‘Was it worth it?’ Intrathecal analgesia for cancer pain: A qualitative study exploring the views of family carers

Background: Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer. Aim: Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer. Design: Thematic analysis of qualitative interviews with carers of deceased individuals who received percutaneous external tunnelled intrathecal drug delivery as part of their pain management, within two UK centres. Setting: A total of 11 carers were recruited from two UK Palliative Care centres. Family carers of adult patients who had received external tunnelled intrathecal drug delivery analgesia for cancer pain and had died between 6 and 48 months prior to contact were included. Carer relatives who were considered likely to be too vulnerable or who had lodged a complaint about treatment within the recruiting department or who had been treated directly by the interviewer were excluded. Results: In total, 11 interviews took place. The emerging themes were (1) making the decision to have the intrathecal – relatives described desperate situations with severe pain and/or sedation, meaning that the individual would try anything; (2) timing and knowing they were having the best – an increased access to pain and palliative care services, meant carers felt everything possible was being done, making the situation more bearable; (3) was it worth it? – the success of the external tunnelled intrathecal drug delivery was judged on its ability to enable the individual to be themselves through their final illness. Side effects were often considered acceptable, if the external tunnelled intrathecal drug delivery enabled improvements in quality of life. Conclusion: Carers perceived external tunnelled intrathecal drug delivery as most valuable when it improved quality of life towards the end of life, by reducing pain and side effects of conventional systemic analgesia to enable individuals ‘to be themselves’. Under these circumstances, the carers judged significant side effects to be acceptable.

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Intrathecal Drug Delivery (ITDD) systems for cancer pain

F1000Research ◽

10.12688/f1000research.2-96.v1 ◽

2013 ◽

Vol 2 ◽

pp. 96 ◽

Cited By ~ 20

Author(s):

Gaurav Bhatia ◽

Mary E Lau ◽

Padma Gulur

Keyword(s):

Quality Of Life ◽

Drug Delivery ◽

Pain Management ◽

Side Effects ◽

Cancer Pain ◽

Management Option ◽

Intrathecal Drug Delivery ◽

Potential Risks ◽

Intrathecal Space

Intrathecal drug delivery is an effective pain management option for patients with chronic and cancer pain. The delivery of drugs into the intrathecal space provides superior analgesia with smaller doses of analgesics to minimize side effects while significantly improving quality of life. This article aims to provide a general overview of the use of intrathecal drug delivery to manage pain, dosing recommendations, potential risks and complications, and growing trends in the field.

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Intrathecal Drug Delivery (ITDD) systems for cancer pain

F1000Research ◽

10.12688/f1000research.2-96.v4 ◽

2014 ◽

Vol 2 ◽

pp. 96 ◽

Cited By ~ 6

Author(s):

Gaurav Bhatia ◽

Mary E Lau ◽

Katharine M Koury ◽

Padma Gulur

Keyword(s):

Quality Of Life ◽

Drug Delivery ◽

Pain Management ◽

Side Effects ◽

Cancer Pain ◽

Management Option ◽

Intrathecal Drug Delivery ◽

Potential Risks ◽

Intrathecal Space

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Pancreatic Cancer Related Pain: Review of Pathophysiology and Intrathecal Drug Delivery Systems for Pain Management

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e583 ◽

2021 ◽

pp. E583-E594

Keyword(s):

