Pain Management In Cancer Patients Research Articles

Recommendations for Pain Management in Cancer Patients

Pain is a symptom that is reported in cancer patients with the prevalence varying from 33% to 64%. Addressing pain remains a critical aspect of cancer treatment with research showing that pain management in this population remains inadequate. Addressing pain is instrumental because of the impact it has on a patient’s life. It affects clinical outcomes, contributes to poor quality of life, and leads to psychological distress. Barriers remain the key challenge that contributes to inadequate management. Addressing these barriers can lead to better outcomes. Carrying out a comprehensive patient assessment and screening is recommended before beginning pain management. Pain is multidimensional in nature and for many patients, different factors may be contributing to pain. Conducting a comprehensive assessment helps to identify these factors. Comprehensive assessment also helps to capture important information that can contribute to better pain management. After conducting an assessment, pain management should begin. Cancer pain can be managed using pharmacological and non-pharmacological interventions. The interventions should aim to improve patient comfort and function. The interventions should also provide more benefits than adverse effects. One of the mainstay interventions in managing cancer pain is opioids. Opioids should be given in accordance with recommendations from different guidelines to ensure they are effective.    

[Pharmacological pain management in cancer patients].

Pharmacological pain therapy in cancer patients is based on guideline recommendations, which, however, do not fully coincide in all aspects due to varying weighting of evidence. The present article discusses current issues including the decreasing significance of the World Health Organization (WHO) analgesic ladder, with its distinction between step2 and3 being increasingly questioned. Risks of nonopioid analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in older populations, are discussed. Paracetamol may potentially reduce the effectiveness of immunotherapies. Aspects of administering analgesics via afeeding tube are considered. Recommendations for the treatment of episodic pain, transitioning between different opioids, and some relevant interactions are also discussed.

Adequacy of Pain Management in Patients Referred for Radiation Therapy: A Subanalysis of the Multicenter ARISE-1 Study.

Pain is a prevalent symptom among cancer patients, and its management is crucial for improving their quality of life. However, pain management in cancer patients referred to radiotherapy (RT) departments is often inadequate, and limited research has been conducted on this specific population. This study aimed to assess the adequacy and effectiveness of pain management when patients are referred for RT. Moreover, we explored potential predictors of adequate pain management. This observational, prospective, multicenter cohort study included cancer patients aged 18 years or older who were referred to RT departments. A pain management assessment was conducted using the Pain Management Index (PMI), calculated by subtracting the pain score from the analgesic score (PMI < 0 indicated inadequate pain management). Univariate and multivariate analyses were performed to identify predictors of adequate pain management. A total of 1042 cancer outpatients were included in the study. The analysis revealed that 42.9% of patients with pain did not receive adequate pain management based on PMI values. Among patients with pain or taking analgesics and referred to palliative or curative RT, 72% and 75% had inadequate or ineffective analgesic therapy, respectively. The odds of receiving adequate pain management (PMI ≥ 0) were higher in patients undergoing palliative RT (OR 2.52; p < 0.001), with worse ECOG-PS scores of 2, 3 and 4 (OR 1.63, 2.23, 5.31, respectively; p: 0.017, 0.002, 0.009, respectively) compared to a score of 1 for those with cancer-related pain (OR 0.38; p < 0.001), and treated in northern Italy compared to central and southern of Italy (OR 0.25, 0.42, respectively; p < 0.001). In this study, a substantial proportion of cancer patients referred to RT departments did not receive adequate pain management. Educational and organizational strategies are necessary to address the inadequate pain management observed in this population. Moreover, increasing the attention paid to non-cancer pain and an earlier referral of patients for palliative RT in the course of the disease may improve pain response and treatment outcomes.

Report of the Second Conference in Zielona Góra: Palliative medicine, supportive care and pain management in cancer patients

Report of the Second Conference in Zielona Góra: Palliative medicine, supportive care and pain management in cancer patients

PP074 Efficacy of breath-guided virtual reality for pain management in cancer patients undergoing percutaneous transhepatic biliary drainage: A randomized controlled study

PP074 Efficacy of breath-guided virtual reality for pain management in cancer patients undergoing percutaneous transhepatic biliary drainage: A randomized controlled study

Interventional pain management in cancer patients-a scoping review.

