scholarly journals The Introduction and Experiences of Methadone for Treatment of Cancer Pain at a Low-resource Governmental Cancer Center in India

2021 ◽  
Vol 0 ◽  
pp. 1-23
Author(s):  
Gayatri Palat ◽  
Charlotte Algotsson ◽  
Spandana Rayala ◽  
Maria Gebre-Medhin ◽  
Eva Brun ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Health Care Professionals ◽  
Economic Status ◽  
Hospital Setting ◽  
Cancer Center ◽  
Cancer Pain Management ◽  
Care Environment ◽  
Low Resource ◽  
Patients With Cancer ◽  
Conventional Content Analysis

Objectives: This study aimed to describe the clinical experience of the health-care professionals (HCPs) responsible for the introduction of methadone, for the treatment of complex cancer pain, at a low-resource hospital in India in a patient-group, burdened by illiteracy, and low socio-economic status. Materials and Methods: Ten HCPs: Four medical doctors, four nurses, one pharmacist, and one hospital administrator were interviewed. The interviews are examined using a qualitative conventional content analysis. Results: The interviews showed a confidence amongst the HCPs, responsible for the safe introduction of methadone in a stressful and low-resource surrounding, to patients with cancer pain and the different aspects of methadone, as initiation, titration, and maintenance of treatment. Conclusion: Introduction of methadone for cancer pain management is safe and feasible although low resources in a challenging hospital setting and care environment.

scholarly journals Perception of Iranian Patients with Cancer, Their Relatives, and Health Care Professionals Towards Length of Life and Quality of Life: A Local Survey

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Negin Nourbakhsh ◽  
Bahareh Tahani ◽  
Azadeh Moghaddas
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Survival Time ◽  
Health Care Professionals ◽  
Treatment Modalities ◽  
Cancer Center ◽  
Treatment Choices ◽  
Patients With Cancer ◽  
Length Of Life

Background: Recently, therapeutic decision-making in oncology is changed to a big challenge for both patients and involved oncologists due to an increase in available treatment modalities with a variety of benefits or adverse effects. Objectives: The current study aimed at comparing the perception of treatment priorities regarding lengthening of survival time or maintenance of the quality of life (QoL) among patients with cancer by health care professionals (HCPs). Methods: The current cross-sectional study was conducted on patients with cancer, their relatives, and healthcare professionals in the referral cancer center of Omid affiliated to Isfahan University of Medical Sciences. To identify treatment choices, priority, and related variables influencing their opinions, all participants were interviewed using a standard and valid questionnaire in Persian. The collected data were analyzed using the SPSS software version 20, and the P-value less than 0.05 was considered statistically significant. Results: A total of 299 participants, including 100 patients, 109 relatives, and 90 HCPs (74.2% nurses, 20.2% physicians, 5.6% others) participated in the study. The priority of treatment between survival time (66.1% for relatives vs. 47.9% for patients and 21.3% for HCP) and QoL (33.9% vs.52.1% and 78.7%) was significantly different between the three groups (P < 0.001). Most of the HCPs, patients, and their relatives believed that the physician is the only person who should accept the responsibility of treatment choices and process (98.9% vs. 100% and 98%, respectively; P = 0.002). Conclusions: Among the Iranian population, both the length of life and QoL were valuable; however, it was observed that patients with cancer and HCPs preferred mostly to expand the QoL, while the length of life was more valuable for relatives. Also, all patients, their relatives, and HCPs preferred to choose the physicians as the decision-makers. The results of the study can be helpful in choosing treatment regimens and designing clinical trials.

