Top

Published in:

01-09-2014 | Original Article

Does a regional comprehensive palliative care program improve pain in outpatient cancer patients?

Authors: Tatsuya Morita, Kazuki Sato, Mitsunori Miyashita, Akemi Yamagishi, Yoshiyuki Kizawa, Yasuo Shima, Hiroya Kinoshita, Satoshi Suzuki, Yutaka Shirahige, Takuhiro Yamaguchi, Kenji Eguchi

Published in: Supportive Care in Cancer | Issue 9/2014

Abstract

Context

Pain is still a major problem for cancer patients, and the effect of a population-based approach on patients’ experience of pain is not fully understood.

Aims

The primary aim of this study was to clarify the changes in pain intensity in outpatients before and after a regional palliative care program. The secondary aim was to clarify the prevalence of patients who had unmet needs for pain treatment and to clarify the reasons for not wanting pain treatment.

Subjects and methods

A regional palliative care program was implemented in four regions of Japan. A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings took part in questionnaire surveys before and after the regional intervention. Responses were obtained from 859 from 1,880 and 857 from 2,123 in the preintervention and postintervention surveys, respectively.

Results

After a regional palliative care program, neither worst, average, nor least pain levels in outpatients changed significantly. A total of 134 patients (16 %) reported that they needed more pain treatment. There were various reasons for not wanting pain treatment, namely, minimum interference with daily life, general nonpreference for medicines, longstanding symptoms before the diagnosis of cancer, concerns about tolerance and addiction, and experienced neuropsychiatric symptoms under current medications.

Conclusion

The regional palliative care program failed to demonstrate improvement of the pain intensity of cancer outpatients. One possible interpretation is that they are less likely to be regarded as target populations and that the study population experienced generally well-controlled pain. Future study including patients with more severe pain is needed, but to improve pain levels of cancer outpatients, intensive, patient-directed intervention seems to be more promising than region-based intervention.

van den Beuken-van E, de Rijke JM, Kessels AG et al (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18:1437–1449CrossRef

Deandrea S, Montanari M, Moja L et al (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19:1985–1991PubMedCentralPubMedCrossRef

Apolone G, Corli O, Caraceni A et al (2009) Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group. Br J Cancer 100:1566–1574PubMedCentralPubMedCrossRef

Shin DW, Hwang SS, Oh J et al (2012) Variations in pain management outcomes among palliative care centers and the impact of organizational factors. Cancer 118:5688–5697PubMedCrossRef

Seow H, Barbera L, Sutradhar R et al (2011) Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 29:1151–1158PubMedCrossRef

Cleeland CS, Gonin R, Hatfield AK et al (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330:592–596PubMedCrossRef

Barbera L, Seow H, Howell D et al (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116:5767–5776PubMedCrossRef

Barbera L, Seow H, Husain A et al (2012) Opioid prescription after pain assessment: a population-based cohort of elderly patients with cancer. J Clin Oncol 30:1095–1099PubMedCrossRef

Yamagishi A, Morita T, Miyashita M et al (2009) Symptom prevalence and longitudinal follow-up in cancer outpatients receiving chemotherapy. J Pain Symptom Manag 37:823–830CrossRef

10.

Valeberg BT, Rustoen T, Bjordal K et al (2008) Self-reported prevalence, etiology, and characteristics of pain in oncology outpatients. Eur J Pain 12:582–590PubMedCrossRef

11.

Schuit KW, Sleijfer DT, Meijler WJ et al (1998) Symptoms and functional status of patients with disseminated cancer visiting outpatient departments. J Pain Symptom Manag 16:290–297CrossRef

12.

Bennett MI, Bagnall AM, Jose CS (2009) How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain 143:192–199PubMedCrossRef

13.

Goldberg GR, Morrison RS (2007) Pain management in hospitalized cancer patients: a systematic review. J Clin Oncol 25:1792–1801PubMedCrossRef

14.

Herman AD, Johnson TM 2nd, Ritchie CS et al (2009) Pain management interventions in the nursing home: a structured review of the literature. J Am Geriatr Soc 57:1258–1267PubMedCrossRef

15.

Lorenz KA, Krebs EE, Bentley TG et al (2009) Exploring alternative approaches to routine outpatient pain screening. Pain Med 10:1291–1299PubMedCrossRef

16.

Luckett T, Davidson PM, Green A, et al. Assessment and management of adult cancer pain: a systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care. J Pain Symptom Manage, in press.

17.

Elliott TE, Murray DM, Oken MM et al (1997) Improving cancer pain management in communities: main results from a randomized controlled trial. J Pain Symptom Manag 13:191–203CrossRef

18.

Hoffmann W, Munzinger H, Horstkotte E et al (2004) A population-based evaluation of an intervention to improve advanced stage cancer pain management. J Pain Symptom Manag 28:342–350CrossRef

19.

Bruera E, Neumann CM, Gagnon B et al (1999) Edmonton Regional Palliative Care Program: impact on patterns of terminal cancer care. CMAJ 161:290–293PubMedCentralPubMed

20.