Pain is the most prevalent symptom in cancer patients. To improve pain care, World Health Organization (WHO) Pain ladder was introduced in 1986 as a template for choosing pain medications in oncological settings. Since then, advancements in oncological treatments have improved the survival of cancer patients, requiring prolonged analgesia in various treatment stages. Additionally, there have been newer challenges in pain management with opioid epidemic and associated opioid use disorders. This has shifted the focus from WHO Pain Ladder and brought new importance to the rapidly evolving realm of interventional pain modalities for cancer pain management. This article reviews such interventional pain and minimally invasive neurosurgical options for pain management in cancer patients. Systemic literature search in PubMed, Cochrane, and Embase. This included review articles, randomized controlled trials, non-randomized clinical trials (RCTs), and case series. A large array of interventional pain modalities are available for oncological pain management. These modalities carry relatively lower risk and provide effective analgesia while reducing concerns related to opioid use disorder. They target various areas in the anatomical and physiological pain pathways and provide more focused options for pain management at various stages of cancer and survivorship. Additionally, with improved sterile techniques, better imaging modalities, and growing technical and clinical expertise, interventional pain modalities offer a safe and often more efficacious method of pain management nowadays. Procedural modalities like intrathecal (IT) pumps, neuromodulation, kyphoplasty, and newer more targeted ablative techniques are now increasingly finding more roles and indications in cancer population. Interventional pain techniques are rapidly evolving and have become an integral part of cancer pain management. They can provide an additional option for cancer pain management, and can help reduce opioid consumption, and associated opioid side effects. With improvement in imaging modalities, procedural techniques, hardware, and infection control, they have a good safety profile and provide a rapid and efficacious approach for cancer pain management. This review articles aims to provide a basic understanding of various interventional pain modalities, their indications, efficacy, safety data, and associated complications.

Complementary and Alternative Medicine for Pain Management in Cancer Patients

The field of Natural Health Sciences and Occult sciences is getting high attention and gaining importance in treatment of several diseases, that are not responding the traditional practice. However, the lack of extensive research and data supporting these fields is preventing them from becoming accepted method of treatment.  Complementary and Alternative Medicine  is not mysterious but science itself. In the last decade there is substantial research in these areas like aura, bioenergy or electromagnetic energy, radiation energy from bodies and techniques to measure these energies leading to wider acceptance. Holistic Healing is the practice of health that considers the  entire person and all of the factors affecting the person and it is based foundational principles of Aurveda, Traditional Chinese Medicine and Herbal medicine. Holistic medicine uses Mind and Body techniques, Natural products, Energy and Spiritual healing. Survey released by National Center for Complementary and Alternative Medicine  (NCCAM-NIH) revealed that 56% of  population in  US and in advanced countries uses CAM. Randomized Clinical studies conducted with 189 Patients undergoing standard chemotherapy, placebo or Reiki found that Energy healing (Reiki) was statistically significant in raising the comfort and well-being of patients post-therapy. Further, in the systematic review of 5 randomized clinical trials,  two studies reported statistically significant reductions in pain when Reiki was used in addition to opioid agents. Additionally, energy healing on oncology patients undergoing infusion, showed 50% reduction in mean pain scores after each treatment. The investigations suggested that the sessions were considered helpful to improve well-being (70%), relaxation (88%), pain relief (45%). Similarly, in another cross over study, it was shown that in all sixteen cancer patients included in energy healing sessions, fatigue decreased, and quality of life was significantly improved with the reiki sessions compared with rest.  Recent studies demonstrated that acupuncture was significantly associated with reduced cancer pain and can decrease the use of analgesics with moderate certainty of evidence. In addition, biology based practices like Herbal, probiotics and vitamins are also used to reduce pain. These methods are accepted by various professional certification agencies like National Certification Center of Energy Practitioners (NCCOEP) and Alliance of Energy practitioners (NAOEP) that is serving as resource for research and literature support. In summary, the complementary and alternative medicine field is upcoming and gaining acceptance as therapeutic method to increase patience confidence and reduce impact of ailment.

Cancer Patients with Chronic Pain and Their Caregivers during COVID-19: A Descriptive Study.

