The Effectiveness of Cancer Pain Management in a Tertiary Hospital Outpatient Pain Clinic in Thailand: A Prospective Observational Study

Suratsawadee Wangnamthip, Skaorat Panchoowong, Carolina Donado, Kimberly Lobo, Pimporn Phankhongsap, Pinyo Sriveerachai, Pramote Euasobhon, Pranee Rushatamukayanunt, Sahatsa Mandee, Nantthasorn Zinboonyahgoon, Charles B Berde, Suratsawadee Wangnamthip, Skaorat Panchoowong, Carolina Donado, Kimberly Lobo, Pimporn Phankhongsap, Pinyo Sriveerachai, Pramote Euasobhon, Pranee Rushatamukayanunt, Sahatsa Mandee, Nantthasorn Zinboonyahgoon, Charles B Berde

Abstract

Objectives: The objective was to examine the effectiveness of the updated approach.

Methods: With IRB approval, outpatients with cancer were enrolled from January to December 2018. Assessments were recorded at baseline and three consecutive visits (BL, FU1, FU2, and FU3), including Numerical Rating Scale (NRS), the Brief Pain Inventory (BPI), the Edmonton Symptom Assessment System (ESAS), side effects, and analgesic use. The primary outcome was a favorable response, defined as an NRS decrease more than 30% or NRS <4. Secondary outcomes included trends over time in BPI, ESAS, side effects, and analgesic use. Pain response predictors at FU3 were analyzed using logistic regression.

Results: Among 150 patients, 72 (48%) completed follow-ups. Of these, 61% achieved a favorable response at FU3. Pain interference diminished at all visits relative to baseline (p < 0.05). Median morphine equivalent daily dosage (MEDD) at BL was 20 mg/day, with a statistically significant, but clinically modest increase to 26.4 mg/day at FU3. Radiation therapy during pain care was a predictor of pain responders.

Conclusion: The current Siriraj multidisciplinary approach provided effective relief of pain and stabilization of other cancer-related symptoms. Radiation therapy during pain care can be used to predict pain outcomes. Ongoing improvement domains were identified and considered in the context of cultural, economic, and geographic factors.

Conflict of interest statement

The authors declare that they have no conflicts of interest regarding the publication of this paper.

Copyright © 2021 Suratsawadee Wangnamthip et al.

Figures

Figure 1
Figure 1
Flow diagram.
Figure 2
Figure 2
(a) Average pain intensity (7 days recall) at each time point. (b) Karnofsky Performance Status at each time point for patients with complete data. ∗p value <0.02 using Wilcoxon signed-rank test when comparing each time point to baseline.

