Strategies for Cancer Pain Management

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 6207

Special Issue Editor

*
E-Mail Website
Guest Editor
Main Regional Center for Pain Relief & Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy
Interests: cancer pain; opioids; palliative care
* Section: Cancer Survivorship and Quality of Life
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite increased attention to cancer pain, pain prevalence in patients with cancer has not significantly changed over the last several decades. Over one-third of patients receiving anticancer therapy suffer from moderate-to-severe pain, and about 50% of the population in the advanced stage of disease has moderate-to-severe pain. The lack of improvement is due to barriers for patients to report pain, poor pain assessment, limited education and knowledge of available analgesic treatments, and limitations of pharmacological treatments. In the last several years, the opioid crisis has also influenced the proper use of opioid analgesics, which remain fundamental for cancer pain management.

Cancer pain is a complex issue that requires specific competence and knowledge of all available methods to relieve it. Despite the extensive experience suggesting the feasibility and efficacy of the WHO method, this approach is just a general recommendation and has been erroneously considered the gold standard of cancer pain management usable by anyone. It is evident that in the third century, the different situations of cancer pain cannot be included in the three-step ladder, and that any specific clinical circumstance requires profound knowledge of all available pharmacological and non-pharmacological techniques.

This Special Issue will highlight the role of different strategies for assessing and treating cancer pain.

Prof. Dr. Sebastiano Mercadante
Guest Editor

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Keywords

  • cancer pain
  • palliative care
  • opioids
  • analgesics
  • management

Published Papers (5 papers)

