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BMC Palliative Care
Published in: BMC Palliative Care 1/2019

Open Access 01-12-2019 | Care | Research article

A systematic review and meta-analysis of randomized controlled trials of palliative care for pain among Chinese adults with cancer

Authors: Xin-Xin Zhao, Meng Cui, Yi-Hang Geng, Yi-Long Yang

Published in: BMC Palliative Care | Issue 1/2019

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Abstract

Background

Pain is one of the most common symptoms that has a severe impact on quality of life and is associated with numerous psychosocial issues in cancer patients. Palliative care, which is a recent development in China, mainly focuses on symptom control and provides psychosocial support in order to improve quality of life for terminally ill patients. This meta-analysis aimed to evaluate the effects of palliative care on cancer pain in China.

Methods

The four most comprehensive Chinese academic databases-CNKI, Wanfang, Vip and CBM-were searched from their inception until July 2019. Medline/PubMed, Web of Science, EBSCO and internet search (Google and Google Scholar) were also searched. Randomized controlled studies assessing the effects of palliative care on cancer pain were analyzed. The pooled random-effect estimates of standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated. Subgroup analysis was conducted by moderating factors for heterogeneity.

Results

The present meta-analysis included 18 studies with a total of 1370 patients. The random-effect model showed a significant effect size of palliative care on cancer pain (SMD = 1.475, p < 0.001; 95% CI = 1.071–1.878). Age, pharmacological/non-pharmacological strategies and publication date could account for the heterogeneity through subgroup analysis to some extent.