The sanitary measures imposed by COVID-19 intensified challenges in the pain management of cancer patients. A descriptive study was conducted in a chronic pain unit of an oncological hospital aiming to explore the experiences of cancer patients with chronic pain and their caregivers during the pandemic period, as well as identify strategies to improve care in chronic pain management. An electronic questionnaire was developed containing sociodemographic variables, the Depression, Anxiety and Stress Scale-21, and open-ended questions exploring the experiences and circumstances of pain management. A total of 30 patients and 13 caregivers filled in the questionnaire. Patients revealed a higher level of depression, anxiety, and stress than caregivers, without statistically significant differences. Both groups mentioned having experienced difficulties in self-care, particularly in relation to sleep, nutrition, and recreation. In total, 83.7% patients needed pain relief medication related to uncontrolled pain. Both mentioned that they would have benefited from a digital application to ease the communication with the healthcare professionals of the chronic pain unit, as well as non-pharmacological interventions, such as therapeutic massage. Recognizing that chronic pain leads to significant limitations, it is essential to implement and anticipate objective and effective responses in pain management.

MP80-03 OPIOID USE IN VETERANS WITH PROSTATE CANCER FOLLOWING SURGERY TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP80-03 OPIOID USE IN VETERANS WITH PROSTATE CANCER FOLLOWING SURGERY TREATMENT Sumedha Chhatre, S Bruce Malkowicz, Thomas Guzzo, Marilyn Schapira, and Ravishankar Jayadevappa Sumedha ChhatreSumedha Chhatre More articles by this author , S Bruce MalkowiczS Bruce Malkowicz More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Marilyn SchapiraMarilyn Schapira More articles by this author , and Ravishankar JayadevappaRavishankar Jayadevappa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Opioid use for pain management in cancer patients is a challenge. Study objective was to determine the incidence of persistent opioid use in Veterans with early stage prostate cancer and treated with surgery. METHODS: Retrospective cohort study of Veterans diagnosed with prostate cancer between 2015 and 2016. Opioid exposure attributable to treatment was defined as the cumulative oral or topical Morphine Milligram Equivalents (MMEs) prescribed from 31 days prior to 14 days post index surgery. Outcome was any opioid use in the 13-month follow-up period. Eligibility criteria was Veterans receiving care at a VA Medical Center, aged ≥21 years, early stage prostate cancer, surgery treatment at VA Medical Center, and opioid naïve in the period 12 months to 31 days prior to index surgery. Logistic regression was used to model association between any opioid use in the follow-up period as a function of any baseline opioid use, baseline opioid use (MMEs), age, race, ethnicity, socio-economic status, dual enrollment-Medicare Part D, comorbidity, mental health conditions, chronic pain, non-opioid pain medications, cancer treatment (adjuvant chemotherapy, radiation, immunotherapy), and district. RESULTS: 2,594 Veterans with prostate cancer met our criteria. Proportion of Veterans with opioid use during the 13-moth follow-up period is shown in Table 1. The largest opioid use was observed in the first follow-up month (31.5%), and 42.5% had at least one month of opioid use in the follow-up period. Baseline opioid use (OR=5.3, 95% CI=4.1, 6.9), diagnosis year 2015 (OR=1.6, 95% CI=1.3, 1.9), Elixhauser comorbidity score of 1-3 (OR=1.9, 95% CI=1.4, 2.7), chronic pain (OR=1.4, 95% CI=1.2, 1.7), anxiety, depression or PTSD (OR=1.4, 95% CI=1.1, 1.8), and Pacific district were associated with higher risk of opioid use in the follow-up period. Dual Medicare enrollment (OR=0.73, 95% CI=0.57, 0.94), and cancer stage I (OR=0.44, 95% CI=0.30, 0.63) were associated with lower risk of opioid use in follow-up period. CONCLUSIONS: Opioid use immediately after surgery was associated with continued opioid use in the follow-up period. This has implications for optimizing pain management for Veterans with prostate cancer. Source of Funding: VA HSR&D PPO 20-121 and DoD W81XWH-19-1-0461 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1152 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumedha Chhatre More articles by this author S Bruce Malkowicz More articles by this author Thomas Guzzo More articles by this author Marilyn Schapira More articles by this author Ravishankar Jayadevappa More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of Acute Cancer Pain in Asia: An Expert Opinion on the Role of Tramadol/Dexketoprofen Fixed-Dose Combination.

