Development of the Practice of Pharmaceutical Care for Cancer Pain Management in Outpatient Clinics Using the Delphi Method.

Background: There exists no broad agreement of experts on the practice of pharmaceutical care for cancer pain management in outpatient clinics. Objectives: This study aimed to use the Delphi consensus process to provide expert recommendations on the practice of cancer pain management in outpatient clinics from the point of view of pharmaceutical care in clinical practice and future clinical trials. Methods: A comprehensive literature review was conducted to draft the initial practice. In this process, 30-40 senior experts from various provinces in China were invited to rank the items of practice during the two Delphi consultations. The definitions of consensus included a combination with an average score of ≥4, the percentage of experts rating the scores at >4 points, and the coefficient of variation of the scores. Results: The expert panel comprised 18 pharmacists, 3 anesthesiologists, 6 oncologists, and 9 nurses. As a result of a comprehensive review, 33 items were initially formed. Among them, the consensus was reached for 27 items after the first Delphi round. The other six items and a total of five items for supplementation entered the second round, among which consensus was reached for eight items and three items were excluded. Expert consensus was achieved on 35 items after two rounds of consultation, which involved the collection of patient basic information, comprehensive pain assessment, breakthrough or neuropathic pain assessment, analgesic treatment evaluation, out-of-hospital follow-up, medical records, and evidence-based documents for reference. Conclusion: The final list of 35 items could be used to develop the practice of pharmaceutical care for cancer pain management in outpatient clinics in China. The practice may aid in the standardization of pharmaceutical care for pain, relieve pain to the greatest extent possible, and enhance the level of pain management in China.

Correction: Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/24555.].

Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial.

BACKGROUND: Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. OBJECTIVE: We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. METHODS: Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. RESULTS: A total of 100 patients were included, with 51 (51%) in the intervention group and 49 (49%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43% to 63% in the intervention group, compared with an increase of 33% to 51% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. CONCLUSIONS: The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901.

Influencing factors of end-of-dose failure in patients with cancer pain after oral oxycodone sustained-release tablets: a retrospective, case-control study.

OBJECTIVE: Comparing the characteristics of end-of-dose failure patients and non-end-of-dose failure patients in the Chinese population and exploring the factors that may affect the occurrence of end-of-dose failure in cancer pain patients. METHODS: The outpatient with cancer pain from 2016 to 2019 were collected through hospital information system, and patients were included who met the following criteria: patients with the average numerical rating scale  ≥4 points within 3 days after taking the oxycodone sustained-release preparation, titrated to an effective therapeutic dose suitable for patients, had at least two clinical visits information of the patient with a minimum of ≥3 days between visits, the average numerical rating scale of the next visit after the treatment of occasional pain is ≥4, and were divided into end-of-dose failure group and non-end-of-dose failure group. RESULTS: Age (P < 0.05, odds ratio 0.933), diagnosis of nasopharyngeal carcinoma (P < 0.05, odds ratio 0.009), pain site is the head and neck (P < 0.05, odds ratio 0.005) and the abdomen (P < 0.01, odds ratio 0.021), and the metastatic site is the liver (P < 0.05, odds ratio 0.001) are related to the occurrence of end-of-dose failure. CONCLUSIONS: Younger patients are more likely to develop end-of-dose failure. Patients diagnosed with nasopharyngeal cancer, with pain in the head and neck and abdomen, and with liver metastases have a lower incidence of end-of-dose failure.

[Application of space-time scan statistics in the analysis of spatial and temporal distribution of Oncomelania hupensis snails in Gaoyou County, Jiangsu Province].

OBJECTIVE: To investigate the distribution features of Oncomelania hupensis infested areas in Gaoyou County so as to formulate surveillance and intervention strategies. METHODS: A database was established through collecting data of the snail infested areas during 1970-2009 in the County. The data were input into SaTScan 9.2 software for spatial-temporal cluster analysis to determine the spatial and temporal cluster of the snail habitats. The results were displayed by ArcGIS 10.1 software. RESULTS: There were historically 720 snail habitats in the County in 1970-2009 including 521 in plain region with water networks and 199 in lake & marshland region. Those in water networks covered an area of 456.62 ha distributing mainly in the northern towns/townships of the County, and the latters distributed in the Xinmin Beach between Gaoyou Lake and Shaobo Lake, and Qiaojian Beach close to Tianchang County of Anhui Province with an area of 4 495.75 ha. The spatial-temporal cluster analysis revealed that among all the historical snail habitats, there were two prominent spatial-temporal clusters with a relative risk of >3. One cluster appeared in Xinmin Beach in 1983-2002 and another one located in the north of Gaoyou in 1970-1973. Separate analysis was performed by the regions of water network or lake & marshland, indicating 2 clusters in each of the regions. During 1970-2009, 244 snail habitats were newly found in the County with 130 in water network region and 114 in lake & marshland region. Again, the spatial-temporal cluster analysis displayed 2 prominent clusters. By separate analysis, 2 clusters existed in each of the regions. CONCLUSION: The space-time scan statistics can be applied in detecting the cluster of snail infested areas in two dimensions, which will provide information for guiding specific measures of surveillance and control.

[Surveillance of endemic situation of schistosomiasis in Gaoyou sections in east route of South-to-North Water Diversion Project before water transfer].

OBJECTIVE: To understand the endemic situation of schistosomiasis and the distribution of Oncomelania hupensis snails in Gaoyou sections in the east route of the South-to-North Water Diversion Project before water transfer. METHODS: The Grand Canal, the Sanyang River and the range of 3 kilometers of both sides of the rivers were chosen as the surveillance area in the Gaoyou sections in the east route of the South-to-North Water Diversion Project, and the Gaoyou Lake area adjacent to the east route was also chosen as the surveillance area. The human and livestock schistosomiasis and Oncomelania hupensis snails were monitored by the conventional method. Three underwater snail surveillance sites were set up in the Grand Canal and the Sanyang River respectively, and the net salvage method and the method of attracting snails with rice straw curtains were used to survey the snails underwater in the surveillance sites. RESULTS: The schistosome infected snails, the human and livestock schistosomiasis were not found in the Gaoyou sections in the east route of the South-to-North Water Diversion Project from 2006 to 2012. The snail areas were on the decline in the Grand Canal. The snail was not found in the Sanyang River. A total of 270 kg floatage was refloated and 720 pieces of rice straw curtains were placed in the surveillance sites, and there were no snails in the floatage and the rice straw curtains. CONCLUSION: There is no evidence showing that the snails spread to northward in the Gaoyou sections in the east route of the South-to-North Water Diversion Project.

[Investigation on HBsAg carrier rate of population in schistosomiasis transmission-interrupted area of Gaoyou City, 2010].

A total of 500 residents in a schistosomiasis transmission-interrupted area, Maogang Village of Gaoyou City were detected simultaneously for the infection status of schistosome and HBV, and the results showed that there was no significant difference between the HBsAg carrier rates of residents with and without the history of schistosomiasis, but the HBsAg carrier rates in some population were high, which needs more concern.