Patient-Reported Outcomes and Opioid Use by Outpatient Cancer Patients

Moryl, Natalie; Dave, Vinnidhy; Glare, Paul; Bokhari, Ali; Malhotra, Vivek; Gulati, Amitabh; Hung, Joseph C.; Puttanniah, Vinay; Griffo, Yvona; Tickoo, Roma; Wiesenthal, Alison; Horn, Susan D.; Inturrisi, Charles E.

doi:10.1016/j.jpain.2017.11.001

Cited by 23 publications

(33 citation statements)

References 48 publications

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“… 1 Patients with cancer often have more than 1 pain location. 2 , 3 , 4 Even when the index pain from the irradiated tumors is controlled, new pain from tumors outside of the irradiated area may have a negative effect in terms of the interference of pain in the patient's life and may negatively affect quality of life. 5 To our knowledge there are no data regarding the frequency or causes of nonindex pain in patients treated with palliative RT.…”

Section: Introductionmentioning

confidence: 99%

“…Pain response after radiation therapy (RT) is assessed using the intensity of the index pain (pain caused by the irradiated tumor) 1 . Patients with cancer often have more than 1 pain location 2, 3, 4. Even when the index pain from the irradiated tumors is controlled, new pain from tumors outside of the irradiated area may have a negative effect in terms of the interference of pain in the patient's life and may negatively affect quality of life 5 .…”

Section: Introductionmentioning

confidence: 99%

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Predictors of the Predominance of NonIndex Pain After Palliative Radiation Therapy for Painful Tumors

Saitô

Toya

Tomitaka

et al. 2019

Advances in Radiation Oncology

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PurposeEven when index pain (pain caused by the irradiated tumor) is palliated after radiation therapy (RT), patients may not derive the full benefits of RT in the presence of another, more intense pain. In this case-control study with prospectively collected data, we sought to identify predictors of the predominance of nonindex pain after palliative RT.Methods and MaterialsBrief Pain Inventory data were collected from patients who received RT for painful tumors. The treating radiation oncologists prospectively evaluated the intensity and origin of nonindex pain. Patients were diagnosed with predominance of other pain (POP) if nonindex pain of malignant or unknown origin was present and had a greater worst pain score than the index pain at the 1- or 2-month follow-up. Changes in pain interference from baseline to follow-up were compared between the 2 groups using Mann-Whitney U tests. Using variables that were identified as significant in a multivariable logistic regression analysis, we developed a prediction model for POP.ResultsOf the 170 patients who were evaluable at the 2-month follow-up, 24 (14%) were diagnosed with POP. At the 2-month follow-up examination of the patients with POP, none of the items of the pain interference scores were reduced from baseline; in contrast, patients without POP experienced significant reductions in all items. Multivariable analysis using the backward elimination method indicated that age ≤65 years, the presence of nonindex pain of malignant or unknown origin at baseline, and no opioid analgesic use at baseline were significant independent predictors of POP. As the number of the risk factors increased, the proportion of patients with POP increased.ConclusionsWe identified three predictors of POP. For patients likely to have POP, careful follow-up is important, and new palliative RT or analgesics should be used when needed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of the Predominance of NonIndex Pain After Palliative Radiation Therapy for Painful Tumors

Saitô

Toya

Tomitaka

et al. 2019

Advances in Radiation Oncology

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“…The results from that study indicate that 26.3% who reported severe pain received opioids during the 30-day pre-period, which matches the 27.0% reported in this study. Several other smaller studies that have assessed pain symptoms and medication management find higher opioid use rates, but these tend to be clinical cohorts of oncology patients undergoing active treatment or surveillance [12,21], which are more homogeneous than our sample. While numerous other studies address pain medication use overall [22][23][24][25][26][27] or either for adults with [28][29][30][31][32][33][34][35] or without cancer [36,37], few compare medication patterns across these groups within a single population setting [8,9]; incorporation of patient-reported pain information is rare.…”

