How Well Do Medical Oncologists Manage Chronic Cancer Pain? A National Survey

Breuer, Brenda; Chang, Victor; Roenn, Jamie H. Von; Gunten, Charles von; Neugut, Alfred I.; Kaplan, Ronald; Wallenstein, Sylvan; Portenoy, Russell K.

doi:10.1634/theoncologist.2014-0276

Cited by 49 publications

(35 citation statements)

References 17 publications

(17 reference statements)

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“…Oncologists generally have more opportunities to make an early diagnosis of BTP, as they see patients more often through the course of disease [18], whereas physicians in palliative care see patients later in the course of their disease, which may explain this result. Another explanation could be that oncologists have improved their pain assessment skills in the years since large surveys showed worrying data, suggesting a great need for continuing education programs in pain management among oncologists [19, 20]. However, it is important to note that these findings may not adequately represent the situation, particularly as the differences in the number of patients with BTP in oncology versus palliative care setting may simply be due to the sampling design.…”

Section: Discussionmentioning

confidence: 99%

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

et al. 2016

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IntroductionAn ongoing national multicenter survey [Italian Oncologic Pain multiSetting Multicentric Survey (IOPS-MS)] is evaluating the characteristics of breakthrough cancer pain (BTP) in different clinical settings. Preliminary data from the first 1500 cancer patients with BTP enrolled in this study are presented here.MethodsThirty-two clinical centers are involved in the survey. A diagnosis of BTP was performed by a standard algorithm. Epidemiological data, Karnofsky index, stage of disease, presence and sites of metastases, ongoing oncologic treatment, and characteristics of background pain and BTP and their treatments were recorded. Background pain and BTP intensity were measured. Patients were also questioned about BTP predictability, BTP onset (≤10 or >10 min), BTP duration, background and BTP medications and their doses, time to meaningful pain relief after BTP medication, and satisfaction with BTP medication. The occurrence of adverse reactions was also assessed, as well as mucosal toxicity.ResultsBackground pain was well controlled with opioid treatment (numerical rating scale 3.0 ± 1.1). Patients reported 2.5 ± 1.6 BTP episodes/day with a mean intensity of 7.5 ± 1.4 and duration of 43 ± 40 min; 977 patients (65.1%) reported non-predictable BTP, and 1076 patients (71.7%) reported a rapid onset of BTP (≤10 min). Higher patient satisfaction was reported by patients treated with fast onset opioids.ConclusionsThese preliminary data underline that the standard algorithm used is a valid tool for a proper diagnosis of BTP in cancer patients. Moreover, rapid relief of pain is crucial for patients’ satisfaction. The final IOPS-MS data are necessary to understand relationships between BTP characteristics and other clinical variables in oncologic patients.FundingMolteni Farmaceutici, Italy.

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Section: Discussionmentioning

confidence: 99%

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

et al. 2016

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“…[17][18][19][20][21][22][23][24][25] Much of the survey content was based on pain management standards of organizations such as the American Pain Society, the World Health Organization, and the Agency for Healthcare Research and Quality. [17][18][19][20][21][22][23][24][25] Much of the survey content was based on pain management standards of organizations such as the American Pain Society, the World Health Organization, and the Agency for Healthcare Research and Quality.…”

Section: Survey Developmentmentioning

confidence: 99%

Practices and perceptions regarding intravenous opioid infusion and cancer pain management

Arthur

Reddy

Smith

et al. 2019

Cancer

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BACKGROUND: In view of the recent opioid crisis, ways to promote safe and effective opioid-related practices are needed. Faster intravenous (iv) opioid infusion rates can result in increased adverse effects and risk for nonmedical opioid use. Data on best practices regarding safe iv opioid administration for cancer pain are limited. This study examined iv opioid bolus infusion practices and perceptions about opioids in cancer pain among 4 groups of inpatient oncology nurses. METHODS: An anonymous cross-sectional survey was conducted among oncology nurses working in medical, surgical, intensive care unit (ICU), and emergency department (ED) settings. An iv opioid bolus infusion speed less than 120 seconds was considered too fast. RESULTS: The participant response rate was 59% (731 of 1234). Approximately 58%, 54%, and 58% of all nurses administered morphine, hydromorphone, and fentanyl, respectively, in less than 120 seconds. The median morphine infusion speeds were 55, 60, 60, and 85 seconds for ICU, surgical, ED, and medical unit nurses, respectively (P = .0002). The odds ratios for infusing too fast were 2.04 and 2.52 for ED (P = .039) and ICU nurses (P = .003), respectively, in comparison with medical unit nurses, and they were 0.27 and 0.18 with frequent (P = .003) and very frequent use of a timing device (P = .0001), respectively, in comparison with no use. CONCLUSIONS: More than half the nurses working in the inpatient setting reported administering iv opioids too fast. ICU nurses administered opioids the fastest. Nurses who frequently used a timing device were less likely to infuse too fast. Further research is needed to standardize and improve the safe intermittent administration of iv opioids to patients with cancer. Cancer 2019;125:3882-3889.

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“…The medical literature is replete with studies that show that most outpatient providers receive little training in appropriate assessment and treatment of both acute and chronic pain. This extends from medical school [11] all the way through subspecialties, such as oncology, that might be expected to have such training due to their patient population [26,27]. As a result of this lack of training and experience, there is an understandable wariness on the part of outpatient providers to prescribe narcotic pain medications for chronic conditions.…”

Section: Pressures On Emergency Department's Pain Management From Extmentioning

confidence: 99%

Ethical Pain Management in the Emergency Department: The Canary in the Coal Mine

Marcus

Venkat

2015

Pain Manag.

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The emergency department serves as the gateway to the acute healthcare system. In the USA and increasingly worldwide, patients view the emergency department as the venue where both diagnostic and therapeutic modalities will be brought to bear regardless of condition or socioeconomic status. At the same time, the emergency department is the canary in the coal mine--the warning location for difficulties in how healthcare is delivered to patients in both the outpatient and inpatient settings. In no area is this more apparent than pain management. Emergency departments are expected to treat patient's pain aggressively, often in the face of incomplete or contradictory histories and the inability to ensure outpatient follow-up. These factors create an ethical challenge for emergency departments in how to approach pain treatment. This paper will provide a framework for how emergency departments can address the ethical challenges posed by pain management.

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How Well Do Medical Oncologists Manage Chronic Cancer Pain? A National Survey

Cited by 49 publications

References 17 publications

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Breakthrough Cancer Pain: Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey (IOPS-MS)

Practices and perceptions regarding intravenous opioid infusion and cancer pain management

Ethical Pain Management in the Emergency Department: The Canary in the Coal Mine

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