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Research

15 pages, 1825 KiB  
Article
Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries
by Michael J. McNeil, Ximena Garcia Quintero, Miriam Gonzalez, Yawen Zheng, Cecilia Ugaz Olivares, Roxana Morales, Erica Boldrini, Débora Rebollo de Campos, Daiane Ferreira, Kamalina Coopasamy, Joliza Caneba, Maria Louisa Padernilla, Stefan Friedrichsdorf, Justin N. Baker and Paola Friedrich
Cancers 2024, 16(5), 1025; https://doi.org/10.3390/cancers16051025 - 01 Mar 2024
Viewed by 819
Abstract
Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the “Children’s Comfort Promise”, includes (1) topical [...] Read more.
Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the “Children’s Comfort Promise”, includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the “Global Comfort Promise” was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children’s Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child’s pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy. Full article
(This article belongs to the Special Issue Strategies for Cancer Pain Management)
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9 pages, 391 KiB  
Article
Pain Catastrophizing in Cancer Patients
by Sebastiano Mercadante, Patrizia Ferrera, Alessio Lo Cascio and Alessandra Casuccio
Cancers 2024, 16(3), 568; https://doi.org/10.3390/cancers16030568 - 29 Jan 2024
Viewed by 712
Abstract
Background: Pain catastrophizing is a group of negative irrational cognitions in the context of anticipated or actual pain. The aim of this study was to decipher the possible role of catastrophism on pain expression and outcomes after a comprehensive palliative care treatment. Methods: [...] Read more.
Background: Pain catastrophizing is a group of negative irrational cognitions in the context of anticipated or actual pain. The aim of this study was to decipher the possible role of catastrophism on pain expression and outcomes after a comprehensive palliative care treatment. Methods: A consecutive sample of patients with uncontrolled pain was assessed. Demographic characteristics, symptom intensity included in the Edmonton symptom assessment system (ESAS), and opioid drugs used were recorded at admission (T0). The Pain Catastrophizing Scale (PCS) was measured for patients. Patients were also asked about their personalized symptom goal (PSG) for each symptom of ESAS. One week after a comprehensive palliative care treatment (T7), ESAS and opioid doses used were recorded again, and the number of patients who achieved their PSG (PSGR) were calculated. At the same interval (T7), Minimal Clinically Important Difference (MCID) was calculated using patient global impression (PGI). Results: Ninety-five patients were eligible. A significant decrease in symptom intensity was reported for all ESAS items. PGI was positive for all symptoms, with higher values for pain, poor well-being, and poor sleep. Only the rumination subscale of catastrophism was significantly associated with pain at T0 (B = 0.540; p = 0.034). Conclusions: Catastrophism was not associated with the levels of pain intensity, PSG, PSGR, and PGI for pain, except the rumination subscale that was associated with pain intensity at T0. A comprehensive palliative care management provided the relevant changes in symptom burden, undoing the pain expression associated with rumination. Full article
(This article belongs to the Special Issue Strategies for Cancer Pain Management)
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13 pages, 431 KiB  
Article
Immunoassay Urine Drug Testing among Patients Receiving Opioids at a Safety-Net Palliative Medicine Clinic
by John M. Halphen, Joseph A. Arthur, Soraira Pacheco, Linh M. T. Nguyen, Nikitha N. Samy, Nathaniel R. Wilson, Gregory Sattler, Shane E. Wing, Rex A. D. Paulino, Christine Feng, Pulin Shah, Simbiat Olayiwola, Bradley Cannell, Supriyanka Addimulam, Riddhi Patel and David Hui
Cancers 2023, 15(23), 5663; https://doi.org/10.3390/cancers15235663 - 30 Nov 2023
Cited by 1 | Viewed by 1027
Abstract
Background: Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics. Objectives: We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine [...] Read more.
Background: Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics. Objectives: We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic. Methods: A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020. We collected longitudinal data on patient demographics, UDT findings, and potential predictors of aberrant results. Results: Of the 913 patients in the study, 500 (55%) underwent UDT testing, with 455 (50%) having the testing within the first three visits. Among those tested within the first three visits, 125 (27%) had aberrant UDT results; 44 (35%) of these 125 patients were positive for cocaine. In a multivariable regression model analysis of predictors for aberrant UDT within the first three visits, non-Hispanic White race (odds ratio (OR) = 2.13; 95% confidence interval (CI): 1.03–4.38; p = 0.04), history of illicit drug use (OR = 3.57; CI: 1.78–7.13; p < 0.001), and history of marijuana use (OR = 7.05; CI: 3.85–12.91; p < 0.001) were independent predictors of an aberrant UDT finding. Conclusion: Despite limitations of immunoassay UDT, it was able to detect aberrant drug-taking behaviors in a significant number of patients seen at a safety-net hospital palliative care clinic, including cocaine use. These findings support universal UDT monitoring and utility of immunoassay-based UDT in resource-limited settings. Full article
(This article belongs to the Special Issue Strategies for Cancer Pain Management)
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11 pages, 261 KiB  
Article
Effectiveness of Opioid Switching in Advanced Cancer Pain: A Prospective Observational Cohort Study
by Aaron K. Wong, Andrew A. Somogyi, Justin Rubio, Tien Dung Pham, Brian Le, Pal Klepstad and Jennifer Philip
Cancers 2023, 15(14), 3676; https://doi.org/10.3390/cancers15143676 - 19 Jul 2023
Cited by 3 | Viewed by 1208
Abstract
Opioid switching is a common practice of substituting one opioid for another to improve analgesia or adverse effects; however, it has limited evidence. This study aimed to examine the effectiveness of opioid switching in advanced cancer. This multi-center prospective cohort study recruited patients [...] Read more.
Opioid switching is a common practice of substituting one opioid for another to improve analgesia or adverse effects; however, it has limited evidence. This study aimed to examine the effectiveness of opioid switching in advanced cancer. This multi-center prospective cohort study recruited patients assessed to switch opioids (opioid switch group) or to continue ongoing opioid treatment (control group). Clinical data (demographics, opioids) and validated instruments (pain and adverse effects) were collected over two timepoints seven days apart. Descriptive analyses were utilized. Non-parametric tests were used to determine differences. Fifty-four participants were recruited (23 control group, 31 switch group). At the follow-up, opioid switching reduced pain (worst, average, and now) (p < 0.05), uncontrolled breakthrough pain (3-fold reduction, p = 0.008), and psychological distress (48% to 16%, p < 0.005). The switch group had a ≥25% reduction in the reported frequency of seven moderate-to-severe adverse effects (score ≥ 4), compared to a reduction in only one adverse effect in the control group. The control group experienced no significant pain differences at the follow-up. Opioid switching is effective at reducing pain, adverse effects, and psychological distress in a population with advanced cancer pain, to levels of satisfactory symptom control in most patients within 1 week. Full article
(This article belongs to the Special Issue Strategies for Cancer Pain Management)
15 pages, 1344 KiB  
Article
The Prevalence of Back Pain in Patients Operated on Due to Colorectal Cancer Depending on the Type of Surgical Procedure Performed
by Iwona Głowacka-Mrotek, Michał Jankowski, Bartosz Skonieczny, Magdalena Tarkowska, Dorota Ratuszek-Sadowska, Anna Lewandowska, Tomasz Nowikiewicz, Karol Ogurkowski, Wojciech Zegarski and Magdalena Mackiewicz-Milewska
Cancers 2023, 15(8), 2298; https://doi.org/10.3390/cancers15082298 - 14 Apr 2023
Viewed by 1383
Abstract
Purpose: Low back pain presents a serious challenge for numerous medical specialties. The purpose of this study was to assess disability due to low back pain in patients operated on due to colorectal cancer depending on the type of surgery performed. Methods: This [...] Read more.
Purpose: Low back pain presents a serious challenge for numerous medical specialties. The purpose of this study was to assess disability due to low back pain in patients operated on due to colorectal cancer depending on the type of surgery performed. Methods: This prospective observational study was carried out in the period of July 2019 through March 2020. Included in the study were patients with colorectal cancer for scheduled surgeries including anterior resection of rectum (AR), laparoscopic anterior resection of rectum (LAR), Hartmann’s procedure (HART), or abdominoperineal resection of rectum (APR). The Oswestry Low Back Pain Disability Questionnaire was used as the research tool. The study patients were surveyed at three time points: before surgery, six months after surgery, and one year after surgery. Results: The analysis of study results revealed that an increase in the degree of disability and functioning impairment occurred in all groups between time points I and II, with the differences being statistically significant (p < 0.05). The inter-group comparative analysis of the total Oswestry questionnaire scores revealed statistically significant differences, with the impairment of function being most severe within the APR group and least severe within the LAR group. Conclusion: The study results showed that low back pain contributes to impaired functioning of patients operated on due to colorectal cancer regardless of the type of procedure performed. A reduction in the degree of disability due to low back pain was observed one year after the procedure in patients having undergone LAR. Full article
(This article belongs to the Special Issue Strategies for Cancer Pain Management)
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