. Logistic regression analyses were conducted to assess the extent of association between genetic polymorphism and pain severity. All SNPs were genotyped using SNPlex. Results: Results showed that 16% of the sample reported severe pain. As expected, severe pain was more prevalent among those with advanced stage of disease (OR=2.34; 95% CI=1.50–3.65), younger age (OR=0.47; 95%CI=0.30–0.75), depressed mood (OR=3.68; 95%CI=1.96–6.93) and fatigue (OR=3.68; 95% CI=1.96–6.93). Of the 59 SNPs, we initially found SNPS in 6 genes [IKB 3’-UTR(C/T), TNFA -308GA, TNFB Arg13Cys, IL2-330T/G, IL8–251 T/A, COX2 3’-UTR(T/C)] to be significantly associated with severe pain. Controlling for clinical and demographic variables, we found that carriers of CC alleles for COX2 3’-UTR T/C (OR= 3.24; 95% CI=1.12, 9.39) and carriers of TT alleles for IL2-330T/G (OR=1.68; 95%CI=1.04, 2.73) persisted as significant correlates of severe pain. Conclusions: Because genetic polymorphisms are stable markers, understanding the extent to which genetic variability plays a role on cancer-related pain may prove useful in identifying patients at high-risk for pain development and importantly, could help in understanding patients who might benefit most from symptom intervention, and ultimately in developing personalized and more effective pain therapies. No significant financial relationships to disclose.

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