Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer

Bandieri, Elena; Sichetti, Daniela; Romero, Marilena; Fanizza, Caterina; Belfiglio, Maurizio; Buonaccorso, Loredana; Artioli, Fabrizio; Campione, Francesco; Tognoni, Gianni; Luppi, Mario

doi:10.1093/annonc/mds103

Cited by 66 publications

(51 citation statements)

References 13 publications

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“…These data suggest that palliative care physicians may positively influence the cultural barriers existing among oncologists about the use of analgesics, particularly opioids, and should work earlier in any oncological department, rather than limiting their activity to end of life issues in hospices or home care [2]. Their role appears to be prominent in all the phases of disease.…”

Section: Discussionmentioning

confidence: 95%

Cancer pain management in an oncological ward in a comprehensive cancer center with an established palliative care unit

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Fatta

et al. 2013

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Section: Discussionmentioning

confidence: 95%

Cancer pain management in an oncological ward in a comprehensive cancer center with an established palliative care unit

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Guccione

Fatta

et al. 2013

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“…Furthermore, the Basic Plan to Promote Cancer Control Programs, which was revised in 2012, recommended implementation of palliative care at this stage of cancer diagnosis as a high priority item to be addressed <http://www.mhlw.go.jp/bunya/kenkou/gan_ keikaku.html>. Temel et al and Bandieli et al have demonstrated that implementation of palliative care beginning in the early stages of treatment, such as narcotic analgesics for pain relief, improved quality of life and overall survival ratio for cancer patients (104,105). Hence, the administration of narcotic analgesics for pain in conjunction with anticancer chemotherapy is expected to increase in coming years.…”

Section: Influence Of Alterations In the Expression And Function Of Pmentioning

confidence: 99%

Mechanisms of P-Glycoprotein Alteration During Anticancer Treatment: Role in the Pharmacokinetic and Pharmacological Effects of Various Substrate Drugs

et al. 2014

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Abstract. In clinical pharmacotherapy, therapeutic benefits and adverse effects of medicines differ substantially between individuals and are often determined by their blood levels. Critical regulators influencing the pharmacokinetics and pharmacodynamics of drugs include drug transporters and drug-metabolizing enzymes. Among these, we have focused on P-glycoprotein (P-gp), a drug efflux transporter. A growing body of evidence indicates that the expression and functional activity of P-gp are altered under several pathological conditions, by exposure to substrate drugs of P-gp, and by ingestion of certain foods. In this critical review, we discuss the mechanisms by which anticancer drugs, most of which are P-gp substrates, alter the expression and functional activity of P-gp in tumors and normal tissues after chronic treatment. Accumulating evidence shows that various transcription factors, in addition to epigenetic and post-translational factors, modulate P-gp expression, which alters the pharmacokinetics and pharmacological effects of drugs. Therefore, it is important to consider individual patients with regard to drug-taking history, as well as levels of P-gp expression and function, when providing clinical pharmacotherapy.Keywords: P-glycoprotein, anticancer drug, drug-drug interaction, opioid, cancer *Corresponding author. stoku@pharm.Kobegakuin.ac.jp Published online in J-STAGE on July 2, 2014 doi: 10.1254/jphs.14R01CRInvited article 243 Changes in P-gp by Anticancer Treatment targeted anticancer drugs acting on specific genes or their products has grown rapidly. In fact, combination treatment with molecularly targeted drugs and cytotoxic chemotherapy against cancers such as acute leukemia or lymphatic malignancy improved therapeutic outcome in comparison to conventional anticancer chemotherapy (8, 9). However, solid tumors often have greater inherent resistance and are less sensitive to anticancer drugs (10). Furthermore, chronic exposure to anticancer drugs frequently leads to multi-drug resistance where the therapeutic effects of these drugs on tumors is largely reduced (11). The development of resistance to anticancer chemotherapy remains one of the major obstacles in effective pharmacological therapy for cancer using current treatment strategies (12).Research revealing the role of drug transporters in cancer began with the discovery of P-glycoprotein (P-gp). In 1976, during research to elucidate the mechanism by which cancer cell lines acquire multi-drug resistance, Juliano et al. discovered that P-gp is over-expressed on the surface membranes of multi-drug resistant cancer cells (13). Subsequent studies have demonstrated that P-gp is present in cancer tissue (11,14), as well as in normal tissues such as small intestine, where it regulates drug absorption, and liver and kidney, where it modulates drug clearance (15). These results suggest that P-gp determines blood levels of its substrate drugs. Furthermore, P-gp is now considered to be an extremely important factor in the pharmacokinetics of drugs bec...

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“…Also, early access to an integrated palliative care team can reduce the occurrence of symptoms, including pain. Bandieri et al [25] found that early access to an integrated palliative care team was associated with a 31% reduced risk of suffering from severe pain. However, Holtan et al [26] found that inadequate pain management, for example the underuse of analgesics, was often caused by a lack of basic knowledge and failure to perform individual pain assessment.…”

Section: Discussionmentioning

confidence: 99%

Palliative care needs in hospitalized cancer patients: a 5-year follow-up study

Sandgren

Strang

2017

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Purpose The aims of this study were to describe and compare diagnoses, symptoms, and care needs in palliative cancer patients in two medium-sized hospitals in a county council with no specialized palliative care available 24/7; to analyze the relationships between diagnosis and symptoms/care needs; and to compare results and trends from two datasets (from 2007 and 2012). Methods The study was population-based with a crosssectional design and was conducted at two acute care hospitals. We performed 142 one-day inventories (n = 2972) in 2007 and 139 in 2012 (n = 2843) to register symptoms, care needs, and diagnosis based on a questionnaire. Multiple logistic regression models were used in the analysis. Results During 2007 and 2012 combined, 10% (n = 589) of hospitalized patients were assessed as having cancer in a palliative phase. Prostate (12%) and colorectal (12%) cancers were most common. Pain (42%) and deterioration (42%) were the most prevalent symptoms and were associated with pancreas cancer in our regression models (p = 0.003 and p = 0.019, respectively). Other cancers had different associations: hematologic malignancies were associated with infections and blood transfusions (p < 0.001), breast cancer with pleurocentesis (p = 0.002), and stomach/esophagus cancer with nausea (p < 0.001). Nausea was more common in women than in men (p < 0.01). The mean number of symptoms/care needs was 2.9; patients with stomach/esophagus cancer had the highest number of symptoms/care needs (3.5). Conclusions Acute care hospitals still play an important role for patients requiring palliative care. Symptoms and care needs were not strongly associated with specific diagnoses. Therefore, symptoms, rather than the specific cancer diagnoses, should be the focus of care.

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Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer

Cited by 66 publications

References 13 publications

Cancer pain management in an oncological ward in a comprehensive cancer center with an established palliative care unit

Cancer pain management in an oncological ward in a comprehensive cancer center with an established palliative care unit

Mechanisms of P-Glycoprotein Alteration During Anticancer Treatment: Role in the Pharmacokinetic and Pharmacological Effects of Various Substrate Drugs

Palliative care needs in hospitalized cancer patients: a 5-year follow-up study

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