Section: Discussion/conclusionmentioning

confidence: 90%

“…Opioids are the most commonly prescribed medications used to treat pain, prescribed for as many as two-thirds of those reporting severe pain [7]. Recent studies have reported higher opioid use rates for adults with, compared with without cancer [8][9][10][11], but few population-based studies have examined associations between pain medication use and pain severity [7,12] and whether it differs for older adults with and without cancer.…”

Section: Background/introductionmentioning

confidence: 99%

Patterns of pain medication use associated with reported pain interference in older adults with and without cancer

Davidoff

Canavan

Feder

et al. 2019

Support Care Cancer

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Context-Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing. Objectives-To examine associations between prescription pain medication receipt and patientreported pain interference in older adults with and without cancer. Methods-Using the 2007-2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519). We measured receipt of opioids, non-steroidal Amy J. Davidoff, Amy.Davidoff@Yale.Edu. Conflict of interest EEK was a contractor for NCI and assisted with project oversight as well as contributing substantial intellectual input. AJD's institution receives research funding from Celgene Corporation outside of the submitted project. CJP is a Paul Calabresi Scholar supported by the OSU K12 Training Grant for Clinical Faculty Investigators (K12 CA133250) and is a consultant for Potentia Metrics. SW's institution receives funding from Genentech to support his research. No other author reports any conflict of interest to disclose. The research team had direct control of the data throughout the study project. We are unable to release the data to other researcher due to constraints of the Data Use Agreement with the NCI. However, we would be willing to provide SAS code for selection of medications identified in the analysis.

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“…Improved night sleep in terms of longer duration and less frequent awakenings, mainly due to the absence of leg cramps and spasms, after ITB treatment was achieved in all patients. BPI is an instrument that was primarily used to assess cancer-related pain, but its use has also been extended to chronic nonmalignant pain with good validity [23, 29]. An improved body posture in patients that had a fixed position before the ITB pump implantation, followed by a better sitting posture in the wheelchair due to the lack of spasticity, was documented in all patients.…”

Section: Discussionmentioning

confidence: 99%

Inherited Ataxia and Intrathecal Baclofen for the Treatment of Spasticity and Painful Spasms

Berntsson

Gauffin

Melberg

et al. 2019

Stereotact Funct Neurosurg

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Background: Intrathecal baclofen (ITB) treatment is considered a powerful tool in the management of severe spasticity in neurological conditions such as multiple sclerosis, cerebral palsy, and traumatic spinal cord and brain injury. Objectives: The objective of this study was to assess the effectiveness of the ITB in patients with inherited ataxia suffering from severe painful spasms and/or spasticity. Method: A total of 5 patients with spinocerebellar ataxia 3 or 7 or Friedreich’s ataxia were included in this observational multicenter study. The patients were interviewed and completed outcome measures assessing pain (The Brief Pain Inventory), fatigue (Fatigue Severity Scale), and life satisfaction (LiSAT-9) before and 1 year after the treatment. Spasticity (Modified Ashworth Scale) and spasm frequency (SPFS) were measured objectively for each patient. Results: The mean treatment time was 1.9 years. Evaluation of established standard forms revealed symptomatic relief from spasticity, spasms, pain, and fatigue in addition to improved body posture, sleep, and life satisfaction after ITB treatment. Conclusions: We report the potential beneficial effects of ITB treatment in patients with inherited ataxia who also suffer from spasticity/spasms. ITB treatment indication in neurological disorders allows for extension to the treatment of spasticity/ spasms in patients with hereditary ataxia.

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Patient-Reported Outcomes and Opioid Use by Outpatient Cancer Patients

Cited by 23 publications

References 48 publications

Predictors of the Predominance of NonIndex Pain After Palliative Radiation Therapy for Painful Tumors

Predictors of the Predominance of NonIndex Pain After Palliative Radiation Therapy for Painful Tumors

Patterns of pain medication use associated with reported pain interference in older adults with and without cancer

Inherited Ataxia and Intrathecal Baclofen for the Treatment of Spasticity and Painful Spasms

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