Prospective Study of a Novel Risk Stratification Process for Opioid-Related Harm Reduction in Cancer Patients Seen in an Outpatient Palliative Care Clinic

Palliative care is seeing cancer patients earlier in the disease trajectory with a multitude of chronic issues. Chronic non-malignant pain (CNMP) in cancer patients is under-studied. In this prospective study, we examined the prevalence and management of CNMP in cancer patients seen at our supportive care clinic for consultation. We systematically characterized each pain type with the Brief Pain Inventory (BPI) and documented current treatments. The attending physician made the pain diagnoses according to the International Association for the Study of Pain (IASP) task force classification. Among 200 patients (mean age 60 years, 69% metastatic disease, 1-year survival of 77%), the median number of pain diagnosis was 2 (IQR 1–2); 67 (34%, 95% CI 28–41%) had a diagnosis of CNMP; 133 (67%) had cancer-related pain; and 52 (26%) had treatment-related pain. In total, 12/31 (39%) patients with only CNMP and 21/36 (58%) patients with CNMP and other pain diagnoses were on opioids. There was a total of 94 CNMP diagnoses among 67 patients, including 37 (39%) osteoarthritis and 20 (21%) lower back pain; 30 (32%) were treated with opioids. In summary, CNMP was common in the timely palliative care setting and many patients were on opioids. Our findings highlight the need to develop clinical guidelines for CNMP in cancer patients to standardize its management.

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A Quality Improvement Project to Provide Early Referral to Palliative Care Clinic for Advanced Oral Cancer Patients (TH341A)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2019.12.081 ◽

2020 ◽

Vol 59 (2) ◽

pp. 429-430

Author(s):

Aanchal Satija ◽

Karl Lorenz ◽

Michelle DeNatale ◽

Jake Mickelsen ◽

Odette Spruijt ◽

...

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Oral Cancer ◽

Cancer Patients ◽

Quality Improvement Project ◽

Early Referral ◽

Improvement Project ◽

Care Clinic ◽

Oral Cancer Patients

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Differences in performance status assessments between palliative care specialists, nurses, and oncologists.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.19 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 19-19

Author(s):

YuJung Kim ◽

Yi Zhang ◽

Ji Chan Park ◽

David Hui ◽

Gary B. Chisholm ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Well Being ◽

Assessment Tools ◽

Advanced Cancer Patients ◽

Care Clinic ◽

Edmonton Symptom Assessment Scale ◽

Ecog Ps

19 Background: The Eastern Cooperative Oncology Group (ECOG) performance status (PS) is one of the most commonly used assessment tools among oncologists and palliative care specialists caring advanced cancer patients. However, the inter-observer difference between the oncologist and palliative care specialist has never been reported. Methods: We retrospectively reviewed the medical records of all patients who were first referred to an outpatient palliative care clinic in 2013 and identified 278 eligible patients. The ECOG PS assessments by palliative care specialists, nurses, and oncologists, and the symptom burden measured by Edmonton Symptom Assessment Scale (ESAS) were analyzed. Results: According to the pairwise comparisons using Sign tests, palliative care specialists rated the ECOG PS grade significantly higher than oncologists (median 0.5 grade, P<0.0001) and nurses also rated significantly higher (median 1.0 grade, P<0.0001). The assessments of palliative care specialists and nurses were not significantly different (P=0.10). Weighted kappa values for inter-observer agreement were 0.26 between palliative care specialists and oncologists, and 0.61 between palliative care specialists and nurses. Palliative care specialists’ assessments showed a moderate correlation with fatigue, dyspnea, anorexia, feeling of well-being, and symptom distress score measured by ESAS. The ECOG PS assessments by all three groups were significantly associated with survival (P<0.001), but the assessments by oncologists could not distinguish survival of patients with PS 2 from 3. Independent predictors of discordance in PS assessments between palliative care specialists and oncologists were the presence of an effective treatment option (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.09-5.23) and poor feeling of well-being (≥4) by ESAS (OR 2.38, 95% CI 1.34-4.21). Conclusions: ECOG PS assessments by the palliative care specialists and nurses were significantly different from the oncologists. Systematic efforts to increase regular interdisciplinary meetings and communications might be crucial to bridge the gap and establish a best care plan for each advanced cancer patients.

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Impact of palliative care clinic (PCC) referrals on pain control in genitourinary (GU) cancer patients: Retrospective analysis at Roswell Park Cancer Institute (RPCI).

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.57 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 57-57

Author(s):

Neha Gupta ◽

Shipra Gandhi ◽

Sidra Anwar ◽

Katy Wang ◽

Yashodhara Satchidanand

Keyword(s):

Palliative Care ◽

Pain Score ◽

Cancer Patients ◽

Retrospective Review ◽

Pain Control ◽

Medical Oncology ◽

Screening Tools ◽

Chi Square ◽

Care Clinic

57 Background: Many cancer patients (pts) with GU cancer suffer from uncontrolled pain, and may benefit from more focused palliative care. We assessed the frequency and impact of specialist PCC referrals on pain management of our GU Medical oncology clinic (GUMOC) pts. Methods: 239 consecutive pts were collected from a retrospective review of GUMOC records from 12/1/2013 to 2/28/2014. This group of pts was used to assess the frequency of PCC referral. Pts were divided into two arms- Arm A= GUMOC pts referred to PCC; Arm B: GUMOC pts not referred to PCC. To be able to detect a 15% between the two arms at 95% significance, 37 additional pts (who were already being seen at GUMOC) were collected from retrospective review of PCC records over 9/1/2013 to 2/28/2014. Total 276 pts were divided into Arm A (n=49), Arm B (n=227 pts). Data for baseline pain score and 4-week follow up pain scores were collected. A palliative care screening tool (retrieved from Center to Advance Palliative care [CAPC] website) was used to assign palliative care screening score (PCSS) to all study pts. Chi square test and T-test were used for statistical analysis. Results: Out of the 239 initially collected GUMOC pts, 5% were referred to PCC. 10% (n=24) had PCSS score of ≥ 4, and 33% pts with PCSS ≥ 4 were referred to PCC. Arm A had worse baseline symptoms, ECOG status and more advanced cancer stage. 4-week pain score follow up revealed significant improvement in Arm A -2.74 vs. Arm B -0.13 (p<0.01). Conclusions: GU cancer pts who are referred to PCC from medical oncology clinic have significant decrease in pain symptoms. Frequency of PCC consultation is still low in comprehensive cancer institutes, and not in congruence with the available palliative care screening tools criteria suggested by CAPC. Standardized tools should be developed to guide PCC referrals, and routine use of these tools will significantly help in pain control by seeking specialist palliative care.

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