Conclusions

Palliative care was largely effective for relieving pain among Chinese adults with cancer, indicating that an adequate system should be urgently established to provide palliative care for cancer patients in Chinese medical settings. However, given the extent of heterogeneity, our findings should be interpreted cautiously.
Appendix
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Literature
1.
van den Beuken-van MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51:1070–90.CrossRef
2.
Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. 2018;167:157–69.CrossRef
3.
Lee YP, Wu CH, Chiu TY, Chen CY, Morita T, Hung SH, et al. The relationship between pain management and psychospiritual distress in patients with advanced cancer following admission to a palliative care unit. BMC Palliat Care. 2015;14:69.CrossRef
4.
Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, et al. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol. 2014;32:4149–54.CrossRef
5.
Are M, McIntyre A, Reddy S. Global disparities in cancer pain management and palliative care. J Surg Oncol. 2017;115:637–41.CrossRef
6.
Kelley AS, Morrison RS. Palliative care for the seriously ill. N Engl J Med. 2015;373:747–55.CrossRef
7.
Kumar SP. Reporting characteristics of cancer pain: a systematic review and quantitative analysis of research publications in palliative care journals. Indian J Palliat Care. 2011;17:57–66.CrossRef
8.
Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza PA, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721–30.CrossRef
9.
Temel JS, Greer JA, El-Jawahri A, Pirl WF, Park ER, Jackson VA, et al. Effects of early integrated palliative care in patients with lung and GI cancer: a randomized clinical trial. J Clin Oncol. 2017;35:834–41.CrossRef
10.
El-Jawahri A, LeBlanc T, VanDusen H, Traeger L, Greer JA, Pirl WF, et al. Effect of inpatient palliative care on quality of life 2 weeks after hematopoietic stem cell transplantation: a randomized clinical trial. JAMA. 2016;316:2094–103.CrossRef
11.
Roberto A, Deandrea S, Greco MT, Corli O, Negri E, Pizzuto M, et al. Prevalence of neuropathic pain in cancer patients: pooled estimates from a systematic review of published literature and results from a survey conducted in 50 Italian palliative care centers. J Pain Symptom Manag. 2016;51:1091–102.CrossRef
12.
Stewart BW, Wild CP. World Cancer report 2014. Switzerland: WHO Press; 2014.
13.
Chen TH, Tung TH, Chen PS, Wang SH, Chao CM, Hsiung NH, et al. The clinical effects of aromatherapy massage on reducing pain for the cancer patients: meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2016;2016:9147974.PubMedPubMedCentral
14.
Yanju B, Yang L, Hua B, Hou W, Shi Z, Li W, et al. A systematic review and meta-analysis on the use of traditional Chinese medicine compound kushen injection for bone cancer pain. Support Care Cancer. 2014;22:825–36.CrossRef
15.
Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. Eur J Cancer Care. 2017;26:e12457.CrossRef
16.
Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y. Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord. 2001;12:232–6.CrossRef
17.
Yang YL, Sui GY, Liu GC, Huang DS, Wang SM, Wang L. The effects of psychological interventions on depression and anxiety among Chinese adults with cancer: a meta-analysis of randomized controlled studies. BMC Cancer. 2014;14:956.CrossRef
18.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Earlbaum: Hillsdale; 1988.
19.
Berben L, Sereika SM, Engberg S. Effect size estimation: methods and examples. Int J Nurs Stud. 2012;49:1039–47.CrossRef
20.
Sosner P, Guiraud T, Gremeaux V, Arvisais D, Herpin D, Bosquet L. The ambulatory hypotensive effect of aerobic training: a reappraisal through a meta-analysis of selected moderators. Scand J Med Sci Sports. 2017;27:327–41.CrossRef
21.
Fatouros-Bergman H, Cervenka S, Flyckt L, Edman G, Farde L. Meta-analysis of cognitive performance in drug-naïve patients with schizophrenia. Schizophr Res. 2014;158:156–62.CrossRef
22.
Borenstein M, Hedges L, Higgins J, Rothstein H. Introduction to meta-analysis. Oxford: Wiley; 2009.CrossRef
23.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.CrossRef
24.
Fei HL, Wang XH, Hu X. Hospice care analysis of patients with advanced liver cancer. Chin Health Stand Manag. 2016;7:189–90 (in China).
25.
Su HX, Yang L. Efficacy of evidence-based nursing in patients with advanced primary liver cancer. Chin J Clin Oncol Rehabil. 2016;23:1261–4 (in China).
26.
Gao DD, Zhao X. Nursing of palliative care for the terminal cancer patients. Psychol Doct. 2017;23:214–5 (in China).
27.
He X, Liu LJ, Ding Y, Yuan WR. Application effect of palliative care in nursing for cancer patients with terminal stage. Nurs Pract Res. 2017;14:113–4 (in China).
28.
Huang MZ, Chen Y, Zhu Q. An intervention study of hospice care about the elderly patients at the community hospital. Chin Med J Metall Indus. 2010;27:641–2 (in China).
29.
Kang HQ, Qi KN, Wu H, Wang SL. The application value of hospice care in patients with advanced liver cancer. Chin Contin Med Educ. 2015;7:249–50.
30.