Most patients experience acute cancer pain at some stage throughout their cancer journey. When inadequately managed, cancer pain has devastating consequences for the patient's quality of life. The suboptimal management of cancer pain in Asia is mainly driven by over-regulation and limited access to opioids. Concerns about adverse events and addiction have resulted in a negative perception of this group of drugs among physicians, as well as patients. There is a need to optimize the management of cancer pain across the region, through the provision of an alternative treatment option that is simple to prescribe, convenient to administer and well tolerated by patients, which will increase patients' compliance and good results. As recommended in many international guidelines, starting by the WHO analgesic ladder, cancer pain can be effectively managed with multimodal analgesia. Fixed-dose combinations (FDCs), in which two or more analgesic agents act synergistically to deliver a broad spectrum of pain relief, represent an effective and convenient option for delivering multimodal analgesia to patients with cancer pain. This is extremely well accepted by patients for several reasons. Any multimodal pharmacological approach to pain management should be based on the potentiality to block pain at different levelsand to reduce the dosages of single analgesics, reducing their side effects. Hence, the use of NSAIDs, combined with other analgesics, is the general basis of multimodal pain management. If NSAIDs are combined with tramadol, a weak opioid that has per se a multimodal analgesic efficacy, it may beideal. The tramadol/dexketoprofen FDC combines the centrally acting weak opioid with a peripherally acting NSAID to deliver rapid-onset, long-lasting analgesia, which has been proven efficacious and safe in the management of moderate-to-severe acute pain in the postoperative setting. This expert opinion explores the role oftramadol/dexketoprofen FDC in the management of patients with moderate-to-severe acute cancer pain. It is essentially based on the incredibly high amount of existing data on the use of the drug, and on the long-lasting experience of the experts in pain management of cancer patients participating in the advisory panel.

Clinical pharmacists’ intervention on pain management in cancer patients (PharmaCAP trial): study protocol for a randomized controlled trial

IntroductionEvidence-based services to support cancer patients with pain via clinical pharmacy services are currently lacking. Therefore, there is a need to undertake a randomized controlled trial (RCT) to explore the effectiveness of clinical pharmacists (CPs)’ input into the multidisciplinary team (MDT) in providing better therapeutic outcomes for cancer pain management.ObjectivesThe main aim of this pilot RCT is to determine the feasibility and preliminary efficacy of integrating CPs into the MDT for cancer pain management on the clinical outcomes of cancer patients experiencing pain.MethodsThis study protocol outlines two-armed multicenter pilot RCT. Cancer patients suffering from pain will be randomly allocated to receive either clinical pharmacy services, i.e., PharmaCAP trial intervention from the CP, or the usual standard care (i.e., control group). Patients will be recruited consecutively from two hospitals in Kathmandu valley, Nepal. The outcomes will be assessed at baseline (pre-intervention) and 4 weeks post-intervention. The primary feasibility outcomes will include eligibility rate, recruitment rate, willingness to participate, acceptability of screening procedures and random allocation, possible contamination between the groups, intervention fidelity and compliance, treatment satisfaction, and patient understanding of the provided interventions. Subsequently, the primary clinical outcome, i.e., pain intensity of cancer patients, will be assessed. The secondary clinical outcomes will include health-related quality of life (HRQoL), anxiety, depression, adverse drug reactions, and patient medication compliance following the integration of CP into the healthcare team.DiscussionThe feasibility and potential for integrating CP involvement in MDT to improve clinical outcomes of cancer patients with pain will be evaluated through the PharmaCAP trial.Trial registration: ClinicalTrials.gov NCT05021393. Registered on 25th August 2022.

Enhancing Cancer Pain Self-Management: A Holistic Supporting Model.

Pain self-management is crucial in reducing pain intensity and improving the quality of life for cancer patients. By acquiring self-management skills, patients can actively participate in managing their pain. The objective of this study was to develop a grounded theory-based model to assist cancer patients in enhancing their pain self-management. This qualitative research was conducted in two stages from 2019 to 2021. The initial phase utilized a grounded theory approach to explore the process of pain self-management in cancer patients. Following Corbin and Strauss' analytical method, a grounded theory of pain management in cancer patients was identified. Subsequently, Walker and Avant's theory synthesis strategy was employed to construct a practical model that provides support for patients in managing their pain. Within the conceptual framework, this study developed the "Holistic Supporting from Pain Self-Management" model. This supportive model consists of three main components: (1) enhancing pain self-management skills in cancer patients and their families, (2) empowering physicians and nurses in pain management for cancer patients, and (3) improving the organizational structure for pain management in cancer patients. The Holistic Supporting from Pain Self-Management model emphasizes the importance of addressing all dimensions of cancer pain, including physical, functional, psychosocial, cultural, and spiritual aspects, to effectively manage pain in cancer patients. This model addresses the needs of patients, healthcare providers, and the healthcare system, aiming to enhance and support pain self-management.