Opioid Rotation for Toxicity Reduction (DRAFT)

2018 ◽  
Author(s):  
Anna Cecilia Tenorio ◽  
Akhila Reddy
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Clinical Case ◽  
Cancer Pain Management ◽  
Opioid Rotation ◽  
Patients With Cancer ◽  
Daily Dose ◽  
Study Intervention ◽  
Morphine Equivalent

This chapter discusses the de Stoutz et al. retrospective review of patients with cancer pain who developed dose-limiting toxicities and underwent opioid rotation that resulted in improvement of symptoms related to opioid induced neurotoxicity, uncontrolled pain, and reduction in morphine equivalent daily dose. This study is the first to establish that opioid rotation, which is substituting one opioid with another using established equianalgesic conversion ratios, is a valuable tool in cancer pain management. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Cancer pain management at a tertiary care cancer center in India—A retrospective analysis of 3,238 patients

2018 ◽  
Vol 4 (6) ◽  
pp. 361 ◽  
Author(s):  
Sushma Bhatnagar, MD ◽  
Seema Mishra, MD ◽  
Madhurima Srikanti, MD ◽  
Deepak Gupta, MD
Keyword(s):  
Cancer Pain ◽  
Tertiary Care ◽  
World Health ◽  
Cancer Center ◽  
Intractable Pain ◽  
Patients With Cancer ◽  
Analgesic Regimen ◽  
Good Pain Relief ◽  
Health Organization

Effective pain control is essential for the management of patients with cancer. About 70-80 percent of patients with cancer present in an advanced stage of disease. Patients with advanced cancer frequently experience intractable pain, with diverse symptoms that can make daily living impossible and affect the quality of life. This article reports the management of 3,238 patients with cancer pain over a period of five years. Nearly 89.6 percent patients had good pain relief, with Visual Analogue Scale score less than 3. These promising results were achieved by careful patient assessment, close liaison with clinicians from other specialties, and using a variety of analgesic regimen including oral analgesics, anesthetic procedures, psychological interventions, and supportive care. However, the main stay of treatment was oral analgesics, following the principles of World Health Organization ladder, with continuing follow-up.

A physician's practice, attitude and approach for the management of palliative care for cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 112-112
Author(s):  
Shijian Feng ◽  
Qiongwen Zhang ◽  
Chunhua Yu ◽  
Huashan Shi ◽  
Wenxiu Yao ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Professional Education ◽  
Physician Education ◽  
Dose Titration ◽  
Categorical Variables ◽  
Cancer Pain Management ◽  
Patients With Cancer ◽  
Knowledge Of Cancer ◽  
Chi Square Analysis

112 Background: Pain is the most frequent and persistent symptom experienced by cancer patients. Thus, exploring how to achieve the best outcome of cancer pain management in China is clearly extremely important. Our study focuses on the Chinese physicians' current clinical practice, attitudes, toward and barriers to opioid use, and knowledge of cancer pain management. Methods: A face to face survey include 23 items was designed and conducted to the doctors working with cancer pain managements (oncologists, internists, hematologists, et al) responsible for the care of patients with cancer in 11 tertiary hospitals in China. Descriptive statistics were used to characterize the total sample and for multiple choice questions and each item. Chi-square analysis was used to examine the difference between categorical variables. Results: 500 questionnaires were received out of 550. Most (62.2%) physicians assessed patients’ cancer pain every day, but 85.5% never or occasionally treated patients’ cancer pain together with psychologists. Most respondents appreciated that > 50% of patients with cancer experience severe chronic pain warranting analgesic therapy (73.5%), and that this therapy could control pain adequately in > 50% of patients (77.2%). More than half of physicians indicated that opioid dose titration in patients with poor pain control and assessment of the cause and severity of pain were urgently needed knowledge for cancer pain management. A majority (65.0%) of physicians responded incorrectly (60.0% agreed and 5.0% had no opinion) that they would increase the dosage of a potent opioid and administer it every 4 h as needed (q4h PRN). Inadequate assessment of pain and pain management (63.0%), patients' reluctance to take opioids (62.2%), and inadequate staff knowledge of pain management (61.4%) were the three most frequently barriers to physicians’ pain management. Conclusions: Our results revealed that physician education in cancer pain management in China does not currently provide the necessary levels of knowledge and skills. Therefore, effective strategies and professional education are still needed to encourage physicians’ concern with, experience in, and knowledge of cancer pain management in China.

