Prevalence of undertreatment in cancer pain. A review of published literature

Deandrea, Silvia; Montanari, Mauro; Moja, Lorenzo; Apolone, Giovanni

doi:10.1093/annonc/mdn419

Cited by 759 publications

(597 citation statements)

References 40 publications

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“…4,5 Opioid therapy is a necessary component of pain control at the end of life, but primary medical teams often shy away from it. 6 Te involvement of a palliative medicine specialist can change this. A 2013 study showed that after a palliative care consult, patients with previously undertreated pain were more likely to be on a long-acting opioid and receive combination therapy with lower-potency adjunct medication.…”

Section: Opioid Treatment In Palliative Medicine: Unmet Needsmentioning

confidence: 99%

“…A review of undertreated pain showed that more than 40% of cancer and AIDS patients reported inadequate treatment for severe pain. 6 An update to that study showed that up to a third of patients with cancer still report undertreated severe pain, even with the involvement of palliative medicine specialists. 8 Palliative care physicians may also fnd themselves treating chronic pain with opioids.…”

Section: Opioid Treatment In Palliative Medicine: Unmet Needsmentioning

confidence: 99%

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Opioid risk assessment in palliative medicine

Dale

Edwards

Ballantyne

2016

J Community Support Oncol

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Pain management with opioids is an integral part of palliative medicine. As the doses and durations of opioid therapy increase, the inherent risks of opioid therapy rise. Although opioids are effective analgesics, they bring with them complex medical and psychological side effects. Aberrant behavior is dangerous and can be diffcult to identify as it results in a splitting in the goals of treatment between the patient and providers. One effective strategy in preventing that situation is through the early identifcation of at-risk patients. There are several tools that can help identify patients at higher risk of addiction and aberrant behaviors during opioid therapy. Structured use of these tools in conjunction with the clinic exam, regular follow-up visits, and lab testing can further reduce patient risk and improve success in opioid therapy. This article will review the background behind a structured strategy for opioid risk assessment using the Opioid Risk Tool, SOAPP-R, and DIRE tools. In addition, example aberrant behaviors and followup strategies will be reviewed. It will be demonstrated that careful screening and follow-up allow risk factors to be recognized and addressed early.

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Section: Opioid Treatment In Palliative Medicine: Unmet Needsmentioning

confidence: 99%

Section: Opioid Treatment In Palliative Medicine: Unmet Needsmentioning

confidence: 99%

Opioid risk assessment in palliative medicine

Dale

Edwards

Ballantyne

2016

J Community Support Oncol

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“…When individual human resource characteristics were considered separately, none significantly predicted outcome (Model 3-1). When human resource characteristics were 12.3AE3.6 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Abbreviations: ECOG, Eastern Cooperative Oncology Group; SD, standard deviation.…”

Section: Organizational and Patient Characteristicsmentioning

confidence: 99%

“…5 However, according to recent systematic review, there was large variability in the adequacy of pain control, and under-treatment and inadequate pain control are common. 6 Pain control is a key component of palliative care, which aims to improve the quality of life for patients with lifethreatening illnesses. Assessment of outcome indicators for pain control is especially important for quality assurance of palliative care centers.…”

Section: Introductionmentioning

confidence: 99%

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Shin

Hwang

et al. 2012

Cancer

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BACKGROUND:The assessment of pain management outcomes is important for the quality assurance of palliative care. The objective of this study was to determine whether there are significant variations in pain management outcomes among palliative care centers and whether they are affected by organizational factors. METHODS: Data used in this investigation were from the 2009 Korean Terminal Cancer Patient Information System and administrative records of the 34 inpatient palliative care centers designated by the Korean Ministry of Health and Welfare in 2009. Self-reported pain scores (range, from 0 to 10) at admission and 1 week after admission were prospectively collected. Multilevel mixed-effect regression models were used to analyze the variations and the impact of organizational-level factors on 2 pain management outcomes (ie, reduction in average pain score and achievement of adequate pain control at 1 week after admission). RESULTS: In total, 1711 patients with terminal cancer were included in the analyses. The mean reduction in the pain score was 0.69 to 1.91 after 1 week, and most patients (82.8%) achieved adequate pain control. There were significant variations in pain management outcomes among palliative care centers. Higher composite scores for human resources adequacy were associated significantly with a greater reduction in pain score (b, 0.11; 95% confidence interval, 0.01-0.21), and achievement of adequate pain control (adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.45). CONCLUSIONS: There were significant variations in pain management outcomes among inpatient palliative care centers, and they were affected by organizational factors, such as human resources adequacy. Cancer 2012;118:5688-97.

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“…9,[17][18][19] However, we have a limited understanding of the demographic, clinical, and health service factors that influence pain management, specifically opioid use, in persons with cancer at the end of life. The objectives of this study were to use a populationbased method to assess the use of opioid analgesics within the community among older persons with CRC in the six months before death and determine factors associated with the use of opioid analgesics in this population.…”

Section: Introductionmentioning

confidence: 99%

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

Fisher

Urquhart

Johnston

2013

Journal of Pain and Symptom Management

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Context-Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life.Objectives-To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics.Methods-Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n = 657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression.Results-In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR] = 3.18, 95% CI = 2.05-4.94), residence in a long-term care facility (OR = 2.19, 95% CI = 1.23-3.89), and a CRC cause of death (OR = 1.75, 95% CI = 1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR = 0.97, 95% CI = 0.95-0.99), male (OR = 0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR = 0.62, 95% CI = 0.41-0.93).Conclusion-PCPs may play an important role in enabling access to end-of-life care within the community.

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Prevalence of undertreatment in cancer pain. A review of published literature

Abstract: Nearly one of two patients with cancer pain is undertreated. The percentage is high, but consists of a large variability of undertreatment across studies and settings.

Cited by 759 publications

References 40 publications

Opioid risk assessment in palliative medicine

Opioid risk assessment in palliative medicine

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

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