Improving PubMed Search Using Medical subject heading ( MeSH) Terms

Medical Subject Headings (MeSH) terms are valuable tools to conduct focused and concise search. This review article evaluates the performance of search strategies for retrieval of information from the national Library of Medicine (NLM) by using the Medical Subject Headings (MeSH) while searching for articles about analgesics used for pain management in cancer patient. We limited our search to 10 types of analgesics. We compared two search strategies MeSH terms and text word searching. Results emphasized that search through MeSH terms provide more precise, efficient and time saving information compared to the text word search. Understanding and learning how to search in PubMed using MeSH terms strategy tool is highly recommended for healthcare professionals to efficiently retrieve the search related information in a timely manner.

Implementation of a Hybrid Care Model for Telemedicine-based Cancer Pain Management at the Cancer Center of Naples, Italy: A Cohort Study.

Telemedicine, the remote delivery of healthcare services, represents a great opportunity for cancer pain management. A care model of telemedicine that combines remote visits and hospital access could be an effective and safe strategy for pain management of cancer patients. A retrospective study was conducted using the dataset of the telemedicine program at the Istituto Nazionale Tumori of Naples, Italy for assessing the efficacy of a telehealth-based model of care. Demographic, clinical, and process variables were investigated. A total of 226 cases and 489 visits were included in the analysis. The mean age of patients was 63.4 years (SD=12.4 years), and no sex differences were observed. Approximately 55% of patients were ECOG-PS ≤2 and 87% suffered from metastatic disease. More than half of the patients were treated with high doses of opioids. Each patient had a mean of 2 remote visits and half of the patients had more than 1 telehealth consultation. The dropout ratio was 5.3%. Most visits (n=472) were conducted on patients in the Campania Region, Italy. The maximum covered distance from the Cancer Center and the patients' location was 555.22 Km. A significant difference in the overall number of visits (p=0.006) and the number of pro-capita remote visits (p=0.010) was found, in favor of the group of patients treated before the end of the Covid-19 emergency in Italy, compared to those treated after the pandemic. Despite various positive outcomes, the analysis highlights several weaknesses, such as the need to assist patients with advanced and non-advanced disease located outside the regional territory. Overall, the telehealth processes should be adapted to post-pandemic scenarios towards their implementation in routine clinical practice.

Pain Management in Cancer Patients

Pain is always a subjective experience that is influenced by behavioral, biological, and social factors. Timely assessment and proper treatment can significantly reduce the consequences associated with inadequate pain relief. The pathophysiology of the pain that is suffered by cancer patients is overly complex and is thought to be due to various mechanisms involved. It is thought that many of them complain of severe neuropathic pains, which may be due to the ongoing compression, ischemia, and inflammation. In addition to the pain of their metastatic disease, they also suffer from treatment-related pains and procedural/surgical pains. This review article highlights the pathophysiology, and assessment and particularly focuses on the management of pain in cancer patients with different modalities using Oncological, Pharmacological, Non-pharmacological, and Interventional techniques.

[Double-edged sword of opioids in the treatment of cancer pain: hyperalgesia].

Hyperalgesia is an occult complication during the treatment of cancer pain, not only related to opioids, but also pertaining to the tumor itself and cancer therapeutic drugs. Yet it is often ignored by clinicians. Patients with cancer pain who were treated with opioids often have sensory abnormalities presented with reduced pain threshold and increased sensitivity to nociceptive stimuli. This phenomenon is clinically called opioid-induced hyperalgesia (OIH). However, due to the complexity of pathogenesis and the lack of clinical diagnostic criteria, the pain management of cancer patients is still facing great challenges. Therefore, this article focuses on the clinical diagnosis, pathogenesis, prevention and treatment of hyperalgesia related to cancer pain treatment, in order to provide a basis for optimal use of opioids in the future.