Impact of parenteral opioid shortage on opioid prescriptions among patients seen by the palliative care team of a comprehensive cancer center.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 201-201
Author(s):  
Ali Haider ◽  
Yu Qian ◽  
Zhanni Lu ◽  
Syed Mussadiq Ali Akbar Naqvi ◽  
Amy Zhuang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Type ◽  
Cancer Pain Management ◽  
Before And After ◽  
The Impact

201 Background: Recent parenteral opioid shortage (POS) has the potential to impact cancer pain management in hospitalized patients. This study aims to compare changes in the opioid prescriptions by the inpatient palliative care (PC) team before and after the institution first reported the POS. Methods: We reviewed and compared the electronic health records of 386 consecutive eligible consultations seen by the inpatient PC team equally in one month before and after the announcement of POS on February 8, 2018. The eligibility criteria include (1) cancer diagnosis, (2) ≥18 years of age, (3) taking opioid medication at the time of consultation, and (4) having at least two consecutive visits with the PC team. Patient demographics, cancer type, opioid type, route, and dose defined as the morphine equivalent daily dose were assessed. Results: POS was associated with less use of parenteral opioids (patient controlled analgesia, and intravenous breakthrough) and more use of non-parenteral opioids (extended release, transdermal, and oral breakthrough) by the referring oncology teams, and PC team (P≤.001) (Table 1). At first PC follow-up, significantly less proportion of patients achieved better pain control after POS [119/193 (62%) versus 144/193 (75%) (P=.006)] However, at second PC follow-up, the proportion of pain improvement was similar in both cohorts. Conclusions: There is a significant change in opioid routes associated with POS. POS was associated with worse analgesia. More research is needed to better understand the impact of POS on cancer pain management.[Table: see text]

Interventional Therapies for Cancer Pain Management: Important Adjuvants to Systemic Analgesics

2007 ◽  
Vol 5 (8) ◽  
pp. 851-858 ◽  
Author(s):  
Anthony Eidelman ◽  
Traci White ◽  
Robert A. Swarm
Keyword(s):  
Pain Management ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Pain Control ◽  
Analgesic Efficacy ◽  
Cancer Pain Management ◽  
Patients With Cancer ◽  
Inflammatory Drugs ◽  
Control Pain ◽  
Interventional Therapies

Optimized use of systemic analgesics fails to adequately control pain in some patients with cancer. Commonly used analgesics, including opioids, nonopioids (acetaminophen and non-steroidal anti-inflammatory drugs), and adjuvant analgesics (anticonvulsants and antidepressants), have limited analgesic efficacy, and their use is often associated with adverse effects. Without adequate pain control, patients with cancer not only experience the anguish of poorly controlled pain but also have greatly diminished quality of life and may even have reduced life expectancy. Interventional pain therapies are a diverse set of procedural techniques for controlling pain that may be useful when systemic analgesics fail to provide adequate control of cancer pain or when the adverse effects of systemic analgesics cannot be managed reasonably. Commonly used interventional therapies for cancer pain include neurolytic neural blockade, spinal administration of analgesics, and vertebroplasty. Compared with systemic analgesics, which generally have broad indications for control of pain, individual interventional therapies generally have specific, narrow indications. When appropriately selected and implemented, interventional pain therapies are important components of broad, multimodal cancer pain management that significantly increases the proportion of patients able to experience adequate pain control.

Analysis of the patient-related barriers in cancer pain anagement in Turkish patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20699-e20699
Author(s):  
G. Bagçivan ◽  
N. Tosun ◽  
S. Kömürcü ◽  
A. Özet ◽  
N. Akbayrak
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Brief Pain Inventory ◽  
Cancer Pain Management ◽  
Cross Sectional ◽  
Patients With Cancer ◽  
Demographic Questionnaire ◽  
Average Pain ◽  
Turkish Patients ◽  
Reliable Scale

