Effective pain management in hematological malignancies

Niscola, Pasquale

doi:10.1586/ehm.09.20

Cited by 3 publications

(5 citation statements)

References 23 publications

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“… 15 – 20 These problems arise due to both the disease processes and associated complications, as well as the side-effects and toxicities of treatments. 21 No correlation has been reported between the presence of symptoms and the likelihood of access to SPC services as a consequence of these. 19 22 …”

Section: Introductionmentioning

confidence: 99%

Variations in specialist palliative care referrals: findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma

Howell

Wang

Roman

et al. 2014

BMJ Support Palliat Care

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ObjectiveTo develop and implement a methodology for capturing complete haematological malignancy pathway data and use it to identify variations in specialist palliative care (SPC) referrals.MethodsIn our established UK population-based patient cohort, 323 patients were diagnosed with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma between May 2005 and April 2008, and died before April 2010. A day-by-day calendar approach was devised to collect pathway data, including SPC referrals, to supplement routinely collected information on clinical presentation, diagnosis, treatment, response, and date and place of death.Results155 (47.9%) of the 323 patients had at least one SPC referral. The likelihood of referral increased with survival (OR 6.58, 95% CIs 3.32 to 13.03 for patients surviving ≥1 year compared to ≤1 month from diagnosis), and varied with diagnosis (OR 1.96, CIs 1.15 to 3.35 for myeloma compared to acute myeloid leukaemia). Compared to patients dying in hospital, those who died at home or in a hospice were also more likely to have had an SPC referral (OR 3.07, CIs 1.59 to 5.93 and 4.74, CIs 1.51 to 14.81, respectively). No associations were found for age and sex.ConclusionsOur novel approach efficiently captured pathway data and SPC referrals, revealing evidence of greater integration between haematology and SPC services than previously reported. The likelihood of referral was much higher among those dying outside hospital, and variations in practice were observed by diagnosis, emphasising the importance of examining diseases individually.

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Section: Introductionmentioning

confidence: 99%

Variations in specialist palliative care referrals: findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma

Howell

Wang

Roman

et al. 2014

BMJ Support Palliat Care

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“…Pain experienced by HM patients may be related to the disease, to investigative procedures or treatments, to complications secondary to the disease process, or it may be coincidental with the disease. Pain has traditionally been a neglected issue in malignant hematology [8]. Therefore, in the absence of specifically dedicated guidelines, pain treatments are derived from those used in the setting of solid tumors, where concerns about undertreatment of cancer pain have been raised [9,10].…”

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confidence: 99%

“…Therefore, in the absence of specifically dedicated guidelines, pain treatments are derived from those used in the setting of solid tumors, where concerns about undertreatment of cancer pain have been raised [9,10]. Thus far, the risk of an inappropriate pain control may also be considered for HM patients, although comprehensive pain treatment should be an elementary part of their global management [8]. With the aim of summarizing current knowledge on this topic, we have conducted a review of the existing literature on adult, as well as pediatric, management of HM in order to provide an understanding of the underlying pain mechanisms and a discussion of the treatment strategies.…”

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confidence: 99%

Pain in malignant hematology

Niscola

Tendas

Scaramucci

et al. 2011

Expert Review of Hematology

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Pain is frequently experienced by patients with hematological malignancies, although it often receives little attention. Different underlying causes and mechanisms may sustain several pain syndromes in hematological malignant patients. Pain may be due to disease itself, to disease-related complications, to iatrogenic causes or may be associated with unrelated medical conditions. The management of pain in this setting requires a multidisciplinary approach, integrating analgesics and causal interventions. An accurate diagnostic assessment and the identification of the underlying causes and pathogenetic mechanisms may dictate the treatment approach. For most pain patients, the WHO's three-step analgesic scale for cancer pain relief can provide adequate relief with oral options, although difficult-to-treat pain syndromes, requiring a more complex treatment approach, may also be observed.

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“…[6] Pain has traditionally represented a neglected issue in malignant hematology. [827] Thus far, in default of specifically dedicated guidelines, pain management in oncohematological patients is derived from those used for the patients affected by solid tumors. As it has been recently reported, cancer pain has been frequently under-recognized and mismanaged.…”

Section: Introductionmentioning

confidence: 99%

“…[2829] Therefore, the same considerations about an inadequate pain control may be translated also in the setting of malignant hematology, although it has firmly stated that a comprehensive pain treatment should be included in the global management of patients with BRC. [27] Epidemiological data on pain syndromes in patients with BRC are scanty and sparse. In the past, several authors have reported a much lower incidence and severity of pain in patients with BRC with respect to those recorded in the setting of solid tumors;[30] however, the former setting a pain incidence ranging from 37 to 90%[1–71331–34] have been reported, for which the occurrence of pain in patients affected by BRC may be considered as similar or even higher compared to patients with solid tumors .…”

Section: Introductionmentioning

confidence: 99%

Pain in blood cancers

Niscola¹,

Tendas²,

Scaramucci³

et al. 2011

Indian J Palliat Care

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Patients with blood-related cancers (BRC) suffer from a substantial symptom burden, including several pain syndromes sustained by different causes and pathogenetic mechanisms. So, with regard to pain, a multifaceted clinical scenario may be observed in this setting. Indeed, pain may be correlated to disease itself, to disease-associated complications, to iatrogenic causes or may be due to unrelated clinical conditions. A close diagnostic procedure for the assessment of the underlying causes of the pain and of its pathogenetic mechanisms may direct the treatment approach which should be based on a multidisciplinary management and requires the integration of etiology-targeted interventions and painkilling drugs. The World Health Organization's three-step analgesic ladder for cancer pain relief can provide adequate pain control using oral drugs in most patients with BRC on pain, although more complex interventions may be necessary for many difficult-to-treat pain syndromes which are not infrequently encountered in this setting.

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Effective pain management in hematological malignancies

Cited by 3 publications

References 23 publications

Variations in specialist palliative care referrals: findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma

Variations in specialist palliative care referrals: findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma

Pain in malignant hematology

Pain in blood cancers

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