Quality Of Life of Cancer Patients Attending a Cancer Hospital, Lumbini Province, Nepal

Background: Quality of life is an important aspect and high priority of the cancer patient care. The objective of the study was to find out the quality of life of cancer patients attending a Cancer hospital, Lumbini Province, Nepal. Methods: An analytical cross sectional study design based on quantitative approach was used in the study. The study was conducted in Sushil Koirala Prakhar Cancer Hospital, Khajura, Banke which was selected purposively considering only one cancer hospital in province five, Nepal. The entire cancer patients receiving at least one cycle of cancer treatment was included in the study using non probability purposive sampling technique. Semi structured interview based questionnaires was used and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – C30 (EORTC QLQ- C30) was used for measuring quality of life. The data was collected by the enumerator by face to face interview. The collected data were   analyzed by using descriptive and inferential statistics. Results: The patients with carcinoma (ca) lungs were in highest proportion (24.5%) followed by ca breast. The transform mean and SD score of Global Health/QoL was 35.84 (16.87), functional scale 36.35(15.54), symptoms scale 53.02 (14.61).Occupation was found to be associated with quality of life at statistically significant level in (p= .000) function score. Site of cancer was found to be associated with quality of life at statistically significant levels (p=.0.009) in symptom score. The patients with stage I and   II had high global health score and least in stage IV. There was positive correlation of .610** (p=.000) significant at 0.01 level with functional scales and high negative correlation of -.521(p=-.521**) with symptom scales at (p=.000) level of significance. The overall quality of life of cancer patients was poor. The pain management of cancer patients should be taken into consideration.

Adequacy of Pain Treatment in Radiotherapy Departments: Results of a Multicenter Study on 2104 Patients (Arise).

Simple SummaryCancer pain is often inadequately treated, as shown by several clinical studies. This problem has been confirmed in different clinical settings but the reasons for this phenomenon are unclear. Furthermore, little evidence is available on the adequacy of pharmacological pain management in patients undergoing radiotherapy. Moreover, studies investigating possible predictors of inadequate pain management reported contradictory results. Therefore, in this analysis, we evaluated a large population of cancer patients undergoing radiotherapy. We recorded, similarly to previous studies, a 45% rate of patients with inadequate analgesic therapy. Furthermore, evaluating the characteristics of patients with inadequate analgesic treatment, we noted that the subjects with better general conditions or better prognostic factors are those most frequently receiving inadequate drug therapy.Aim: The frequent inadequacy of pain management in cancer patients is well known. Moreover, the quality of analgesic treatment in patients treated with radiotherapy (RT) has only been rarely assessed. In order to study the latter topic, we conducted a multicenter, observational and prospective study based on the Pain Management Index (PMI) in RT Italian departments. Methods: We collected data on age, gender, tumor site and stage, performance status, treatment aim, and pain (type: CP—cancer pain, NCP—non-cancer pain, MP—mixed pain; intensity: NRS: Numeric Rating Scale). Furthermore, we analyzed the impact on PMI on these parameters, and we defined a pain score with values from 0 (NRS: 0, no pain) to 3 (NRS: 7–10: intense pain) and an analgesic score from 0 (pain medication not taken) to 3 (strong opioids). By subtracting the pain score from the analgesic score, we obtained the PMI value, considering cases with values < 0 as inadequate analgesic prescriptions. The Ethics Committees of the participating centers approved the study (ARISE-1 study). Results: Two thousand one hundred four non-selected outpatients with cancer and aged 18 years or older were enrolled in 13 RT departments. RT had curative and palliative intent in 62.4% and 37.6% patients, respectively. Tumor stage was non-metastatic in 57.3% and metastatic in 42.7% of subjects, respectively. Pain affected 1417 patients (CP: 49.5%, NCP: 32.0%; MP: 18.5%). PMI was < 0 in 45.0% of patients with pain. At multivariable analysis, inadequate pain management was significantly correlated with curative RT aim, ECOG performance status = 1 (versus both ECOG-PS3 and ECOG- PS4), breast cancer, non-cancer pain, and Central and South Italy RT Departments (versus Northern Italy).Conclusions: Pain management was less adequate in patients with more favorable clinical condition and stage. Educational and organizational strategies are needed in RT departments to reduce the non-negligible percentage of patients with inadequate analgesic therapy.

Randomized double-blind controlled trial to assess the efficacy of intravenous acetaminophen associated with strong opioids in the treatment of acute pain in adult cancer patients: study protocol

BackgroundCancer pain is one of the most frequent and relevant symptoms in cancer patients and impacts on patient’s quality of life. International and local standards recommend as an initial strategy the use of an analgesic scheme composed of strong opioids associated with adjuvants such as acetaminophen, based upon the assumption that combining drugs could have a better analgesic effect, could allow lowering opioid dosing, and could prevent the occurrence of adverse effects of opioids. However, there is uncertainty about the impact of acetaminophen as an adjuvant in patients who use strong opioids for moderate to severe pain management in cancer patients. The aim of this study is to assess the efficacy and safety of intravenous acetaminophen associated with strong opioids in hospitalized adult cancer patients who have moderate to severe cancer-related pain.MethodsWe will perform a randomized double-blinded controlled study comparing intravenous acetaminophen 1 g 4 times a day versus placebo for 48 h as an adjuvant to strong opioids. We will assess pain intensity as a primary outcome, using the verbal numerical rating scale (VNRS, I0 to 10 scale with higher scores meaning higher pain intensity), and we will compare the mean difference in pain intensity between baseline and 48 h among the placebo and intervention groups. We estimate that a decrease of 1 point in the VNRS would be clinically significant. Assuming a standard deviation in pain intensity of 1.7 points, an alpha of 0.025, and a power of 0.8, we estimate a sample size of 112 patients, with 56 patients in each arm. Secondary outcomes include the difference in total opioid use between baseline and at 48 h among the groups, and adverse effects such as drowsiness, constipation, nausea, and vomiting would be evaluated.DiscussionThe randomized, double-blind, placebo-controlled design is the best strategy to assess the efficacy of acetaminophen as an adjuvant in adult cancer patients with moderate to severe pain who are receiving strong opioids. We expect to contribute to national and international guidelines with these results.Trial registrationClinicaltrials.gov NCT04779567. Registered on March 3, 2021. Retrospectively registered.

Inferior survival outcomes with concomitant immune checkpoint inhibitors and chronic opioid use.

e14564 Background: Immune checkpoint inhibitors (ICI) are monoclonal antibodies that promote immune recognition of tumor cells to facilitate their elimination. Opioids are a major facet of pain management in cancer patients. Since chronic opioid use results in immunosuppression, the purpose of this study was to evaluate the survival outcomes of cancer patients on concurrent ICI and opioid therapy. Methods: This single-institute retrospective study from an NCI-designated comprehensive cancer center evaluated all patients in the primary or recurrent setting who underwent ICI therapy (anti-PD-1/PD-L1/CTLA-4) from 1 January 2020 to 18 June 2021. Demographic, clinicopathologic, and co-morbidity data were obtained from electronic medical records and the New York State Cancer Registry data. The New York State Prescription Monitoring Program was used to collect data about opioid prescriptions filled by patients from 30 days prior to and 30 days after the end of ICI therapy. Patient characteristics were analyzed with the Mann-Whitney U or chi-square tests. Survival analyses were performed using the Kaplan-Meier and Cox model regression, adjusting for relevant clinical factors. Results: A total of 869 patients were evaluable based on inclusion criteria and data availability. Most patients (77.15% chronic users and 64.62% occasional users) had stage III/IV disease. The most represented services included: gynecology (11.54%), soft tissue/melanoma (14.13%), thoracic (38.75%), urology (11.9%). Comorbidities did not vary between the two groups. Pre-treatment median opioid consumption was higher in the chronic users compared to occasional users (240 oral morphine equivalents (OME) vs 120, p = 0.03). Total opioid prescriptions filled was significantly higher for chronic users compared to occasional users (4275.0 vs 520.1 OME, p &lt; 0.001). Chronic users were more likely to be on an additional anti-neoplastic agent (64% vs 44.07% for occasional users). Occasional users had significantly longer progression free (44.7 vs 16.0 months, p &lt; 0.001) and overall (42.7 vs 16.2 months, p &lt; 0.001) survival. When controlling for age, stage, and concurrent therapy, chronic opioid use retained a significantly negative association with PFS and OS. Conclusions: Patients on ICI therapy in the primary and recurrent setting who chronically use opioids exhibit significantly decreased PFS and OS compared to the occasional user cohort. This study provides evidence that chronic opioid use during ICI therapy results in inferior clinical outcomes.