Abstract
BackgroundThe undertreatment of cancer pain is a global issue although many international guidelines and various studies bloom to explore the approaches in pain management. However, there is no standard care for cancer pain in routine practices. To set up a standardized procedure for improving cancer pain management in Taiwan, the Good Pain Management (GPM) program is explored to provide treatments following the US National Cancer Care Network (NCCN) Adult Cancer Pain Guideline.MethodPatients diagnosed with moderate-to-severe cancer pain were eligible and randomized into the GPM or control arm and observed the first 48 h to evaluate the effects of pain management between 2 arms. Pain control, adequacy of treatments, patient satisfaction, and quality of life (QoL) of eligible patients were analyzed. Ad hoc analyses based on the pain medication category were also conducted.ResultFifty-one patients were enrolled, with 26 and 25 assigned to the GPM and control arms, respectively. Significant differences among the GPM and control arms were found including a greater decrease in the mean numerical rating scale (NRS) score in the GPM arm (− 4.6 vs. − 2.8), a lower proportion of moderate-to-severe pain in the GPM arm (23.2% vs. 39.8%), and a higher pain management index (PMI) score in the GPM arm (0.64 points vs. 0.33 points) (all p < 0.05). Ad hoc analyses revealed that the patient subgroups using strong opioids showed better patient satisfaction in GPM arm when compared with the same subgroup in the control arm.ConclusionIn summary, our study demonstrated that the implementation of a standardized pain assessment and management approach (GPM ward program) showed significant improvements on pain relief, decreased the portion of moderate-to-severe cancer pain, and increased patient satisfaction in the 1st 48 h after admission. The implementation of the GPM approach in the cancer ward may provide sooner and better improvement of cancer pain management for patients who suffered moderate-to-severe cancer pain.Trial registrationClinicalTrials.gov (Identifier: NCT03155516)
Highlights
Pain is one of the most common symptoms occurring in 53% of cancer patients in all stages of the disease, and over 70% of patients in advanced stages experience uncontrolled pain of moderate-to-severe intensity worldwide [1,2,3]
Continuous variables were described using the number of observations, mean, median, standard deviation (SD), and 95% confidence intervals
Changes from baseline were analyzed by paired t test or Wilcoxon signed rank test based on the normality assumption, and the difference between groups was compared by two-sample t test for normal distribution or the Wilcoxon rank sum test for non-normal distribution
Summary
Pain is one of the most common symptoms occurring in 53% of cancer patients in all stages of the disease, and over 70% of patients in advanced stages experience uncontrolled pain of moderate-to-severe intensity worldwide [1,2,3]. There are international guidelines for pain management [7,8,9,10], the undertreatment of cancer pain is still a widespread issue in Asia, Europe, and North America for 59.1%, 40.3%, and 39.1% of cancer patients, respectively [2]. The undertreatment of cancer pain is a global issue many international guidelines and various studies bloom to explore the approaches in pain management. Method Patients diagnosed with moderate-to-severe cancer pain were eligible and randomized into the GPM or control arm and observed the first 48 h to evaluate the effects of pain management between 2 arms. Adequacy of treatments, patient satisfaction, and quality of life (QoL) of eligible patients were analyzed. Ad hoc analyses revealed that the patient subgroups using strong opioids showed better patient satisfaction in GPM arm when compared with the same subgroup in the control arm
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