Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

Abstract

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8-55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on followup) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes.

Cancer Pain Prevalence and its Management

“…In a prospective study performed by Apolone et al (2009) at 110 sites (specific oncology, pain, palliative and care centers) in 1802 outpatients and in-patients with advanced stage and metastatic solid tumor, even though sufficient analgesic supplementation was provided to the patients, pain palliation has been ensured only in 25.3% of patients according to PMI (Apolone et al, 2009. It has reported that 11% of patients with moderate-severe intensity of pain received no treatment for pain (Breivik et al, 2009).…”

The Convenience-Based Pain Management Model with Coaching Strategy on Breast Cancer Patients

“…The results of their study mentioned the mildest pain of 1.9; worst pain 6.7; and a mean of 4.1 degrees. In general, the results of this model of pain management research can be an answer solution from some literature that mentions the inadequate management of cancer pain (Apolone et al, 2009Foley, 2011 or has not been handled thoroughly (Desen&Japaries, 2011).…”

Managing severe cancer pain: the role of transdermal buprenorphine: a systematic review

“…The authors planned to carry out a systematic review based on an electronic search of 5 databases, including the contact of the original authors of the primary studies for clarification, or to obtain missing information or individual data. Finally, on the basis of the results of this review and according to the preliminary results of a prospective outcome research study carried out in Italy on 1800 cancer patients with pain, 50 a multicenter RCT to compare the efficacy of 4 strong opioids on cancer pain (buprenorphine, morphine, fentanyl, and oxycodone) will be launched at the end of this year, involving about 80 centers and 1000 patients.…”