Gómez-Batiste X, Caja C, Espinosa J et al (2012) The Catalonia World Health Organization demonstration project for palliative care implementation: quantitative and qualitative results at 20 years. J Pain Symptom Manag 43:783–794CrossRef

21.

Gilbert JE, Howell D, King S et al (2012) Quality improvement in cancer symptom assessment and control: the Provincial Palliative Care Integration Project (PPCIP). J Pain Symptom Manag 43:663–678CrossRef

22.

Dudgeon DJ, Knott C, Chapman C et al (2009) Development, implementation, and process evaluation of a regional palliative care quality improvement project. J Pain Symptom Manag 38:483–495CrossRef

23.

Jordhøy MS, Fayers P, Saltnes T et al (2000) A palliative-care intervention and death at home: a cluster randomized trial. Lancet 356:888–893PubMedCrossRef

24.

Jordhøy MS, Fayers P, Loge JH et al (2001) Quality of life in palliative cancer care: results from a cluster randomized trial. J Clin Oncol 19:3884–3894PubMed

25.

Morita T, Miyashita M, Yamagishi A et al (2013) Effects of a programme of interventions on regional comprehensive palliative care for patients with cancer: a mixed-methods study. Lancet Oncol 14:638–646PubMedCrossRef

26.

Morita T, Miyashita M, Yamagishi A et al (2012) A region-based palliative care intervention trial using the mixed-method approach: Japan OPTIM study. BMC Palliat Care 11:2PubMedCentralPubMedCrossRef

27.

Imura C, Morita T, Kato M et al (2013) How and why did a regional palliative care program lead to changes in a region? A qualitative analysis of the Japan OPTIM-study. J Pain Symptom Manag. doi:10.1016/j.jpainsymman.2013.06.002

28.

Morita T, Sato K, Miyashita M, et al. Exploring the perceived changes and the reasons why expected outcomes were not obtained in individual levels in a successful regional palliative care intervention trial: an analysis for interpretations. Support Care Cancer, in press

29.

Uki J, Mendoza T, Cleeland CS et al (1998) A brief cancer pain assessment tool in Japanese: the utility of the Japanese Brief Pain Inventory—BPI-J. J Pain Symptom Manag 16:364–373CrossRef

30.

Morita T, Hirai K, Sakaguchi Y et al (2004) Measuring the quality of structure and process in end-of-life care from the bereaved family perspective. J Pain Symptom Manag 27:492–501CrossRef

31.

Miyashita M, Morita T, Sato K et al (2008) Good Death Inventory: a measure for evaluating good death from the bereaved family member's perspective. J Pain Symptom Manag 35:486–498CrossRef

32.

Jacobsen R, Møldrup C, Christrup L et al (2009) Patient-related barriers to cancer pain management: a systematic exploratory review. Scand J Caring Sci 23:190–208PubMedCrossRef

33.

Weiss SC, Emanuel LL, Fairclough DL et al (2001) Understanding the experience of pain in terminally ill patients. Lancet 357:1311–1315PubMedCrossRef

34.

Jacobsen R, Sjøgren P, Møldrup C et al (2007) Physician-related barriers to cancer pain management with opioid analgesics: a systematic review. J Opioid Manag 3:207–214PubMed

35.

Oldenmenger WH, Sillevis Smitt PA, van Dooren S et al (2009) A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer 45:1370–1380PubMedCrossRef

36.

Morita T, Miyashita M, Shibagaki M et al (2006) Knowledge and beliefs about end-of-life care and the effects of specialized palliative care: a population-based survey in Japan. J Pain Symptom Manag 31:306–316CrossRef

37.

Popovic M, Nguyen J, Chen E, Di Giovanni J, Zeng L, Chow E (2012) Comparison of the EORTC QLQ-BM22 and the FACT-BP for assessment of quality of life in cancer patients with bone metastases. Expert Rev Pharmacoecon Outcomes Res 12:213–219PubMedCrossRef

38.

Keirns CC, Goold SD (2009) Patient-centered care and preference-sensitive decision making. JAMA 302:1805–1806PubMedCrossRef

Title: Does a regional comprehensive palliative care program improve pain in outpatient cancer patients?
Authors: Tatsuya Morita
Kazuki Sato
Mitsunori Miyashita
Akemi Yamagishi
Yoshiyuki Kizawa
Yasuo Shima
Hiroya Kinoshita
Satoshi Suzuki
Yutaka Shirahige
Takuhiro Yamaguchi
Kenji Eguchi
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 9/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-014-2232-1

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Context

Aims

Subjects and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2014

Psychosocial factors predicting survival after allogeneic stem cell transplant

Spiritual well-being and depressive symptoms among cancer survivors

What about Alice? Peripheral neuropathy from taxane-containing treatment for advanced nonsmall cell lung cancer

Validation and feasibility of a caloric expenditure measuring device in women with early-stage breast cancer

The impact of radiotherapy on quality of life for cancer patients: a longitudinal study

A need for cancer patient education from the perspective of Chinese patients and nurses: a comparison study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer