Analyzing Differences in Perception between Oncologists and Patients to Adapt Pharmacological Treatment for Breakthrough Cancer Pain: Observational ADAPTATE Study.

Background: Transmucosal fentanyl (TF), used for breakthrough cancer pain (BTcP) treatment, has different formulations with distinctive attributes. The hypothesis is that, in shared decision making for the prevention of certain therapeutic problems, doctors and patients assign different value to the characteristics of treatment options. Aim: The aim of this study was to assess the discordance between the oncologists' opinion of attributes of TF and patients' expectations in BTcP treatment. Methods: This is a multicenter, cross-sectional observational study using simultaneous written surveys of doctors and patients suffering from BTcP episodes. The opinion of Spanish oncologists and patients regarding the importance of 14 different attributes of TF treatment (start of action, potency, duration, presentations and doses available, ease of use, titration, administration time, need for saliva, oral mucositis, rhinitis, adverse events, risk of abuse, evidence available, and need for instructions or health personnel to handle the medication), using two surveys, one for each group. Results: Sixty-three clinical oncologists and 272 patients participated in the study. The patients' satisfaction with and knowledge of BTcP treatment was 6.4 and 6.8 points, respectively (scale 1-9). The attributes with the highest relevance were shared by both groups, although their priority differed. Significant differences were observed in the greater importance given by oncologists (onset and duration of analgesia, need for saliva, presence of mucositis, and time required for patient education) and patients (risk of opioid abuse/aberrant behavior). Conclusion: Our results confirm that some aspects that most concern patients about the treatment of BTcP differ from those to which oncologists attach most importance. Increased patient awareness and education about BTcP and its treatment could lead to greater satisfaction and better patient involvement in therapeutic decisions. Certain barriers need to be overcome, such as lack of time in consultations and poor communication skills of oncologists that hinder patient health education.

Dolor irruptivo oncológico en el anciano / Breakthrough cancer pain in the elderly

El dolor irruptivo se define como una exacerbación aguda del dolor de rápida aparición, corta duración y de intensidad moderada o elevada, que ocurre de forma espontánea o en relación con un evento predecible o no predecible a pesar de existir un dolor basal estabilizado y controlado. Sin embargo, existen dudas sobre la definición, terminología, epidemiología y valoración del dolor irruptivo sin una clara contestación y consenso, especialmente en la población anciana. En esta revisión no sistematizada se intentarán sintetizar y resumir los aspectos más relevantes del dolor irruptivo en los ancianos en base a las escasas publicaciones existentes en dicho grupo poblacional (AU)

Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group (AU)

[Breakthrough cancer pain in the elderly]. / Dolor irruptivo oncológico en el anciano.

Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group.

Actualización del dolor oncológico en el anciano / Update on oncological pain in the elderly

El dolor es un síntoma muy prevalente en los pacientes geriátricos oncológicos, apareciendo hasta en el 90% en las fases finales de la enfermedad. Requiere de un manejo multidimensional, con un alto porcentaje de valoración y tratamiento inadecuado. El dolor no reconocido o tratado deficientemente en la población geriátrica, y especialmente en los pacientes oncológicos, conlleva la aparición de síntomas invalidantes como depresión, ansiedad, aislamiento, alteraciones del sueño y del apetito, y muy especialmente pérdida de la capacidad funcional y de la calidad de vida. En esta revisión pretendemos analizar los estudios más relevantes sobre el diagnóstico y manejo del dolor en población de edad avanzada con patología oncológica (AU)

Pain is a prevalent symptom in cancer geriatric patients, appearing in up to 90% of patients with terminal cancer. This requires a multidimensional approach, as there is a high percentage of inappropriate assessments and treatments. Unrecognized or poorly treated pain in the geriatric population, especially in cancer patients, leads to the development of disabling symptoms such as depression, anxiety, isolation, sleep disturbances, and appetite, and very especially, loss of functional capacity and quality of life. In this review an analysis is made on the most relevant studies on the diagnosis and management of cancer pain in the geriatric population (AU)

Evaluación de la calidad de vida en la mujer menopáusica mediante la escala Cervantes: impacto del tratamiento en la práctica clínica / Assessment of quality of life in postmenopausal women through the Cervantes scale: impact of treatment in clinical practice

Objetivo: Evaluar la calidad de vida actual de las mujeres menopáusicas y conocer el efecto del tratamiento instaurado. Sujetos y métodos: El estudio epidemiológico transversal y multicéntrico que incluyó a 1.344 mujeres menopáusicas. Se empleó la escala Cervantes para valorar la calidad de vida. Resultados: La puntuación global de la calidad de vida fue mejor en los grupos con tratamiento (terapia hormonal e isoflavonas, diferencia puntuación total: 13,62 y 7,93 puntos, respectivamente; p < 0,001) versus las que no recibían terapia. Factores que influyen en la calidad de vida son: el alcohol, los antecedentes de enfermedad y el tiempo de evolución de la menopausia. Conclusiones: Las mujeres menopáusicas pueden mejorar su calidad de vida con el tratamiento con terapia hormonal y con isoflavonas, siendo la escala Cervantes una herramienta clínica muy útil (AU)

Objective: To assess the current quality of life of menopausal women and determine the effect of treatment. Subjects and methods: This multicenter, cross-sectional, epidemiological study included 1344 postmenopausal women. The Cervantes scale was used to assess quality of life. Results: The overall quality of life score was better in the treatment groups (hormonal therapy and isoflavones, with differences in total scores of 13.62 and 7.93 points, respectively; P<.001) versus those not receiving therapy. Factors influencing quality of life were alcohol, history of disease, and time since onset of menopause. Conclusions: Menopausal women can improve their quality of life with treatment with hormonal therapy and isoflavones. The Cervantes scale is a useful clinical tool (AU)

[Update on oncological pain in the elderly]. / Actualización del dolor oncológico en el anciano.

Pain is a prevalent symptom in cancer geriatric patients, appearing in up to 90% of patients with terminal cancer. This requires a multidimensional approach, as there is a high percentage of inappropriate assessments and treatments. Unrecognized or poorly treated pain in the geriatric population, especially in cancer patients, leads to the development of disabling symptoms such as depression, anxiety, isolation, sleep disturbances, and appetite, and very especially, loss of functional capacity and quality of life. In this review an analysis is made on the most relevant studies on the diagnosis and management of cancer pain in the geriatric population.

Prescripción conjunta de antidepresivos y tamoxifeno: una cuestión a tener en cuenta / Co-prescription of antidepressants and tamoxifen: an issue to consider

Objetivo. La prescripción conjunta de tamoxifeno y antidepresivos en pacientes con cáncer de mama puede disminuir la actividad y eficacia del primero. El objetivo fue determinar las pautas de prescripción de antidepresivos y su adecuación en estas pacientes. Material y métodos. Encuesta telefónica a 100 mujeres con cáncer de mama en tratamiento con tamoxifeno. Se determinó tiempo de tratamiento con tamoxifeno y especialidad del facultativo prescriptor, presencia o no de tratamiento concomitante con antidepresivos, tiempo de tratamiento y especialidad del facultativo prescriptor. Resultados. Se detectó prescripción concomitante de tamoxifeno y antidepresivos en 11 pacientes (11%), con posibles interacciones potentes en 4 pacientes, 2 moderadas, 2 leves y 3 nulas. Mediana de duración del tratamiento concomitante: un año. Mediana de duración de interacciones potentes: 9 meses. Todas las prescripciones de tamoxifeno fueron realizadas por Oncología Médica, prescribiéndose los antidepresivos desde Oncología Médica, Psiquiatría o Atención Primaria. Conclusiones. Existen prescripciones que podrían generar interacciones con efecto negativo sobre la actividad del tamoxifeno, pudiendo influir en el pronóstico. Afectan aproximadamente al 10% de las pacientes que toman tamoxifeno, siendo la mitad potencialmente potentes (AU)

Objective. Co-prescription of tamoxifen and antidepressants can cause interactions that decrease the activity and efficacy of tamoxifen. The objective of this study was to determine the prescribing patterns of antidepressants and to analyze their appropriateness. Material and methods. A telephone questionnaire was administered to 100 breast cancer patients treated with tamoxifen to determine the length of tamoxifen treatment, the prescribing physician, concomitant treatment, the length of antidepressant treatment and the physician's field that prescribed the antidepressants. Results. Concomitant prescription was identified in 11 patients (11%): a potential for severe interactions was identified in 4, for moderate interactions in 2, and for mild interactions in 2. No potential for interactions was identified in 3 patients. All tamoxifen prescriptions were made by medical oncologists; antidepressants were prescribed by medical oncologists, psychiatrists and primary care physicians. Conclusions. Some antidepressants could cause serious interactions with a negative impact on the activity of tamoxifen. These prescriptions affect approximately 10% of patients on tamoxifen, and half pose a risk of serious interactions (AU)