Palliative care resource (PCR) utilization associated with cancer pain management background

Abstract

8077 Background: Resources required for cancer pain management are not well documented. We monitored the use of PCR, including medications, consultations, imaging needs and hospitalizations in patients (pts) undergoing management of cancer pain by Hematology/Oncology palliative care program at a VA Medical Center. Methods: 99 inpts and 96 outpts with worst pain \(\underline{\mathrm{{>}}}\) 4/10 completed the Brief Pain Inventory at baseline and 1 week (wk). Pain management followed the Agency Health Care Policy Research Cancer Pain Management Guidelines. PCR were obtained prospectively. Results: The median (M) age was 69.2 yrs (range 44.3–87.6). Pts had metastatic cancer of the prostate (29.2%), lung (26.7%), head and neck (9.2%), colorectal (7.7%), pancreas (5.1%), and advanced lymphoma (5.1%) and multiple myeloma (4.6%). Pain pathophysiology included somatic (56.9%), neuropathic (32.8%) and visceral pain (10.3%) By wk 1, worst pain severity (mean 8.4 vs 6.1,p<0.0001), pain relief (40.8% vs 70.9%,p<0.0001) and pain interference scores (38.1 vs 19.9,p<0.0001) improved significantly. PCR by category included: (A) Medications: 71% of pts changed opioids. The M morphine equivalent daily dose (MEDD) was 20 mg orally (0–3,120mg) on day 1 and 90mg (0–3,200mg) at wk 1 (p<0.0001). Adjuvant analgesics included steroids (27%), anticonvulsants (16%) and NSAIDs (8%). Opioid-related side effect treatments included laxatives (72%), antiemetics (19%), anxiolytics (8%), psychostimulants (7%) and neuroleptics (3%). (B) Consultation referrals included radiation (26%), neurology (14%), psychiatry (9%), surgery (14%) and physical therapy (13%); 30 pts (15%) were started on radiation therapy. (C) Imaging studies included 234 plain films, 135 CT scans, 86 MRIs, 54 bone scans, 27 ultrasounds; pain specific imaging needs were identified. (D) Hospitalization: 58 pts (29.7%) were admitted for pain management and the M length of stay was 7 days (1–21). Conclusions: These identifiable costs for effective cancer pain management in a VA population provide a basis for cost effectiveness evaluation and comparison to the private sector (VAHSR&D PCC 98–068). No significant financial relationships to disclose.