The quality of pain management in pancreatic cancer: A prospective multi-center study.
Pancreatology
; 20(7): 1511-1518, 2020 Oct.
Article
en En
| MEDLINE
| ID: mdl-32952041
ABSTRACT
BACKGROUND/OBJECTIVES:
Pancreatic ductal adenocarcinoma (PDAC) is frequently associated with severe pain. Given the almost inevitably fatal nature of the disease, pain control is crucial. However, data on quality of pain management in PDAC is scarce.METHODS:
This is a multi-center, prospective study to evaluate the quality of pain management in PDAC. Insufficient pain treatment (undertreatment) was prevalent if there was an incongruence between the patients level of pain and the potency of analgesic drug therapy. Determinants of pain and undertreatment were identified using multivariable logistic regression.RESULTS:
139 patients with histologically confirmed PDAC were analyzed. The prevalence of pain was 63%, with approximately one third of the patients grading their pain as moderate to severe. Palliative stage (OR 3.37, 95%CI 1.23-9.21, p = 0.018) and localization of the primary tumor in the body or tail (OR 2.57, 95%CI 1.05-6.31, p = 0.039) were independent determinants of pain. Of those reporting pain, 60% were undertreated and in 89% pain interfered with activities and emotions. Age ≥ 70 years (OR 3.20, 95%CI 1.09-9.41, p = 0.035) was an independent predictor of undertreatment. Patients with longer-known PDAC ( ≥ 30 days) showed improved pain management compared to new cases (OR 0.19, 95%CI 0.05-0.81, p = 0.025). Treatment by gastroenterologists (OR 0.22, 95%CI 0.05-0.89, p = 0.034) was associated with less undertreatment.CONCLUSIONS:
The results show a high proportion of PDAC patients with pain, pain interference and undertreatment, whose characteristics could help to identify patients at risk in the future. Several changes in the management of cancer-related pain are necessary to overcome barriers to optimal treatment.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias Pancreáticas
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Carcinoma Ductal Pancreático
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Manejo del Dolor
/
Dolor en Cáncer
Tipo de estudio:
Clinical_trials
/
Observational_studies
/
Prevalence_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Pancreatology
Asunto de la revista:
ENDOCRINOLOGIA
/
GASTROENTEROLOGIA
Año:
2020
Tipo del documento:
Article