Background Breakthrough cancer pain (BTcP) is one of the most common symptoms related to the disease and its treatment. Its management differs from that of chronic pain but there is not a wide consensus about fundamental aspects of BTcP definition, diagnosis, follow-up, and management. The objective of this study is to reach a consensus on the follow-up of patients with BTcP under opioid treatment. Background This work was conducted using a modified Delphi method organized in two rounds and involving a panel of 84 medical oncologists. A questionnaire of 66 items was developed with the following topics: (1) When to perform the first and subsequent BTcP treatment evaluations; (2) What to assess at the first follow-up visit and how; and (3) What to assess in the following visits and how. Results After two rounds, a consensus was reached in 53 of 66 items proposed (80.3%). The main agreements reached include: The first follow-up visit should preferably be face-to-face; increase the number of visits after detecting poor control of BTcP; assess pain control episodes of BTcP in the first and following visits; adjust treatment dose of opioids due to poor control of BTcP; and adopt measures to prevent aberrant opioid-induced behaviors when treating BTcP in patients with cancer. Conclusion This Delphi consensus highlights the different points of view of medical oncologists regarding the follow-up of patients with BTcP under opioids treatment. Nonetheless, the conclusions reached can facilitate optimizing monitoring of these patients and promote long-term effectiveness of BTcP control.
negative symptoms. The results suggest that functioning and improvement in functioning are more strongly correlated with negative than with positive and other symptom factors. OBJECTIVES:To examine the association of antidepressant-related weight gain with degree of enjoyment and satisfaction from general daily activities, medication and overall quality of life. METHODS: Employed individuals (Ն18 years of age) with depression (excluding bipolar disorder) completed a web-based computer-generated 25-minute survey (population identified by Harris Interactive). Weight gain was measured using the Toronto Side Effects Scale which measures medicationrelated side effects in the two weeks preceding the survey, and analyzed as a 4-level ordinal variable (none, Ͻϭ2lbs, Ͻϭ4lbs, Ͻϭ7lbs). Degree of enjoyment and satisfaction related to general activities, satisfaction with current medication, and overall quality of life were measured using a 5-point ordinal scale (1ϭvery poor; 5ϭvery good) employing the Quality of Life Enjoyment and Satisfaction Questionnaire -Short Form (QLESQ-SF). A summary "percent-of-max" score was calculated for general activity items, and transformed to a 5-level ordinal variable using cutpoints of 20, 40, 60 and 80% (Ͻ20% represented least overall enjoyment/satisfaction) . Gender stratified cumulative logit models were used to estimate the effect of weight gain on QLESQ-SF measures. RESULTS: Of the 1,521 survey respondents, 872 (57%) reported current antidepressant use (60.6% female, mean age 49.9 Ϯ 13.5 years). Compared to females with no weight gain, the odds of having lower enjoyment/satisfaction were greater for females who experienced any weight gain: Ͻϭ2lbs (odds ratio [OR] ϭ2.22; pϭϽ0.0001), Ͻϭ4lbs (ORϭ2.27; pϭ0.004) and Ͻϭ7lbs (ORϭ12.50; pϭϽ0.0001). Among males lower QLESQ score was associated only with the Ͻϭ7lbs category (ORϭ5.26; pϭ0.0004). Satisfaction with medication was inversely associated with weight gain for females; Ͻϭ2lbs (ORϭ1.49; pϭ0.051), Ͻϭ4lbs (ORϭ2.33; pϭ0.002) and Ͻϭ7lbs (ORϭ8.33; pϭϽ0.0001) and males; Ͻϭ7lbs (ORϭ2.78; pϭ0.031). CONCLUSIONS: These data suggest that antidepressant-related weight gain may have strong associations with patient perceptions of diminished enjoyment and satisfaction in general daily activities and with current medication, which may affect medication adherence.
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