"Living Well with Chronic Pain": Integrative Pain Management via Shared Medical Appointments.

OBJECTIVE: To evaluate the effectiveness of a multidisciplinary, nonpharmacological, integrative approach that uses shared medical appointments to improve health-related quality of life and reduce opioid medication use in patients with chronic pain. DESIGN: This is a retrospective, pre-post review of "Living Well with Chronic Pain" shared medical appointments (August 2016 through May 2018). SETTING: The appointments included eight 3-hour-long visits held once per week at an outpatient wellness facility. SUBJECTS: Patients with chronic, non-cancer-related pain. METHODS: Patients received evaluation and evidence-based therapies from a team of integrative and lifestyle medicine professionals, as well as education about nonpharmacological therapeutic approaches, the etiology of pain, and the relationship of pain to lifestyle factors. Experiential elements focused on the relaxation techniques of meditation, yoga, breathing, and hypnotherapy, while patients also received acupuncture, acupressure, massage, cognitive behavioral therapy, and chiropractic education. Patients self-reported data via the Patient-Reported Outcomes Measurement Information System (PROMIS-57) standardized questionnaire. Use of opioid medications was evaluated in morphine milligram equivalents. RESULTS: A total of 178 participants completed the PROMIS-57 questionnaire at the first and the last visits. Statistically significant improvements in all domains (Physical Functioning, Anxiety, Depression, Fatigue, Social Roles, Pain Interference, and Sleep Disturbance) were observed (P < 0.001) between the pre-intervention (visit 1) and post-intervention (visit 8) scores. Average opioid use decreased nonsignificantly over the 8-week intervention, but the lower rate of opioid use was not sustained at 6 and 12 months' follow-up. CONCLUSIONS: Patients suffering from chronic pain who participated in a multidisciplinary, nonpharmacological treatment approach delivered via shared medical appointments experienced reduced pain and improved measures of physical, mental, and social health without increased use of opioid pain medications.

Prophylactic Cranial Irradiation in Extensive Stage Small Cell Lung Cancer: Outcomes at a Comprehensive Cancer Centre.

PURPOSE: The role of prophylactic cranial irradiation (PCI) remains controversial in extensive stage small cell lung cancer (ES-SCLC) with the publication of 2 randomized control trials demonstrating differing outcomes in overall survival. The aim of this study is to determine the impact of PCI on survival and the development of brain metastasis while addressing the disparate use of postchemotherapy brain imaging in the aforementioned trials. METHODS AND MATERIALS: The medical records of 397 consecutive patients with ES-SCLC between Jan. 1, 2005 and Dec. 31, 2011 were retrospectively reviewed. In those eligible patients (n = 155) without baseline brain metastases and who had at least a partial response to chemotherapy, overall survival and time to brain metastasis were estimated using the Kaplan-Meier method comparing patients receiving PCI or not, using both univariate and multivariate analyses. Patients were stratified by their receipt of initial postchemotherapy brain imaging. Follow-up did not include serial brain imaging, which was performed when clinically indicated. Differences between the groups with covariates were analyzed using χ2 statistics and Student's t-tests. RESULTS: By multivariate analysis, statistically significant predictors of overall survival were the presence of extrathoracic metastases, performance status and use of PCI. There was a statistically significant difference in overall survival (HR 0.55; 95% CI: 0.39-0.77; P = .0005) and time to brain metastasis (HR 0.40; 95% CI: 0.23-0.66; P = .0004) with the use of PCI. Median survival for the PCI and non-PCI groups was 13.5 and 8.5 months respectively. A survival difference with PCI was observed in both patients that received postchemotherapy brain imaging (HR 0.55; 95% CI: 0.35-0.88; P = .012) and those who did not (HR 0.48; 95% CI: 0.29-0.77; P = .0025). CONCLUSIONS: PCI in the setting of at least a partial response to chemotherapy was found to have a survival benefit and prolongation of the time to development of brain metastases, when factoring in the use of initial postchemotherapy but not routine surveillance brain imaging.