ABSTRACT
AIMS: This prospective, cross-sectional study aimed to assess cancer pain and its management in an inpatient setting at a comprehensive cancer centre in Denmark. METHODS: One hundred and eighty-eight inpatients with cancer were invited to participate (May/June 2011). Demographics, diagnoses, World Health Organization performance status, health-related quality of life, pain and data regarding analgesic treatment were registered. RESULTS: One hundred and thirty-four (71.3%) patients agreed to participate in the study. Most frequent diagnoses were leukaemia (27.6%) and lung cancer (14.2%). A high prevalence of pain was observed, 65.7%. Thirty-two per cent reported moderate to severe pain when it was at its worst, 96% reported no or mild pain when it was at its least. Nearly 22% reported moderate to severe pain when the pain was categorised as average. Breakthrough pain episodes were reported by 30.5%. Adjuvant medication was sparsely used and not always correctly indicated. Out of 88 patients with pain, 62.5% were left untreated according to the Electronic Medication System. Higher health-related quality of life was associated with lower pain intensity. The use of opioids with or without adjuvants was associated with higher pain intensity and higher number of breakthrough pain episodes. CONCLUSIONS: Approximately two thirds of inpatients reported pain and one third had breakthrough pain. A substantial number of patients with pain were left untreated. Opioid-treated patients reported highest pain intensity and number of breakthrough episodes; however, analgesic medication seemed to be underused. Measures to improve pain assessment and management are highly required.
Subject(s)
Neoplasms/physiopathology , Pain, Intractable/drug therapy , Adult , Aged , Analgesics, Opioid/therapeutic use , Breakthrough Pain/drug therapy , Cross-Sectional Studies , Female , Humans , Inpatients , Male , Middle Aged , Prospective StudiesABSTRACT
BACKGROUND: Patients' self-assessment of symptoms is central in drug treatment trials of functional dyspepsia. The validity of such ratings is important. AIM: To validate a diary for monitoring severity and duration of dyspepsia. METHOD: We compared the diary-cards with two clinicians' ratings of the patient's open-ended responses to the same questions administered by interview. Agreements were evaluated by estimation of the overall agreement and weighted kappa values (Kw). RESULTS: Forty-six patients were evaluated. The Kw between the two clinicians rating severity and duration of symptoms were 0.59 and 0.86, respectively. Overall agreement between patients' diary rating and clinicians' consensus rating of severity were 52%, and a moderate agreement with Kw of 0.49 was found. For duration of symptoms the overall agreement and Kw were 67% and 0.59, respectively. Qualitative data revealed useful insight in the possible causes of suboptimal agreement between patients and clinicians. CONCLUSIONS: We found a moderate to good agreement between patient and observer ratings, indicating that patients to a reasonable extent interpret severity and duration of dyspeptic symptoms in the same way as do investigators. A ceiling effect of the duration scale indicates suboptimal response categories, which should be adjusted before further use.
Subject(s)
Dyspepsia/psychology , Physicians , Adolescent , Adult , Aged , Aged, 80 and over , Dyspepsia/classification , Dyspepsia/epidemiology , Female , Humans , Male , Middle Aged , Observer Variation , Quality of Life/psychology , Self-Assessment , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
Adjuvant therapy in cancer of the breast is given to patients with high risks for recurrence after the primary operation. This involves cytotoxic therapy, endocrine therapy and radiotherapy and results in reduction of the mortality. The increasing interest in how the patients experience these treatments has resulted in numerous publications about the quality of life. Physical, mental, sexual and social conditions are influenced by adjuvant therapy. The majority of published works have, however, methodological weaknesses so that the extent and duration of these influences are not yet known in detail. Increased knowledge concerning the significance for the quality of life of various forms of therapy may improve the basis for information, choice between therapeutic alternatives and prevention and treatment of conditions which reduce the quality of life.