Quality Of Life ◽

Drug Delivery ◽

Pancreatic Cancer ◽

Pain Management ◽

Cancer Pain ◽

Drug Delivery Systems ◽

Delivery Systems ◽

Narrative Review ◽

Intrathecal Drug Delivery

BACKGROUND: Pancreatic cancer (PC) is one of the most lethal cancers and is the eleventh most common cancer worldwide. This disease is characterized by an often-fatal evolution and a high burden of symptoms, particularly pain. Several studies have demonstrated that pancreatic cancer patients have a high prevalence of pain, with up to 82% of patients reporting pain, often requiring systemic strong opioids as mainstay treatment. This comprehensive review of pancreatic cancer related pain (PCRP), focuses on current mechanisms that lead to pain including regional invasion processes, as well as the local secretion of factors that sensitize nociceptive nerves. OBJECTIVE: Our objective was to conduct a review of PCRP and provide updates on intrathecal drug delivery in PC therapeutic recommendations. STUDY DESIGN: We used a narrative review design. We present a novel perspective in the field of pain research by converging data from intrathecal drug delivery trials with previous elements of molecular pain research in PCRP. METHODS: The literature review relating to PCRP pathophysiology and intrathecal drug delivery systems (IDDS) was done with searches of English, French, and Spanish abstracts, using PubMed, Dynamed, EMBASE, SciELO, Uptodate, Google Scholar, and manual searches of the bibliographies of known primary and review articles from IDDS inception until August 2020. Different search strings based on MESH terms were used including: pain, chronic pain, cancer pain, prevalence, pathophysiology, pancreatic cancer, analgesia, invasive pain procedures, celiac plexus neurolysis, pancreatic neuropathy, intrathecal drug delivery, or a combination of these terms. A narrative review based on these sources was prepared. RESULTS: This paper reviews aspects related to pancreatic adenocarcinoma and PCRP prevalence and focuses on recent developments in pathophysiology with IDDS as a pain management strategy. We summarize the best available evidence regarding intrathecal therapy (IT) for PCRP management; 18 studies of IDDS including at least 236 PC patients are analyzed. LIMITATIONS: Some limitations include: IDDS studies heterogeneity regarding disease stage, patient population, and technical aspects, such as catheter placement and treatment regimen, do not allow integration of studies. CONCLUSION: This review analyzes both past and current literature with a critical analysis of findings and respective recommendations. Most studies of IDDS in PCRP evaluate outcomes on pain using one-dimensional pain scales, such as VAS. Other relevant results, such as performance status or quality of life, are not frequently reported. Burden of disease variables, such as cancer stage, location, and comorbidities, like depression and systemic analgesia co-prescription, are usually not presented in these studies. In the same way, most studies do not precisely inform IDDS titration and IT medication. These factors make integration of IDDS in PC studies difficult. Future studies regarding impact of IDDS on pain control on quality of life, in this particular population, may help clinicians in deciding the optimal time and approach for IDDS. The studies should report data on particular disease, comorbidities, and treatment regimens. KEY WORDS: Adenocarcinoma, cancer pain, pain, pancreatic carcinoma, pancreatic neoplasms, pain management, physiopathology, prevalence

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Quality-of-Life Measurement in Advanced Cancer: Assessing the Individual

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.11.3603 ◽

1999 ◽

Vol 17 (11) ◽

pp. 3603-3611 ◽

Cited By ~ 130

Author(s):

Dympna Waldron ◽

Ciaran A. O'Boyle ◽

Michael Kearney ◽

Michael Moriarty ◽

Desmond Carney

Keyword(s):

Quality Of Life ◽

Advanced Cancer ◽

Internal Validity ◽

Semistructured Interview ◽

Incurable Cancer ◽

Life Measurement ◽

The Difference ◽

The Individual ◽

Very High

PURPOSE: Despite the increasing importance of assessing quality of life (QoL) in patients with advanced cancer, relatively little is known about individual patient's perceptions of the issues contributing to their QoL. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and the shorter SEIQoL–Direct Weighting (SEIQoL-DW) assess individualized QoL using a semistructured interview technique. Here we report findings from the first administration of the SEIQoL and SEIQoL-DW to patients with advanced incurable cancer. PATIENTS AND METHODS: QoL was assessed on a single occasion using the SEIQoL and SEIQoL-DW in 80 patients with advanced incurable cancer. RESULTS: All patients were able to complete the SEIQoL-DW, and 78% completed the SEIQoL. Of a possible score of 100, the median QoL global score was as follows: SEIQoL, 61 (range, 24 to 94); SEIQoL-DW, 60.5 (range, 6 to 95). Psychometric data for SEIQoL indicated very high levels of internal consistency (median r = .90) and internal validity (median R2 = 0.88). Patients' judgments of their QoL were unique to the individual. Family concerns were almost universally rated as more important than health, the difference being significant when measured using the SEIQoL-DW (P = .002). CONCLUSION: Patients with advanced incurable cancer were very good judges of their QoL, and many patients rated their QoL as good. Judgments were highly individual, with very high levels of consistency and validity. The primacy given to health in many QoL questionnaires may be questioned in this population. The implications of these findings are discussed with regard to clinical assessment and advance directives.

