A Multidisciplinary Project to Improve the Quality of Cancer Pain Management in Italy

Abstract

Pain afflicts most cancer patients, mainly in the advanced and metastatic phases of the disease. Despite the existence of several guidelines for cancer pain management that are based on the recommendations by the World Health Organization and the availability of effective treatments for 70% to 90% of cases, undertreatment is well documented and can involve up to 40% of patients. Undertreatment is usually attributed to an incorrect use of opioids for reasons often conceptualized in terms of barriers related to healthcare provider, patient, family, institution, and society. In Italy, opioid consumption rates are among the lowest in Europe despite some of recent efforts to improve the analgesic prescription and utilization. In the context of a wide project coordinated by the Mario Negri Institute, a non-for-profit private foundation located in Milan, Italy, 4 activities were launched: (1) a critical appraisal of information available on the Web, with the preparation and publication of a meta-site to facilitate the use of selected resources; (2) an evaluation of prescriptions of analgesic drugs in a cohort of cancer patients using a large administrative database; (3) a nationwide outcome research study to assess the epidemiology, quality, and effectiveness of different analgesic strategies; and (4) a multimodal, community-based intervention based on information, education, and training programs to change the knowledge, opinions, and attitude toward cancer pain treatment. Activities started in 2005. Some results and outputs are already available; others will be ready by the end of 2007.

Controlled-Release Oxycodone and Pregabalin in the Treatment of Neuropathic Pain: Results of a Multicenter Italian Study

“…In Italy, opioids are considerably underused in pain management and as a result clinical experience with these analgesics is limited [19]. The aim of our study was to compare the efficacy and safety of combination therapy with CR oxycodone plus pregabalin with that of monotherapy with either drug alone in patients with neuropathic pain that has not been adequately relieved by previous treatments.…”

Transdermal buprenorphine and fentanyl patches in cancer pain: a network systematic review

“…Two studies reported outcomes associated with utilization of TB buprenorphine or TD fentanyl in patients with cancer pain. 33 , 37 Of these one study directly compared TD buprenorphine with TD fentanyl 33 and one study compared TD buprenorphine and/or TD fentanyl with other pain medications. 37 …”

How useful are systematic reviews for informing palliative care practice? Survey of 25 Cochrane systematic reviews

“…They can be entire populations, as in the death register in the UK, or all patients with a specific characteristic (eg twins) or condition (eg breast cancer) within a defined population. At least one large registry-based programme for continuous quality improvement aimed at cancer pain is ongoing in Italy [ 51 ]. An extensive search for observational studies in palliative care has been undertaken, with the aim of identifying good quality observational studies and aspects of their design that make them reliable and useful (Hadley et al, manuscript in preparation).…”