Prediction and management of pain in patients with advanced cancer

McKegney, F. Patrick; Bailey, Linda R.; Yates, Jerome W.

doi:10.1016/0163-8343(81)90050-5

Cited by 50 publications

(6 citation statements)

References 11 publications

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“…Further primary research should be powered and include a concurrent economic evaluation. New home palliative care interventions must respond to the challenges ahead, posed by rapidly ageing populations with increased complexity and growing need for home palliative care; these are international challenges (Gomes 2008 ; Gomes 2011 ). Research in middle-income and low-income countries does not yet exist.…”

Section: Authors' Conclusionmentioning

confidence: 99%

“…The importance of providing optimal palliative care that supports patients with advanced illness and caregivers who wish to stay at home is particularly topical in ageing populations (Khaw 1999 ; WHO 2011 ). With the number of deaths predicted to rise dramatically in the future due to longer life expectancy and large cohorts of 'baby-boom' generations reaching older age, high numbers of hospital deaths are difficult to sustain and an expansion of palliative care provision will need to happen in all settings – in hospitals, hospices, nursing and residential homes, and importantly at home (Gomes 2008 ; Gomes 2011 ). Already in a few countries such as the UK, Canada and the US, there has been a reversal of secular trends towards institutionalised dying and increasingly more people die at home (Gomes 2012a ; Gao 2013 ; Wilson 2009 ;Teno 2013 ; Flory 2004 ).…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

Gomes

Calanzani

Curiale

et al. 2013

Cochrane Database of Systematic Reviews

488

341

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Background Extensive evidence shows that well over 50% of people prefer to be cared for and to die at home provided circumstances allow choice. Despite best efforts and policies, one-third or less of all deaths take place at home in many countries of the world. Objectives 1. To quantify the effect of home palliative care services for adult patients with advanced illness and their family caregivers on patients' odds of dying at home; 2. to examine the clinical effectiveness of home palliative care services on other outcomes for patients and their caregivers such as symptom control, quality of life, caregiver distress and satisfaction with care; 3. to compare the resource use and costs associated with these services; 4. to critically appraise and summarise the current evidence on cost-effectiveness. Search methods We searched 12 electronic databases up to November 2012. We checked the reference lists of all included studies, 49 relevant systematic reviews, four key textbooks and recent conference abstracts. We contacted 17 experts and researchers for unpublished data. Selection criteria We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITSs) evaluating the impact of home palliative care services on outcomes for adults with advanced illness or their family caregivers, or both. Data collection and analysis One review author assessed the identified titles and abstracts. Two independent reviewers performed assessment of all potentially relevant studies, data extraction and assessment of methodological quality. We carried out meta-analysis where appropriate and calculated numbers needed to treat to benefit (NNTBs) for the primary outcome (death at home). Main results We identified 23 studies (16 RCTs, 6 of high quality), including 37,561 participants and 4042 family caregivers, largely with advanced cancer but also congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), HIV/AIDS and multiple sclerosis (MS), among other conditions. Meta-analysis showed increased odds of dying at home (odds ratio (OR) 2.21, 95% CI 1.31 to 3.71; Z = 2.98, P value = 0.003; Chi 2 = 20.57, degrees of freedom (df) = 6, P value = 0.002; I 2 = 71%; NNTB 5, 95% CI 3 to 14 (seven trials with 1222 participants, three of high quality)). In addition, narrative synthesis showed evidence of small but statistically significant beneficial effects of home palliative care services compared to usual care on reducing symptom burden for patients (three trials, two of high quality, and one CBA with 2107 participants) and of no effect on caregiver grief (three RCTs, two of high quality, and one CBA with 2113 caregivers). Evidence on cost-effectiveness (six studies) is inconclusive. Authors' conclusions ...