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Role of Oxycodone Hydrochloride in Treating Radiotherapy-Related Pain

Pain Research and Management ◽

10.1155/2020/7565962 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Yinxia Wang ◽

Ligang Xing

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Cancer Pain ◽

Cancer Patients ◽

Pain Control ◽

Analgesic Drugs ◽

Oxycodone Hydrochloride ◽

Radiation Esophagitis

Radiotherapy is commonly used to treat cancer patients. Besides the curable effect, radiotherapy also could relieve the pain of cancer patients. However, cancer pain is gradually alleviated about two weeks after radiotherapy. In addition, cancer patients who receive radiotherapy may also suffer from pain flare or radiotherapy-induced side effects such as radiation esophagitis, enteritis, and mucositis. Pain control is reported to be inadequate during the whole course of radiotherapy (before, during, and after radiotherapy), and quality of life is seriously affected. Hence, radiotherapy is suggested to be combined with analgesic drugs in clinical guidelines. Previous studies have shown that radiotherapy combined with oxycodone hydrochloride can effectively alleviate cancer pain. In this review, we firstly presented the necessity of analgesia during the whole course of radiotherapy. We also sketched the role of oxycodone hydrochloride in radiotherapy of bone metastases and radiotherapy-induced oral mucositis. Finally, we concluded that oxycodone hydrochloride shows good efficacy and tolerance and could be used for pain management before, during, and after radiotherapy.

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Complications after Intrathecal Drug Delivery Due to the Underlying Malignancy in Two Patients with Intractable Cancer Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e107 ◽

2013 ◽

Vol 2;16 (2;3) ◽

pp. E107-E111

Author(s):

Thomas Chai

Keyword(s):

Drug Delivery ◽

Side Effects ◽

Cancer Pain ◽

Systemic Absorption ◽

Pain Patient ◽

Drug Side Effects ◽

Intrathecal Drug Delivery ◽

Underlying Malignancy ◽

History Of ◽

Intractable Cancer Pain

Intrathecal drug delivery is a mode of analgesic delivery that can be considered in those experiencing both refractory pain and excessive side effects from opioid and adjuvant analgesic use. Delivery of analgesic agents directly to the cerebral spinal fluid allows binding of the drug to receptors at the spinal level. Therefore, a reduced analgesic dosage can be afforded, resulting in reduction of drug side effects due to decreased systemic absorption. Drug delivery into the intrathecal space provides this benefit, yet it does not eliminate the possibility of drug side effects or risks of complications. Complications from this route of administration may be seen in the perioperative period or beyond, including infection, inflammatory mass, bleeding, and catheter or pump dysfunction, among others. This may manifest as new/worsening pain or as a neurologic deficit, such as a sensorimotor change and bladder/bowel dysfunction. Urgent evaluation with a detailed physical examination, device interrogation, and other workup including imaging is called for if symptoms suspicious for device-related problems arise. For the cancer pain patient, the underlying malignancy should also be considered as a potential cause for these new symptoms after intrathecal system implantation. We present 2 such cases of complications in the cancer pain patient after intrathecal drug delivery due to progression of the underlying malignant process rather than to surgical or device-related problems. The first patient had a history of metastatic osteosarcoma who, shortly after undergoing an intrathecal drug delivery trial with external pump, presented with new symptoms of both pain and neurologic changes. The second patient with a history of chondrosarcoma developed new symptoms of pain and sensorimotor change several days after intrathecal drug delivery system implantation. Key words: Intrathecal analgesia, intrathecal drug delivery, perioperative complications, cancer pain, malignant pain, pain pump

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Disease-modifying therapies in advanced cancer

10.1093/med/9780198821328.003.0077 ◽

2021 ◽

pp. 800-807

Author(s):