References

    1. Bray F., Ferlay J., Soerjomataram I., Siegel R. L., Torre L. A., Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018;68(6):394–424. doi: 10.3322/caac.21492.
    1. Van Den Beuken-Van Everdingen M. H. J., Hochstenbach L. M. J., Joosten E. A. J., Tjan-Heijnen V. C. G., Janssen D. J. A. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. Journal of Pain and Symptom Management. 2016;51(6):1070–1090. doi: 10.1016/j.jpainsymman.2015.12.340.e1079
    1. Zech D. F. J., Grond S., Lynch J., Hertel D., Lehmann K. A. Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain. 1995;63(1):65–76. doi: 10.1016/0304-3959(95)00017-m.
    1. Carlson C. Effectiveness of the World Health Organization cancer pain relief guidelines: an integrative review. Journal of Pain Research. 2016;9:515–534. doi: 10.2147/jpr.s97759.
    1. Neufeld N. J., Elnahal S. M., Alvarez R. H. Cancer pain: a review of epidemiology, clinical quality and value impact. Future Oncology. 2017;13(9):833–841. doi: 10.2217/fon-2016-0423.
    1. Banning A., Sjogren P., Henriksen H. Treatment outcome in a multidisciplinary cancer pain clinic. Pain. 1991;47(2):129–134. discussion 127-128.
    1. Chen J., Lu X.-Y., Wang W.-J., et al. Impact of a clinical pharmacist-led guidance team on cancer pain therapy in China: a prospective multicenter cohort study. Journal of Pain and Symptom Management. 2014;48(4):500–509. doi: 10.1016/j.jpainsymman.2013.10.015.
    1. Ferrell B. R., Temel J. S., Temin S., et al. Integration of palliative care into standard Oncology care: American society of clinical Oncology clinical practice guideline update. Journal of Clinical Oncology. 2017;35(1):96–112. doi: 10.1200/jco.2016.70.1474.
    1. Sayed D. The interdisciplinary management of cancer pain. Techniques in Regional Anesthesia and Pain Management. 2013;17(4):163–167. doi: 10.1053/j.trap.2014.07.003.
    1. WHO. Noncommunicable Diseases Country Profiles 2018. Geneva, Switzerland: World Health Organization; 2018. p. p. 223.
    1. World Health Organization. Thailand Population Fact Sheets: Globocan 2020. Geneva, Switzerland: World Health Organization; 2020.
    1. Euasobhon P., Wangnamthip S., Payomyam C., et al. Cancer pain management: is it still problematic? Siriraj Medical Journal. 2019;71(1):38–43.
    1. Wangnamthip S., Euasobhon P., Siriussawakul A., Jirachaipitak S., Laurujisawat J., Vimolwattanasarn K. Effective pain management for inpatients at Siriraj hospital: a retrospective study. Journal of the Medical Association of Thailand. 2016;99(5):565–571.
    1. Farrar J. T., Young J. P., Jr., LaMoreaux L., Werth J. L., Poole M. R. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–158. doi: 10.1016/s0304-3959(01)00349-9.
    1. Yennurajalingam S., Kang J. H., Hui D., Kang D.-H., Kim S. H., Bruera E. Clinical response to an outpatient palliative care consultation in patients with advanced cancer and cancer pain. Journal of Pain and Symptom Management. 2012;44(3):340–350. doi: 10.1016/j.jpainsymman.2011.09.014.
    1. Paul S. M., Zelman D. C., Smith M., Miaskowski C. Categorizing the severity of cancer pain: further exploration of the establishment of cutpoints. Pain. 2005;113(1-2):37–44. doi: 10.1016/j.pain.2004.09.014.
    1. Hawker G. A., Mian S., Kendzerska T., French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-mpq), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP) Arthritis Care Res (Hoboken) 2011;63(11):S240–S252. doi: 10.1002/acr.20543.
    1. Crooks V., Waller S., Smith T., Hahn T. J. The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. Journal of Gerontology. 1991;46(4):M139–M144. doi: 10.1093/geronj/46.4.m139.
    1. Péus D., Newcomb N., Hofer S. Appraisal of the karnofsky performance status and proposal of a simple algorithmic system for its evaluation. BMC Medical Informatics and Decision Making. 2013;13(1):p. 72. doi: 10.1186/1472-6947-13-72.
    1. Chaudakshetrin P. Validation of the Thai version of brief pain inventory (BPI-T) in cancer patients. Journal of the Medical Association of Thailand. 2009;92(1):34–40.
    1. Dworkin R. H., Turk D. C., Wyrwich K. W., et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. The Journal of Pain. 2008;9(2):105–121. doi: 10.1016/j.jpain.2007.09.005.
    1. Serlin R. C., Mendoza T. R., Nakamura Y., Edwards K. R., Cleeland C. S. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995;61(2):277–284. doi: 10.1016/0304-3959(94)00178-h.
    1. Chinda M., Jaturapatporn D., Kirshen A. J., Udomsubpayakul U. Reliability and validity of a Thai version of the edmonton symptom assessment scale (ESAS-Thai) Journal of Pain and Symptom Management. 2011;42(6):954–960. doi: 10.1016/j.jpainsymman.2011.02.020.
    1. Watcha M. F., White P. F. Postoperative nausea and vomiting. Anesthesiology. 1992;77(1):162–184. doi: 10.1097/00000542-199207000-00023.
    1. Wirz S., Klaschik E. Management of constipation in palliative care patients undergoing opioid therapy: is polyethylene glycol an option? American Journal of Hospice and Palliative Medicine. 2005;22(5):375–381. doi: 10.1177/104990910502200511.
    1. Pasero C. Assessment of sedation during opioid administration for pain management. Journal of Peri Anesthesia Nursing. 2009;24(3):186–190. doi: 10.1016/j.jopan.2009.03.005.