Li YQ, Zhang MX, Fu GX, Zhao LH, Li WY, Li H, et al. Effect of hospice care on the quality of life and psychological state of aged mortal inpatients. J Cent South Univ. 2006;31:538–42 (in China).
31.
Liu YL, Guo LZ. Effect of palliative comprehensive nursing intervention on pain and anxiety of patients with advanced liver cancer. J Bethune Med Sci. 2016;14:389–91 (in China).
32.
Luo YL, Feng SZ, Zhou XP, Yang QY. Pain management and hospice nursing intervention among primary late liver cancer patients. Guangdong Med J. 2017;38:2421–3 (in China).
33.
Wu L. Application of high quality nursing service on hospice care of patients with terminal stages of cancer. Med Inf. 2015;28:161 (in China).
34.
Wu L. Effects of pain care and hospice care on quality of life in patients with advanced gastric cancer. Med Inf. 2017;30:139–40 (in China).
35.
Xu YF. The effect of comprehensive nursing intervention in negative emotions and pain of patients with advanced cancer. Chin Contin Med Educ. 2014;6:71–2 (in China).
36.
Yao LP. Hospice care analysis of patients with advanced liver cancer. Oriental Diet Therapy and Health Care. 2017;10:314 (in China).
37.
Zhang M, Kang LY, Li QY. Application of hospice care in the management of pain in patients with advanced primary lung cancer. Chin J Clin Oncol Rehabil. 2018;25:198–201 (in China).
38.
You Y. Effect of palliative care on pain control of patients with cancer at terminal stage. Gen Nurs. 2018;5:109 (in China).
39.
Rao JF, Zhu T, Zhang L. Study on the effect of hospice care in the nursing of advanced liver cancer. Psychologies. 2018;3:62 (in China).
40.
Cao Y. Application effect of palliative care service in nursing for patients with advanced liver cancer. Psychol Doct. 2018;24:246–7 (in China).
41.
Yang QY, Zhang P. Effect of family palliative care on quality of life and mental states in patients with end stage lung cancer. Shanxi Med J. 2019;48:1505–7 (in China).
42.
Dalal S, Tanco KC, Bruera E. State of art of managing pain in patients with cancer. Cancer J. 2013;19:379–89.CrossRef
43.
McPherson CJ, Hadjistavropoulos T, Lobchuk MM, Kilgour KN. Cancer-related pain in older adults receiving palliative care: patient and family caregiver perspectives on the experience of pain. Pain Res Manag. 2013;18:293–300.CrossRef
44.
Gagliese L, Jovellanos M, Zimmermann C, Shobbrook C, Warr D, Rodin G. Age-related patterns in adaptation to cancer pain: a mixed-method study. Pain Med. 2009;10:1050–61.CrossRef
45.
Strömgren AS, Groenvold M, Petersen MA, Goldschmidt D, Pedersen L, Spile M, et al. Pain characteristics and treatment outcome for advanced cancer patients during the first week of specialized palliative care. J Pain Symptom Manag. 2004;27:104–13.CrossRef
46.
Barbera L, Seow H, Husain A, Howell D, Atzema C, Sutradhar R, et al. Opioid prescription after pain assessment: a population-based cohort of elderly patients with cancer. J Clin Oncol. 2012;30:1095–9.CrossRef
47.
Lindskog M, Tavelin B, Lundström S. Old age as risk indicator for poor end-of-life care quality-a population-based study of cancer deaths from the Swedish register of palliative care. Eur J Cancer. 2015;51:1331–9.CrossRef
48.
Prommer EE. Pharmacological management of cancer-related pain. Cancer Control. 2015;22:412–25.CrossRef
49.
Wood H, Dickman A, Star A, Boland JW. Updates in palliative care–overview and recent advancements in the pharmacological management of cancer pain. Clin Med. 2018;18:17–22.CrossRef
50.
Chao PW, Lin SP, Tsou MY, Kuo IT, Chang KY. Assessing the impact of renal function on trajectory of intravenous patient-controlled analgesic demands over time after open and laparoscopic colorectal surgery using latent curve analysis. Clin J Pain. 2016;32:695–701.CrossRef
51.
Zhou Y, Huang JX, Lu XH, Zhang YF, Zhang W. Patient-controlled intravenous analgesia for non-small cell lung cancer patient after thoracotomy. Cancer Res Ther. 2015;11:128–30.CrossRef
52.
Wang Y, Tang H, Guo Q, Liu JS, Liu XH, Luo JM, et al. Effects of intravenous patient-controlled sufentanil analgesia and music therapy on pain and hemodynamics after surgery for lung cancer: a randomized parallel study. J Altern Complement Med. 2015;21:667–72.CrossRef
53.
Tse MMY, Wong ACF, Ng HN, Lee HY, Chong MH, Leung WY, et al. The effect of a pain management program on patients with cancer pain. Cancer Nurs. 2012;35:438–46.CrossRef
54.
Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ, et al. Psychological and behavioral approaches to cancer pain management. J Clin Oncol. 2014;32:1703–11.CrossRef
55.
Wu Y, Li L, Su H, Yao X, Wen M. Hospice and palliative care: development and challenges in China. Clin J Oncol Nurs. 2016;20:E16–9.CrossRef
56.
Hølen JC, Hjermstad MJ, Loge JH, Fayers PM, Caraceni A, et al. Pain assessment tools: is the content appropriate for use in palliative care? J Pain Symptom Manag. 2006;32:567–80.CrossRef
Metadata
Title
A systematic review and meta-analysis of randomized controlled trials of palliative care for pain among Chinese adults with cancer
Authors
Xin-Xin Zhao
Meng Cui
Yi-Hang Geng
Yi-Long Yang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2019
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-019-0456-z

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