e20699 Background: The most important issue, which may be preventing effective cancer pain management, have generally been the barriers originating from misbelieve or misunderstandings, which lead patients to be reluctant to report pain and receive the appropriate analgesic. It is the first study about this issue in Turkey. Methods: This study was planned as a descriptive and cross-sectional. The sample was 170 patients with cancer, who used or is still using analgesic medication for pain related to cancer. Demographic Questionnaire, Brief Pain Inventory and BQ-II were used for data collection. The reliability coefficient for the total scale and subscales (Cronbach's α) were calculated. Test and retest results were compared to determine the scales validity for Turkish patients. All statistical analyses were performed with the SPSS 15.0.The value p≤0.05 was considered ‘statistically significant’. Results: As a result of the factor analysis made for BQ-II, seven factors that make up for 66.451% of the total variance were found. Cronbach's alpha value was 0.87 for the BQ-II. According to the points given by patients to the items in BQ-II, it was seen that they have beliefs that may be barriers to optimal pain management mostly in “addiction” and minimally in “physical side effects” subscale. It was ascertained that male, not married patients, patients with a chronic disease other than cancer, patients whose “average pain” level is >5 and who use inadequate analgesic have more beliefs that may be barriers to optimal pain management. Conclusions: BQ-II was a valid and reliable scale for Turkish defining patient related barriers in cancer pain management. Items suggested by patients such as “family related barriers” and “family members’ role and responsibilities” could be added to the BQ-II for future studies. No significant financial relationships to disclose.

Physician-related barriers to cancer pain management with opioid analgesics: A systematic review

2007 ◽  
Vol 3 (4) ◽  
pp. 207 ◽  
Author(s):  
Ramune Jacobsen, MS, MPH ◽  
Per Sjøgren, MD, DMS ◽  
Claus Møldrup, PhD ◽  
Lona Christrup, PhD
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Cancer Pain ◽  
Search Strategy ◽  
Opioid Analgesics ◽  
Drug Prescribing ◽  
Cancer Pain Management ◽  
Patients With Cancer ◽  
Text Word ◽  
Questionnaire Surveys

Objective: The purpose of this review is to summarize the results of studies on physician-related barriers to cancer pain management with opioid analgesics.Methods: A literature search was conducted in PUBMED, using a combined text word and MeSH heading search strategy. Those articles whose full texts were not available in PUBMED were retrieved from the electronic databases of specific journals.Results: Sixty-five relevant articles, published in the period from 1986 to 2006, were identified. Physicians’ barriers to cancer pain management were studied in questionnaire surveys and in the reviews of drug prescribing documents. The results of the articles found were analyzed with respect to (a) knowledge, beliefs, concerns, problems endorsed or acknowledged by physicians treating cancer pain, (b) physicians’ skills in pain assessment, and (c) adequacy of opioid prescription.Conclusions: This review revealed mostly general and common physician-related barriers to cancer pain management: concerns about side effects to opioids, prescription of not efficient doses of opioids, and very poor prescription for the treatment of side effects from opioids. In the future, the evaluation of the influence of cultural-social-economical background, as well as the differences between the various specialists involved in the care of patients with cancer, should be explored to better understand physicians’ barriers and more effectively address them in interventional and educational programs.

Tramadol: Does it have a role in cancer pain management?

2005 ◽  
Vol 1 (3) ◽  
pp. 131 ◽  
Author(s):  
Eric E. Prommer, MD
Keyword(s):  
Neuropathic Pain ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Drug Interactions ◽  
Low Dose ◽  
World Health ◽  
Cancer Pain Management ◽  
Patients With Cancer ◽  
The World ◽  
Dual Mechanism

Tramadol (Ultram, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ) is considered a Step 2 analgesic under the World Health Organization’s guidelines for the treatment of patients with cancer pain. It is a centrally acting analgesic that has affinity for opioid receptors and influences the action of norepinephrine and serotonin at the synapse. This dual mechanism of analgesia makes it unique among Step 2 agents. It is metabolized by CYP2D6, which increases the potential for drug interactions. Unlike other opioids, it does not cause respiratory depression. Tramadol has been studied in cancer pain and neuropathic pain. It compares well with low-dose morphine as an analgesic. The purpose of this review is to critically examine the pharmacodynamics, pharmacology, drug interactions, and adverse effects of the drug, and, based on the data presented, discuss the drug’s role in cancer care.

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