Olav Dajani ◽

Karin Jordan

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Side Effects ◽

Well Being ◽

Patient Comfort ◽

Optimal Care ◽

Disease Modifying ◽

Critical Components ◽

Improve Patient

In many situations, anticancer therapies may be critical components when optimizing patient comfort, function, quality of life, and duration of survival. Optimal care requires the integration of oncological and palliative care and it is very important for palliative care clinicians to be familiar with oncological approaches to improve patient well-being, and also the limitations of such approaches. This integrative role requires that palliative care clinicians have a basic literacy regarding anticancer therapies and the expectations and side effects of their treatments. Together with anticancer therapies, medical oncology should encompass patient-centred care by providing supportive and palliative interventions at all stages of the disease, from the time of diagnosis.

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Reduction of Opioid Side Effects by Prophylactic Measures of Palliative Care Team May Result in Improved Quality of Life

Journal of Palliative Medicine ◽

10.1089/jpm.2009.0355 ◽

2010 ◽

Vol 13 (4) ◽

pp. 401-406 ◽

Cited By ~ 10

Author(s):

Michiaki Myotoku ◽

Akiko Nakanishi ◽

Miwa Kanematsu ◽

Noriko Sakaguchi ◽

Norio Hashimoto ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Side Effects ◽

Palliative Care Team ◽

Care Team ◽

Prophylactic Measures

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Challenging Symptoms

10.1093/med/9780190204709.003.0004 ◽

2017 ◽

Author(s):

Barton T. Bobb ◽

Devon Fletcher

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Side Effects ◽

Sleep Disorders ◽

Assessment Tools ◽

Dry Mouth ◽

Advanced Practice ◽

Medication Side Effects ◽

Medication Side

Dry mouth, hiccups, fevers, pruritus, and sleep disorders are symptoms often found in palliative care patients. These symptoms can be challenging to treat, and they require that the advanced practice registered nurse (APRN) has a working knowledge of the causative conditions in order to effectively manage the symptoms. Appropriate assessment tools for these common symptoms are reviewed, as are their various causes, from medication side effects, systemic illness, and physical and psychological causes. Pharmacological, nonpharmacological, and interventional treatments are offered, with the caveat that all interventions must be individualized to the patient’s care goals and with quality of life in mind.

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Efficacy and cost-utility of the eHealth application ‘Oncokompas’, supporting patients with incurable cancer in finding optimal palliative care, tailored to their quality of life and personal preferences: a study protocol of a randomized controlled trial

BMC Palliative Care ◽

10.1186/s12904-019-0468-8 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Anouk S. Schuit ◽

Karen Holtmaat ◽

Nienke Hooghiemstra ◽

Femke Jansen ◽

Birgit I. Lissenberg-Witte ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Intervention Group ◽

Cost Utility ◽

Control Group ◽

Incurable Cancer ◽

Randomized Controlled

Abstract Background Patients with incurable cancer have to deal with a wide range of symptoms due to their disease and treatment, influencing their quality of life. Nowadays, patients are expected to adopt an active role in managing their own health and healthcare. Oncokompas is an eHealth self-management application developed to support patients in finding optimal palliative care, tailored to their quality of life and personal preferences. A randomized controlled trial will be carried out to determine the efficacy and cost-utility of Oncokompas compared to care as usual. Methods 136 adult patients with incurable lung, breast, colorectal and head and neck cancer, lymphoma and glioma, will be included. Eligible patients have no curative treatment options and a prognosis of at least three months. Patients will be randomly assigned to the intervention group or the control group. The intervention group directly has access to Oncokompas alongside care as usual, while the waiting list control group receives care as usual and will have access to Oncokompas after three months. The primary outcome measure is patient activation, which can be described as a patient’s knowledge, skills and confidence to manage his or her own health and healthcare. Secondary outcome measures comprise self-efficacy, health-related quality of life, and costs. Measures will be assessed at baseline, two weeks after randomization, and three months after the baseline measurement. Discussion This study will result in knowledge on the efficacy and cost-utility of Oncokompas among patients with incurable cancer. Also, more knowledge will be generated into the need for and costs of palliative care from a societal and healthcare perspective. Trial registration Netherlands Trial Register identifier: NTR 7494. Registered on 24 September 2018.

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