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Section: Authors' Conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

Gomes

Calanzani

Curiale

et al. 2013

Cochrane Database of Systematic Reviews

488

341

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“…In 46 studies, (part of) the aim of the study had been to determine the prevalence of pain in cancer patients. This had not been a primary goal in the other eight studies [11,13,49,65,71,73,75,82,84]. One study looked at unmet needs, one described the experiences of a palliative care programme, two compared usual care with intensive care, one was on the influence of demographic and disease specific variables on pain and one compared differences in symptoms between cancer and noncancer patients.…”

Section: General Characteristicsmentioning

confidence: 99%

Prevalence of pain in patients with cancer: a systematic review of the past 40 years

Everdingen

Rijke

Kessels³

et al. 2007

Annals of Oncology

1,612

859

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Background: Despite the abundant literature on this topic, accurate prevalence estimates of pain in cancer patients are not available. We investigated the prevalence of pain in cancer patients according to the different disease stages and types of cancer.Patients and methods: A systematic review of the literature was conducted. An instrument especially designed for judging prevalence studies on their methodological quality was used. Methodologically acceptable articles were used in the meta-analyses.Results: Fifty-two studies were used in the meta-analysis. Pooled prevalence rates of pain were calculated for four subgroups: (i) studies including patients after curative treatment, 33% [95% confidence interval (CI) 21% to 46%]; (ii) studies including patients under anticancer treatment: 59% (CI 44% to 73%); (iii) studies including patients characterised as advanced/metastatic/terminal disease, 64% (CI 58% to 69%) and (iii) studies including patients at all disease stages, 53% (CI 43% to 63%). Of the patients with pain more than one-third graded their pain as moderate or severe. Pooled prevalence of pain was >50% in all cancer types with the highest prevalence in head/neck cancer patients (70%; 95% CI 51% to 88%). Conclusion:Despite the clear World Health Organisation recommendations, cancer pain still is a major problem.

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“…In our study, the prevalence of pain was high during the last few days before death. It has been reported that the frequency of pain increased before cancer patients died . However, other studies showed that the prevalence of pain was only approximately 40–70% and tended to decline in the dying phase .…”

Section: Discussionmentioning

confidence: 97%

“…It has been reported that the frequency of pain increased before cancer patients died. 18,19 However, other studies showed that the prevalence of pain was only approximately 40-70% and tended to decline in the dying phase. [1][2][3]20 This difference in result of studies may be caused by differences in evaluation of pain or type of primary cancer.…”

Section: Discussionmentioning

confidence: 99%

Symptom prevalence in patients with advanced skin cancer

Goto

Yoshikawa

Otsuka

et al. 2016

The Journal of Dermatology

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Knowledge of the prevalence of symptoms in patients with incurable cancer in the terminal stage is important for clinicians. However, there has been no report on the prevalence of symptoms in patients with incurable skin cancer. We analyzed the prevalence of symptoms in 224 patients who died due to skin cancer in our center. These data were obtained from medical records compiled by a miscellaneous population of medical staff retrospectively. We evaluated the symptoms at 3 months, 1 month, 2 weeks, 1 week and 3 days before the patients died. Data for symptoms included Eastern Cooperative Oncology Group performance status and the presence or absence of the following 13 symptoms: (i) bleeding or exudate; (ii) pain or necessity for an analgesic; (iii) fatigue; (iv) anorexia; (v) nausea; (vi) dyspnea or need for oxygen administration; (vii) bloating; (viii) insomnia; (ix) delirium; (x) drowsiness; (xi) anemia; (xii) spasm; and (xiii) paralysis. The average performance status gradually progressed. Pain and anorexia were the most common symptoms in patients with advanced skin cancer. Dyspnea, anemia and drowsiness also tended to be frequent as death approached despite the fact that the frequencies of these symptoms were not high 3 months before death. We considered that frequencies of prevalence of pain and dyspnea were due to bone and lung metastases. Bleeding or exudate from lesions is a characteristic symptom in patients with skin cancer. Our results regarding the prevalence of symptoms in patients with advanced skin cancer will be helpful for medical professionals to assess patients' conditions and to plan treatment.

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Prediction and management of pain in patients with advanced cancer

Cited by 50 publications

References 11 publications

Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

Prevalence of pain in patients with cancer: a systematic review of the past 40 years

Symptom prevalence in patients with advanced skin cancer

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