    1. Hoots B. E., Xu L., Kariisa M., et al. CDC’s Injury Center. Atlanta, Georgia, USA: 2018. 2018 annual surveillance report of drug-related risks and outcomes—United States.
    1. Elashoff J., Crede F. nQuery Advisor (versión 7.0) [Software de computación] Los Angeles, CA, USA: Statistical Solutions LTD; 2007.
    1. Perez J., Olivier S., Rampakakis E., Borod M., Shir Y. The McGill university health centre cancer pain clinic: a retrospective analysis of an interdisciplinary approach to cancer pain management. Pain Research & Management. 2016;2016 doi: 10.1155/2016/2157950.2157950
    1. Yennurajalingam S., Lu Z., Reddy S. K., et al. Patterns of opioid prescription, use, and costs among patients with advanced cancer and inpatient palliative care between 2008 and 2014. Journal of Oncology Practice. 2019;15(1):e74–e83. doi: 10.1200/jop.18.00205.
    1. Kwon J. H., Oh S. Y., Chisholm G., et al. Predictors of high score patient-reported barriers to controlling cancer pain: a preliminary report. Supportive Care in Cancer. 2013;21(4):1175–1183. doi: 10.1007/s00520-012-1646-x.
    1. Mercadante S., Porzio G., Adile C., et al. Pain intensity as prognostic factor in cancer pain management. Pain Practice. 2015;15(1):E1–E8. doi: 10.1111/papr.12259.
    1. Worakul W., Petpichetchian W., Nilmanat K. Barriers to pharmacological management of cancer pain: a comparison of beliefs between patients and caregivers. Thai Journal of Nursing Council. 2008;23(2):70–81.
    1. Al-Atiyyat N., MSNc R. Barriers toward using opioids in cancer pain management. Journal of Nursing and Health Science. 2016;5(1):78–84.
    1. Chen C. H., Tang S. T., Chen C. H. Meta-analysis of cultural differences in Western and Asian patient-perceived barriers to managing cancer pain. Palliative Medicine. 2012;26(3):206–221. doi: 10.1177/0269216311402711.
    1. Smith-Toner M. How Buddhism influences pain control choices. Nursing. 2003;33(4):p. 17.
    1. Lumlerdkij N., Tantiwongse J., Booranasubkajorn S., et al. Understanding cancer and its treatment in Thai traditional medicine: an ethnopharmacological-anthropological investigation. Journal of Ethnopharmacology. 2018;216:259–273. doi: 10.1016/j.jep.2018.01.029.
    1. Nilmanat K. Palliative care in Thailand: development and challenges. Clinical Journal of Oncology Nursing. 2016;26(3):p. 262.
    1. Amr Y. M., Makharita M. Y. Neurolytic sympathectomy in the management of cancer pain-time effect: a prospective, randomized multicenter study. Journal of Pain and Symptom Management. 2014;48(5):944–956. doi: 10.1016/j.jpainsymman.2014.01.015. e942.
    1. Dobosz Ł., Stefaniak T., Dobrzycka M., et al. Invasive treatment of pain associated with pancreatic cancer on different levels of WHO analgesic ladder. BMC Surgery. 2016;16(1):p. 20. doi: 10.1186/s12893-016-0136-3.
    1. Smith T. J., Staats P. S., Deer T., et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. Journal of Clinical Oncology. 2002;20(19):4040–4049. doi: 10.1200/jco.2002.02.118.
    1. Stearns L. J., Narang S., Albright R. E., Jr., et al. Assessment of health care utilization and cost of targeted drug delivery and conventional medical management vs conventional medical management alone for patients with cancer-related pain. JAMA Network Open. 2019;2(4) doi: 10.1001/jamanetworkopen.2019.1549.e191549
    1. Chow E., Zeng L., Salvo N., Dennis K., Tsao M., Lutz S. Update on the systematic review of palliative radiotherapy trials for bone metastases. Clinical Oncology. 2012;24(2):112–124. doi: 10.1016/j.clon.2011.11.004.
    1. Macleod N., Price A., O’Rourke N., Fallon M., Laird B. Radiotherapy for the treatment of pain in malignant pleural mesothelioma: a systematic review. Lung Cancer. 2014;83(2):133–138. doi: 10.1016/j.lungcan.2013.11.004.
    1. Rich S. E., Chow R., Raman S., et al. Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiotherapy and Oncology. 2018;126(3):547–557. doi: 10.1016/j.radonc.2018.01.003.
    1. Chou P.-L., Fang S.-Y., Sun J.-L., Rau K.-M., Lee B.-O. Gender difference in cancer patients’ adherence to analgesics and related outcomes of pain management. Cancer Nursing. 2018;41(6):E11–e18. doi: 10.1097/ncc.0000000000000532.
    1. Wang H.-L., Kroenke K., Wu J., Tu W., Theobald D., Rawl S. M. Predictors of cancer-related pain improvement over time. Psychosomatic Medicine. 2012;74(6):642–647. doi: 10.1097/psy.0b013e3182590904.
    1. Reis-Pina P., Lawlor P. G., Barbosa A. Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic. Journal of Pain Research. 2017;10:2097–2107. doi: 10.2147/jpr.s139715.
    1. Arthur J., Tanco K., Park M., et al. Personalized pain goal as an outcome measure in routine cancer pain assessment. Journal of Pain and Symptom Management. 2018;56(1):80–87. doi: 10.1016/j.jpainsymman.2018.03.004.
    1. World Bank Country and Lending Groups. World Bank Country and Lending Groups – World Bank Data Help Desk, 2021, .
    1. Shah S. C., Kayamba V., Peek R. M., Jr., Heimburger D. Cancer control in low- and middle-income countries: is it time to consider screening? Journal of Global Oncology. 2019;5(5):1–8. doi: 10.1200/jgo.18.00200.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel