Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 130
Filtrar
1.
Anticancer Res ; 41(4): 1971-1974, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813403

RESUMO

BACKGROUND/AIM: Oncological care has faced several challenges during the COVID-19 pandemic, e.g. treatment delay and worsening symptoms. Patient-reported anxiety, depression and sleep quality might have changed due to these special circumstances. Therefore, we analyzed the symptom burden of patients treated with palliative radiotherapy at our center. PATIENTS AND METHODS: A retrospective study was performed of 50 consecutive patients and the results were compared to those obtained in a previous pre-COVID study. The Edmonton Symptom Assessment Scale was employed to assess the preradiotherapy symptoms. RESULTS: The highest mean scores were reported for pain in activity (3.2) and dry mouth (3.1). Regarding anxiety, sadness/depression and sleep, the corresponding scores were 1.5, 1.2 and 2.7, respectively. Compared to the previous study, no significant increases were found. Most items had numerically lower mean values, e.g. anxiety (1.5 vs. 2.7). Both study populations had comparable median age (70.5 vs. 70 years), gender distribution and proportion of patients with bone metastases. However, there were two significant imbalances, namely a lower proportion of patients with prostate cancer (12 vs. 30%, p=0.02) and breast cancer (0 vs. 12%, p=0.02). CONCLUSION: In patients who showed up for radiation treatment planning, the suspected increase in anxiety, sadness/depression and sleep disturbance was not demonstrable. It is not known whether or not patients with substantial worries chose to decline referral to palliative radiotherapy. Therefore, comprehensive large-scale studies of patterns of care are needed to fully understand the impact of COVID-19-related measures.


Assuntos
/epidemiologia , Efeitos Psicossociais da Doença , Neoplasias/radioterapia , Cuidados Paliativos/métodos , Pandemias , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/etiologia , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/secundário , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Dor do Câncer/etiologia , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/patologia , Noruega/epidemiologia , Estudos Retrospectivos , Análise de Sobrevida , Avaliação de Sintomas
2.
Rev. Soc. Esp. Dolor ; 27(4): 246-251, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196840

RESUMO

INTRODUCCIÓN: El síndrome de dolor posmastectomía (SDPM) aparece recogido en la nueva clasificación ICD-11 (International Classification of Diseases 11th Revision) como un subgrupo de dolor crónico posquirúrgico. Waltho y Rockwell han consensuado recientemente en un artículo de revisión lo que ellos denominan síndrome de dolor poscirugía mamaria (estos criterios han sido publicados en nuestra lengua en una carta al Director en la RESED), que describen esta situación como un dolor que se produce después de cualquier cirugía de mama; es de, al menos, intensidad moderada, presenta características neuropáticas, se localiza en la mama, pared torácica, axila o brazo ipsilateral, tiene una duración mínima de 6 meses, ocurre al menos el 50 % del tiempo y puede ser exacerbado por los movimientos de la cintura escapular. Es probablemente secundario a una lesión del nervio intercostobraquial o intercostales durante la disección a nivel axilar, lo que explica las características neuropáticas de este dolor. La incidencia documentada de SDPM varía según las publicaciones entre un 11 y un 57 %, bajando a un 5-10 % en caso de que sea severo, destacando que hasta el 65 % de los casos presentan características neuropáticas. El objetivo primario de este trabajo es determinar la frecuencia y la intensidad de la incidencia del SDPM y el secundario identificar posibles factores de riesgo para su desarrollo. MATERIA Y MÉTODOS: Se realizó un análisis retrospectivo de todas las mastectomías parciales o totales con o sin vaciamiento ganglionar realizadas entre el 1 de enero de 2017 y el 31 de diciembre 2017. RESULTADOS: De los 119 pacientes analizados, 30 pacientes refirieron dolor (25,2 %). La intensidad fue leve en 24 pacientes, moderado en 4 y severo en 2. No hubo relación entre el riesgo de dolor crónico y cualquiera de las variables analizadas. DISCUSIÓN: En nuestra opinión, parece necesario realizar nuevos estudios prospectivos que incluyan una definición consensuada del SDPM para evaluar los posibles factores de riesgo que afecten tanto en incidencia, intensidad e impacto en la calidad de vida de nuestros pacientes


INTRODUCTION: The posmastectomy pain syndrome (PMPS) is included in the new ICD-11 (International Classification of Diseases 11th Revision) classification under the postsurgical pain syndrome subset. Waltho and Rockwell have recently consensuated what they call post breast surgery pain syndrome (PBSPS) and conclude that a complete definition of PBSPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50 % of the time; and may be exacerbated by movements of the shoulder girdle. The published incidence of PMPS varies between 11-57 % according to different sources. The incidence lowers to 5-10 % when the pain is judged severe. Up to the 65 % of the patients present neuropathic characteristics. The aim of this article is to primary to determine the frequency and intensity of the incidence of, and seconddly to elucidate possible risk factors to influence its appearance. MATERIAL AND METHOD: A retrospective analysis, of all partial or total mastectomies with or without axillary nodal resection, performed between January the 1st 2017 December 31st 2017, was carried out. RESULTS: A total number 119 patients were studied, 30 of which (25,2 %) declared to feel pain. The intensity was low in 24 patients, moderate in 4 and severe in 2. No relationship was found between the appearance of chronic pain and any of the variables studied. DISCUSSION: We judge necessary to perform new prospective studies which include a consensuated definition of PMPS to clearly elucidate possible risk factors that can contribute either to the incidence, intensity or impact in quality of life of our patients


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Mastectomia/estatística & dados numéricos , Dor Pós-Operatória/epidemiologia , Dor do Câncer/epidemiologia , Neoplasias da Mama/cirurgia , Analgesia/métodos , Complicações Pós-Operatórias/epidemiologia , Incidência , Manejo da Dor/métodos , Medição da Dor/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Estudos Retrospectivos
3.
Pain Res Manag ; 2020: 6190862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566062

RESUMO

Background: Better understanding of the episodic cancer pain (CP) spectrum, including pains that occur in addition to its conventionally defined breakthrough CP (BTcP) and incident CP (IcP) components, may inform CP assessment and management. This study aimed to determine the prevalence of episodic patient-reported CP and the prevalence and associations of study-defined BTcP (S-BTcP) and IcP (S-IcP) in patients with CP. Methods: In a cross-sectional study at their first CP clinic attendance, participants with CP had the following assessments: Brief Pain Inventory (BPI); Pain Management Index (PMI), with PMI-negative status indicating undertreatment; standardized neuropathic pain component (NPC) status; S-BTcP (no trigger identified) and S-IcP (trigger identified) status, based on a preceding 7-day history of transitory pain flares distinct from background pain, and BPI-Worst or BPI-Now pain intensity ≥ 4. Clinicodemographic variables' association with S-BTcP and S-IcP was examined in logistic regression analyses. Results: Of 371 participants, 308 (83%) had episodic CP by history alone; 140 (37.7%) and 181 (48.8%) had S-BTcP and S-IcP, respectively. Multivariable analyses demonstrated significant (p < 0.05) associations (odds ratios: 95% CIs) for 6 variables with S-BTcP: head and neck pain location (2.53; 1.20-5.37), NPC (2.39; 1.34-4.26), BPI average pain (1.64; 1.36-1.99), abdominal pain (0.324; 0.120-0.873), S-IcP (0.207; 0.116-0.369), and PMI-negative status (0.443; 0.213-0.918). Similar independent associations (p < 0.05) occurred for S-IcP with NPC, BPI average pain, and PMI-negative status, in addition to radiotherapy, S-BTcP, soft tissue pain, and sleep interference. Conclusions: Episodic or transient patient-reported CP flares often do not meet the more conventional criteria that define BTcP and IcP, the principal episodic CP types. Both BTcP and IcP occur frequently and both are associated with a NPC, higher pain intensity, and less opioid underuse in the management of CP. Further studies are warranted to both better understand the complex presentations of episodic CP and inform its classification.


Assuntos
Dor do Câncer/classificação , Dor do Câncer/epidemiologia , Adulto , Dor Irruptiva/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prevalência
4.
Support Care Cancer ; 28(11): 5315-5321, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32124025

RESUMO

PURPOSE: Opioid-induced constipation (OIC) is the most common side effect in patient-prescribed opioids for cancer pain treatment. Current guidelines recommend routine prescription of a laxative for preventing OIC in all patients prescribed an opioid unless a contraindication exists. We determined patterns of prescription of laxative agents in patients with lung cancer initiating opioids. METHODS: We performed a retrospective cohort study evaluating the prescription of laxatives for OIC to adult patients with incident lung cancer seen in the Veteran's Affairs (VA) system, between January 1, 2003, and December 31, 2016. Exposure to laxative agents was categorized as follows: none, docusate monotherapy, docusate plus another laxative, and other laxatives only. Prevalence of OIC prophylaxis was analyzed using descriptive statistics. Linear regression was performed to identify time trends in the prescription of OIC prophylaxis. RESULTS: Overall, 130,990 individuals were included in the analysis. Of these, 87% of patients received inadequate prophylaxis (75% no prophylaxis and 12% docusate alone), while 5% received OIC prophylaxis with the unnecessary addition of docusate to another laxative. Through the study period, laxative prescription significantly decreased, while all other categories of OIC prophylaxis were unchanged. We noted an inverse relationship with OIC prophylaxis and likelihood of a diagnosis of constipation at 3 and 6 months. CONCLUSIONS: In this study of veterans with lung cancer, almost 90% received inadequate or inappropriate OIC prophylaxis. Efforts to educate physicians and patients to promote appropriate OIC prophylaxis in combination with systems-level changes are warranted.


Assuntos
Quimioprevenção/estatística & dados numéricos , Laxantes/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Constipação Induzida por Opioides/prevenção & controle , Veteranos/estatística & dados numéricos , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Dor do Câncer/tratamento farmacológico , Dor do Câncer/epidemiologia , Quimioprevenção/métodos , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Constipação Induzida por Opioides/epidemiologia , Manejo da Dor/efeitos adversos , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Estudos Retrospectivos
5.
Breast Cancer Res Treat ; 180(1): 63-71, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31938939

RESUMO

PURPOSE: Breast cancer survivors may experience pain, fatigue, or psychological distress as a result of the treatment. These symptoms may co-occur and form a cluster. However little is known about symptom clusters (SCs) in long-term breast cancer survivors. This study aimed to identify subgroups of breast cancer survivors with the SC of pain, fatigue, and psychological distress, and to examine sociodemographic and clinical characteristics associated with this SC. METHODS: Data were obtained from a nationwide survey of breast cancer survivors (N = 834). Exhaustive enumeration of possible combination of the three binary variables (pain, fatigue, psychological distress) was conducted. They were identified using the recommended threshold for the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire, and a score of one or more on a numeric rating scale for pain. The SC was defined to include all the three variables, all other combinations were defined as no SC. Logistic regression analyses were conducted to examine the association between sociodemographic and clinical variables and the SC. RESULTS: Of the 834 survivors, 13% had the SC. Younger age (OR 2.3, 95% CI 1.3-4.1, p = 0.003), lymphedema (OR 1.9, 95% CI 1.1-3.2, p = 0.02), working part-time (OR 2.9, 95% CI 1.6-5.3, p < 0.001), or being disabled (OR 4.1, 95% CI 2.2-7.8, p < 0.001) were all associated with the SC. CONCLUSION: Thirteen percent of the survivors experienced the SC. It appears that premenstrual women are at greater risk, than postmenopausal women. Having this SC might have an impact on the survivors' ability to work.


Assuntos
Neoplasias da Mama/epidemiologia , Dor do Câncer/epidemiologia , Sobreviventes de Câncer , Fadiga/epidemiologia , Angústia Psicológica , Adulto , Idoso , Neoplasias da Mama/complicações , Dor do Câncer/etiologia , Fadiga/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Noruega/epidemiologia , Razão de Chances , Prevalência , Vigilância em Saúde Pública , Fatores Socioeconômicos
6.
Support Care Cancer ; 28(10): 4813-4824, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31980895

RESUMO

PURPOSE: Pain, fatigue and depression are common sequelae of a cancer diagnosis. The extent to which these occur together in prostate cancer survivors is unknown. We (i) investigated prevalence of the pain-fatigue-depression symptom cluster and (ii) identified factors associated with experiencing the symptom cluster among prostate cancer survivors. METHODS: Men in Ireland diagnosed with prostate cancer 2-18 years previously were identified from population-based cancer registries and sent postal questionnaires. Cancer-related pain and fatigue were measured using the EORTC QLQ-C30 and depression using the DASS-21. Cut-offs to define 'caseness' were pain ≥ 25, fatigue ≥ 39 and depression ≥ 10. Associations between survivor-related factors, clinical variables and specific prostate cancer physical symptoms and the symptom cluster were assessed using multivariate logistic regression. RESULTS: A total of 3348 men participated (response rate = 54%). Twenty-four percent had clinically significant pain, 19.7% had clinically significant fatigue, and 14.4% had depression; 7.3% had all three symptoms. In multivariate analysis, factors significantly associated with the symptom cluster were living in Northern Ireland, experiencing back pain at diagnosis and being affected by incontinence, loss of sexual desire, bowel problems, gynecomastia and hot flashes post-treatment. There was a strong association between the cluster and health-related quality of life. CONCLUSIONS: The pain-fatigue-depression symptom cluster is present in 1 in 13 prostate cancer survivors. Physical after-effects of prostate cancer treatment are associated with this cluster. More attention should be paid to identifying and supporting survivors who experience multiple symptoms; this may help health-related quality of life improve among the growing population of prostate cancer survivors.


Assuntos
Dor do Câncer/epidemiologia , Sobreviventes de Câncer/estatística & dados numéricos , Depressão/epidemiologia , Fadiga/epidemiologia , Neoplasias da Próstata/epidemiologia , Idoso , Humanos , Irlanda/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Irlanda do Norte/epidemiologia , Prevalência , Neoplasias da Próstata/psicologia , Qualidade de Vida , Sistema de Registros , Inquéritos e Questionários , Síndrome , Incontinência Urinária/epidemiologia
7.
Support Care Cancer ; 28(9): 4201-4209, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31900614

RESUMO

PURPOSE: Concerns around chronic opioid use (COU), misuse, and harms have led to increased scrutiny of opioid prescribing in oncology. There is lack of research examining patient-level factors associated with COU. Our aim was to examine patient-level factors associated with COU in newly diagnosed cancer patients. METHODS: Population-based retrospective cohort study using administrative health data of patients in Alberta, Canada, diagnosed between February 2016 and October 2017. Adult cancer patients who completed a symptom survey within ± 60 days of diagnosis were included. Patients were divided into two groups: COU (defined as continuous opioid prescriptions for at least 90 days post-diagnosis) and non-chronic opioid use (NCOU). Logistic regression was used to evaluate factors associated with COU. RESULTS: We included 694 patients (mean age 65 years; 51% female). Most had breast (20%), colorectal (13%), and lung (33%) cancers. Of the 14% with COU, 79% were opioid naïve at diagnosis. Those in the COU group were more often diagnosed with advanced cancer (66% versus 40%), had lung cancer (47%), and were opioid tolerant (> 90 days of continuous opioids within one-year pre-diagnosis). A total of 64% of COU versus 27% of NCOU had moderate to severe pain at diagnosis (p < 0.001). Irrespective of treatment type or stage, those with moderate to severe pain, were opioid tolerant at diagnosis, or had multiple prescribers were at greater risk for COU. CONCLUSIONS: Specific patient groups were at increased risk of COU and should be the focus of adaptive prescribing approaches to ensure that opioid use is appropriate.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor do Câncer/tratamento farmacológico , Adulto , Idoso , Alberta/epidemiologia , Dor do Câncer/epidemiologia , Estudos de Coortes , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Neoplasias/fisiopatologia , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Prevalência , Projetos de Pesquisa , Estudos Retrospectivos
8.
Support Care Cancer ; 28(6): 2911-2919, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31758321

RESUMO

PURPOSE: Sleep disturbances are common in cancer patients, but little is known about preoperative insomnia and its associated factors in colorectal cancer (CRC) patients. The aim of this study was to clarify the relationship between preoperative insomnia and its associated factors (i.e., pain, anxiety, self-esteem, and coping styles) in CRC patients. METHODS: A cross-sectional study was conducted in consecutive CRC inpatients (N = 434), who were required to complete the questionnaires about insomnia, pain, anxiety, self-esteem, and coping styles (acceptance/resignation, confrontation, avoidance) before the day of surgery. Hierarchical regression analyses were conducted to explore the relationships between preoperative anxiety and its associated factors. RESULTS: Based on the cutoff value of Athens Insomnia Scale (scores ≥ 6) in Chinese cancer patients, the prevalence of insomnia was 38.2% before surgery. Pain (ß = 0.087, p = 0.015) and anxiety (ß = 0.372, p < 0.001) were positively associated with preoperative insomnia, while self-esteem (ß = - 0.479, p < 0.001) and confrontation coping (ß = - 0.124, p = 0.003) showed protective effects on preoperative insomnia when putting them together into hierarchical regression. The associated factors together accounted for an additional variance of preoperative insomnia (47.6%). CONCLUSIONS: In line with previous findings, the detrimental effects of pain and anxiety on preoperative insomnia were also observed in our study. More importantly, our main new findings were that self-esteem and confrontation coping played important roles in alleviating preoperative insomnia among CRC patients. Clinicians should take these results into account when developing cancer care management to relieve preoperative insomnia.


Assuntos
Ansiedade/epidemiologia , Dor do Câncer/epidemiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/cirurgia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Adaptação Psicológica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/complicações , Ansiedade/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Dor do Câncer/psicologia , Dor do Câncer/cirurgia , China/epidemiologia , Neoplasias Colorretais/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prevalência , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Inquéritos e Questionários
9.
Cancer ; 126(6): 1183-1192, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31860135

RESUMO

BACKGROUND: Little is known about longitudinal symptom burden, its consequences for well-being, and whether lifestyle moderates the burden in older survivors. METHODS: The authors report on 36-month data from survivors aged ≥60 years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self-reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]-Fatigue scale), cognitive (on the FACT-Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State-Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well-being was measured using the FACT-General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatment group (chemotherapy with or without hormone therapy, hormone therapy only, and controls) and symptom burden, lifestyle, and covariates. Separate models tested the effects of fluctuations in symptom burden and lifestyle on function. RESULTS: All groups reported high baseline symptoms, and levels remained high over time; differences between survivors and controls were most notable for cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among chemotherapy-exposed survivors, followed by hormone therapy-exposed survivors versus controls (P < .001). The burden score was related to physical, emotional, and functional well-being (eg, survivors with lower vs higher burden scores had 12.4-point higher physical well-being scores). The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome (P < .005). CONCLUSIONS: Cancer and its treatments are associated with a higher level of actionable symptoms and greater loss of well-being over time in older breast cancer survivors than in comparable noncancer populations, suggesting the need for surveillance and opportunities for intervention.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Sobreviventes de Câncer , Estilo de Vida , Avaliação de Sintomas , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos , Antineoplásicos Hormonais/uso terapêutico , Ansiedade/epidemiologia , Neoplasias da Mama/psicologia , Dor do Câncer/epidemiologia , Sobreviventes de Câncer/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Transtornos Cognitivos , Estudos de Coortes , Depressão/epidemiologia , Exercício Físico , Fadiga/epidemiologia , Feminino , Nível de Saúde , Cardiopatias/epidemiologia , Humanos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Autorrelato , Transtornos do Sono-Vigília/epidemiologia , Sobrevivência , Avaliação de Sintomas/estatística & dados numéricos , Exacerbação dos Sintomas
10.
Surgery ; 167(3): 631-637, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31862171

RESUMO

BACKGROUND: Survivors of cancer in the United States are often financially encumbered by expenses and lost wages from cancer treatment. The majority of patients with thyroid cancer are diagnosed before age 65, when they are not eligible for Medicare. We hypothesized that financial distress would be common among thyroid cancer survivors and would be associated with poor health-related quality of life. METHODS: A financial distress questionnaire and Patient-Reported Outcomes Measurement Information System (29-item) were completed online by 1,743 adult thyroid cancer survivors living in the United States. Multivariable modeling was used to identify variables which independently predicted poor health-related quality of life. The magnitude of predicted change was estimated by ß coefficients and 95% confidence intervals. A ß ≥3 was considered clinically significant; α was set at 0.01. RESULTS: Financial difficulties were reported by 43% of thyroid cancer survivors and were associated with worse anxiety (ß = 5.07; P < .01) and depression (ß = 5.47; P < .01). Living in poverty was associated with worse anxiety (ß = 4.14; P < .01) and depression (ß = 4.35; P < .01). Lost productivity at work was associated with worse fatigue (ß = 5.99; P < .01) and social functioning (ß = -4.07; P < .01). Inability to change jobs was associated with worse fatigue (ß = 3.08; P < .01), pain interference (ß = 3.56; P < .01), and social functioning (ß = -3.09; P < .01). Receiving disability benefits was associated with worse pain interference (ß = 3.93; P < .01). Impaired ability to obtain a job was associated with worse social functioning (ß = -3.02; P < .01). Reported unemployment rate was 12.3%. CONCLUSION: Financial distress and negative financial events were common among thyroid cancer survivors and were associated with poorer health-related quality of life across 5 Patient-Reported Outcomes Measurement Information System health domains.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Efeitos Psicossociais da Doença , Qualidade de Vida , Neoplasias da Glândula Tireoide/economia , Atividades Cotidianas/psicologia , Adulto , Ansiedade/epidemiologia , Ansiedade/psicologia , Falência/estatística & dados numéricos , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Dor do Câncer/psicologia , Sobreviventes de Câncer/psicologia , Depressão/epidemiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Sobrevivência , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/psicologia , Desemprego/psicologia , Desemprego/estatística & dados numéricos , Estados Unidos/epidemiologia
11.
Support Care Cancer ; 28(7): 3061-3072, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31637515

RESUMO

CONTEXT: Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing. OBJECTIVES: To examine associations between prescription pain medication receipt and patient-reported pain interference in older adults with and without cancer. METHODS: Using the 2007-2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519). We measured receipt of opioids, non-steroidal anti-inflammatory drugs, and antiepileptics, and selected antidepressants within 30 days prior to survey. Patient-reported activity limitation due to pain (pain interference) within the past 30 days was summarized as severe, moderate, or mild/none. Logistic regression using predictive margins estimated associations between pain interference, cancer history, and pain medication receipt, adjusting for socio-demographics, chronic conditions, and Part D low-income subsidy. RESULTS: Severe or moderate pain interference was reported by 21.3% and 46.1%, respectively. Pain medication was received by 21.5%, with 11.6% receiving opioids. Among adults reporting severe pain interference, opioid prescriptions were filled by 27.0% versus 23.8% (p = 0.040) with and without cancer, respectively. Over half (56%) of adults reporting severe pain in both groups failed to receive any prescription pain medication. CONCLUSIONS: Older adults with cancer were more likely to receive prescription pain medications compared with adults without cancer; however, many older adults reporting severe pain interference did not receive medications. Improved assessment and management of pain among older adults with and without cancer is urgently needed.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor do Câncer/tratamento farmacológico , Neoplasias/tratamento farmacológico , Dor/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/administração & dosagem , Dor do Câncer/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Medicare Part D , Neoplasias/epidemiologia , Dor/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Programa de SEER , Estados Unidos/epidemiologia
12.
Support Care Cancer ; 28(1): 5-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650294

RESUMO

BACKGROUND: Gabapentinoid use for long-term cancer pain control may be problematic, given unclear mechanisms of action and increased concerns for physical dependence. The purpose of this report is to examine trends of gabapentinoid use among US adults with cancer from 2005 to 2015. METHODS: We conducted a serial, cross-sectional study using data from the Medical Expenditure Panel Survey (MEPS). We performed multiple logistic regression to examine the annual percentages of gabapentinoid users, which were adjusted for age, sex, and US region of residence. The amount of gabapentinoid prescriptions filled in 2015 was also estimated. RESULTS: The adjusted percentage of gabapentinoid users in 2015 was 5.60% (3.79%, 7.41%), 2.39 times greater than the percentage in 2005 (p < .001). By 2015, the number of gabapentinoid prescriptions had grown to approximately 3.52 million (2.40 million, 4.65 million). CONCLUSION: We observed greater than a twofold increase in the trend of gabapentinoid medication use among US adults with cancer. Investigations on the long-term efficacy of gabapentinoids for complex pain syndromes, and mitigation of risks, is essential to guide informed clinical management and keep patients safe.


Assuntos
Analgésicos/uso terapêutico , Dor do Câncer/tratamento farmacológico , Gabapentina/uso terapêutico , Neoplasias/tratamento farmacológico , Manejo da Dor/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/epidemiologia , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Estudos Transversais , Feminino , Gabapentina/análogos & derivados , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Cuidados Paliativos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
13.
Cancer ; 126(3): 670-680, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31714598

RESUMO

BACKGROUND: Pain is a common problem, especially in the first few years of breast cancer survivorship. Asian American survivors of breast cancer reportedly have inadequate cancer pain management, and subsequently report a lower quality of life compared with other racial/ethnic groups. Technology-based programs could improve the cancer pain management process. The purpose of the current study was to examine the efficacy of a technology-based information and coaching/support program on cancer pain and its accompanying symptoms among Asian American survivors of breast cancer. METHODS: The current study adopted a randomized pretest/posttest group design. The sample included 115 Asian American survivors of breast cancer (49 in the control group and 66 in the intervention group). The participants' background features, pain (frequency and distress), accompanying symptom distress (global, physical, and psychological), and 4 theory-based mediators (attitude, self-efficacy, perceived barriers, and social influence) were measured using multiple instruments at 3 time points (pretest, after 1 month, and after 3 months). The current study used an intent-to-treat approach and conducted linear mixed model growth curve analyses. RESULTS: There were significant decreases noted in all outcome variables, including pain and symptoms over time in both groups. There were greater decreases in physical symptom distress scores among the intervention group compared with the control group (P = .0229). The mediators as a whole significantly explained overall decreases in general, physical, and psychological symptom distress scores after 3 months in both groups and the intervention group's greater decreases in general, physical, and psychological symptom distress scores after 1 month. CONCLUSIONS: The technology-based program described herein could help to reduce cancer pain and its accompanying symptoms among Asian American survivors of breast cancer.


Assuntos
Neoplasias da Mama/epidemiologia , Dor do Câncer/epidemiologia , Sobreviventes de Câncer/psicologia , Dor/epidemiologia , Adulto , Americanos Asiáticos/psicologia , Neoplasias da Mama/patologia , Neoplasias da Mama/psicologia , Dor do Câncer/psicologia , Feminino , Humanos , Tutoria , Pessoa de Meia-Idade , Dor/patologia , Dor/psicologia , Manejo da Dor/psicologia , Qualidade de Vida , Autoeficácia
14.
Pain Pract ; 20(2): 122-128, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31419371

RESUMO

INTRODUCTION: For adequate pain treatment in patients with cancer, it is important to monitor and evaluate pain regularly. Although the numeric rating scale (NRS) is implemented in hospitals in the Netherlands, pain is still not systematically registered during outpatient consultations. The aim of this study was to assess whether home telemonitoring increases pain registration in medical records of outpatients with cancer. METHODS: Patients with cancer were included in the intervention group (IG) when they visited the outpatient clinic. They received a short message service and an interactive voice response on their mobile phones 3 times a week, asking them to provide their pain score (NRS). When the reported NRS pain score was ≥5, a specialized oncology nurse adapted the pain treatment when necessary. Outcomes were compared to a control group (CG) without home telemonitoring. In both groups, medical records were analyzed and data on pain and analgesics were collected. RESULTS: In each group, the medical records of 54 patients were analyzed on 3 consecutive outpatient visits. In the CG, pain registration or its absence was described in 60 visits (37.0%). In the IG, pain registration or its absence was reported in 83 visits (51.2%). Patients in the IG received a prescription for analgesics significantly more often (36/54 patients [66.6%]) than did patients in the CG (18/54 patients [33.3%]), P < 0.01). CONCLUSION: Home telemonitoring for patients with cancer significantly increases registration of pain and prescriptions of analgesics in outpatient medical records. Home telemonitoring helps to increase the awareness of pain and its management.


Assuntos
Dor do Câncer/terapia , Telefone Celular , Serviços de Assistência Domiciliar , Manejo da Dor/métodos , Telemedicina/métodos , Envio de Mensagens de Texto , Adulto , Idoso , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Telefone Celular/normas , Feminino , Serviços de Assistência Domiciliar/normas , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Países Baixos/epidemiologia , Manejo da Dor/normas , Telemedicina/normas , Envio de Mensagens de Texto/normas
15.
Support Care Cancer ; 28(1): 141-153, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30993452

RESUMO

PURPOSE: Head-to-head comparison of reliability, validity and responsiveness of four patient-reported outcome measures (PROMS) suitable for assessing health-related quality of life (HRQOL) in palliative care settings: EORTC QLQ-C15-PAL, FACT-G7, FACIT-Pal and short-form FACIT-Pal-14. METHODS: Secondary analysis of two phase III randomised trials: ketamine for chronic cancer pain, octreotide for vomiting in inoperable malignant bowel obstruction. Sub-groups were defined by Australia-modified Karnofsky performance status (AKPS) and participants' global impression of change (GIC). Two aspects of reliability were assessed: internal consistency (Cronbach alpha, α); test-retest reliability (intra-class correlation coefficient (ICC)) of patients with stable AKPS and those who self-reported 'no change' on GIC. Construct validity was assessed via pre-determined hypotheses about sensitivity of PROM scores to AKPS groups and responsiveness of PROM change scores to GIC groups using analysis of variance. RESULTS: FACIT-Pal had better internal consistency (α ranged 0.59-0.80, 15/18 ≥ 0.70) than QLQ-C15-PAL (0.51-0.85, 4/8 ≥ 0.70) and FACT-G7 (0.54-0.64, 0/2 ≥ 0.70). FACIT scales had better test-retest reliability (FACIT-Pal 11/27 ICCs ≥ 0.70, FACT-G7 2/3 ICCs ≥ 0.70) than QLQ-C15-PAL (2/30 ICCs ≥ 0.70, 18/30 ≤ 0.5). Four scales demonstrated sensitivity to AKPS: QLQ-PAL-15 Physical Functioning and Global QOL, FACT-G Functional Wellbeing and FACIT-Pal Trial Outcome Index (TOI). Nine scales demonstrated responsiveness: three in the ketamine trial population (QLQ-C15-PAL Pain, FACIT-Pal-14, FACT-G7), six in the octreotide trial population (QLQ-C15-PAL Fatigue; FACIT-Pal PalCare, TOI, Total; FACT-G Physical Wellbeing and Total). CONCLUSIONS: No PROM was clearly superior, confirming that choosing the best PROM requires careful consideration of the research goals, patient population and the domains of HRQOL targeted by the intervention being investigated.


Assuntos
Cuidados Paliativos , Medidas de Resultados Relatados pelo Paciente , Psicometria , Qualidade de Vida , Adulto , Idoso , Austrália/epidemiologia , Dor do Câncer/epidemiologia , Dor do Câncer/terapia , Dor Crônica/epidemiologia , Dor Crônica/terapia , Ensaios Clínicos Fase III como Assunto/estatística & dados numéricos , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/terapia , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Psicometria/métodos , Psicometria/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários , Vômito/epidemiologia , Vômito/terapia
16.
Support Care Cancer ; 28(4): 1793-1797, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31332514

RESUMO

PURPOSE: Opioid-induced constipation (OIC) is a distressing physical symptom for patients with cancer taking opioids. Total opioid consumption may contribute to developing worsening OIC-related symptoms. We completed a retrospective analysis examining the association of total daily opioid consumption on self-reported constipation in patients with cancer. METHODS: In over 5 clinic visits, we collected self-reported constipation scores and 24-h oral morphine equivalents (OME). We examined the association between OME and the presence of constipation (i.e., score > 3) and the relationship of OME between patients with or without constipation. RESULTS: Of 297 patients with cancer, we observed 57.8% with constipation and 42.4% without constipation at the first clinic visit. Age was similar in both groups (54.2 ± 14.5 vs. 56.4 ± 14.8 years [mean ± SD]) and the majority of patients were women (63.7% vs. 61.1%). The most common cancer type in patients with constipation was non-colorectal gastrointestinal (n = 25, 14.6%), while in patients without constipation was colorectal gastrointestinal (n = 25; 19.8%). Across visits, we observed weak or no association between OME and self-reported constipation (r = 0.01-0.27). At the first visit, higher mean OME was seen in patients who self-reported constipation (133.4 vs 76; p < 0.05). Age, sex, metastatic disease, and stimulant laxative use were not associated with constipation. CONCLUSIONS: We observed weak to no association between OME and constipation in patients with cancer. These results suggest a lack of a clear association between total opioid consumption and self-reported constipation.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Dor do Câncer/tratamento farmacológico , Constipação Induzida por Opioides/etiologia , Administração Oral , Adulto , Idoso , Dor do Câncer/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/efeitos adversos , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Constipação Induzida por Opioides/epidemiologia , Estudos Retrospectivos , Autorrelato/estatística & dados numéricos
17.
Support Care Cancer ; 28(4): 1809-1816, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31338641

RESUMO

PURPOSE: The impact of supportive medications on patient-reported outcomes (PROs) has not been systematically evaluated. We describe the supportive medications used by treatment-naïve lung cancer patients and assess their association with PROs from MD Anderson Symptom Inventory (MDASI). METHODS: Treatment-naïve lung cancer patients who completed PROs from MDASI at the initial visit to MD Anderson Cancer Center were included. Medications from the initial visit were abstracted from the electronic medical records system and categorized into therapeutic classes based on U.S. Pharmacopeia v7.0. A chi-square or Mann-Whitney U test was conducted as appropriate. RESULTS: Among 459 patients, ~ 50% took any analgesics and 25% were on opioids. One-third of patients with moderate-severe pain were not on any analgesics. Patients taking opioids had significantly worse median pain scores (6 vs. 0) compared with those not taking any analgesics (p < 0.0001). Higher proportion of patients with moderate-severe pain took opioids compared with those with mild pain (52% vs. 16%, p < 0.0001). Patients on opioids also reported significantly worse scores for five other cancer-specific core symptoms and all six symptoms rating interference with daily life. Only 15% of patients with higher composite score for depression-related symptoms were on antidepressants. However, patients taking antidepressants did not significantly differ in any individual MDASI symptom scores compared with those not on antidepressants (p = 0.4858). CONCLUSIONS: Our results suggest a need for better screening for pain and depression and optimization of pain management in treatment-naïve lung cancer patients since their poor functional status may result in suboptimal cancer therapy.


Assuntos
Neoplasias Pulmonares/tratamento farmacológico , Cuidados Paliativos/métodos , Medidas de Resultados Relatados pelo Paciente , Medicamentos sob Prescrição/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Antidepressivos/uso terapêutico , Dor do Câncer/tratamento farmacológico , Dor do Câncer/epidemiologia , Depressão/tratamento farmacológico , Depressão/epidemiologia , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/psicologia , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/psicologia , Manejo da Dor/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Polimedicação , Medicamentos sob Prescrição/classificação , Estudos Retrospectivos , Adulto Jovem
18.
Support Care Cancer ; 28(1): 279-285, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31041583

RESUMO

PURPOSE: Tumor-related cancer pain often comprises mixed pain with both nociceptive and neuropathic components. Whether tumor-related cancer pain includes a neuropathic component impacts the therapeutic strategy. The aim of this cross-sectional study was to investigate the usefulness of two screening tools for neuropathic pain, painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), in identifying the neuropathic component of mixed pain among patients with tumor-related cancer pain. METHOD: This cross-sectional study recruited consecutive inpatients and outpatients at a single site. The diagnostic accuracy of painDETECT and S-LANSS was evaluated using receiver operating characteristic curve analysis and classification probability. RESULTS: Of the study group, 106 patients had tumor-related cancer pain. Analyses of the nociceptive and mixed pain groups (n = 104) showed that neither painDETECT nor S-LANSS had satisfactory areas under the curve (AUCs) for identifying the neuropathic component of mixed pain (0.59 for painDETECT and 0.56 for S-LANSS). By pain intensity, the AUC for painDETECT was significantly higher in the mild pain group than in the moderate or severe pain group (0.77 vs. 0.43, P = 0.002). All parameters of classification probability for both tools were higher in the mild pain group than in the moderate or severe pain group. CONCLUSIONS: painDETECT and S-LANSS could not identify the neuropathic component of mixed pain among patients with tumor-related cancer pain, especially when pain was moderate or severe. Contrarily, these screening tools might be useful for identifying the neuropathic component of mixed pain for mild pain.


Assuntos
Dor do Câncer/diagnóstico , Programas de Rastreamento/métodos , Neuralgia/diagnóstico , Medição da Dor/métodos , Autorrelato , Idoso , Dor do Câncer/epidemiologia , Comorbidade , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neuralgia/epidemiologia , Neuralgia/etiologia , Valor Preditivo dos Testes , Autoavaliação , Inquéritos e Questionários
19.
J Cancer Educ ; 35(2): 284-291, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-30607804

RESUMO

Attitudinal barriers to pain management are supposed to contribute to the uncontrolled cancer pain in mainland China. The purpose of this study was (1) to investigate the attitudinal barriers to pain management among cancer patients in mainland China, (2) to examine relationships between the attitudinal barriers and patients' pain management conditions in the light of medication adherence and adequacy of analgesic use, and (3) to identify factors associated with the attitudinal barriers. A cross-sectional questionnaire survey, including the Barriers Questionnaire-Chinese (BQ-C) and two scales that measure the medication adherence and the adequacy of analgesic use, was carried out among patients with a variety of cancers. The questionnaires were completed by 246 cancer patients (response rate 94.6%); their mean age was 51.5 years (SD = 11.7). Almost all the patients had various attitudinal barriers to pain management. The mean scores for the total scale and several subscales of the BQ-C were significantly different by the patients' characteristics, the medication adherence, and the adequacy of analgesic use. The associations with these variables for a given subscale, e.g., the subscale regarding concerns about side effects, were different from those for other subscales, e.g., the subscale regarding fatalism that cancer pain is uncontrollable. The findings suggest that a nurse-led educational program in the light of patients' characteristics is required for overcoming the attitudinal barriers to pain management among cancer patients in mainland China.


Assuntos
Dor do Câncer/terapia , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação/psicologia , Neoplasias/complicações , Manejo da Dor/métodos , Educação de Pacientes como Assunto , Grupo com Ancestrais do Continente Asiático , Dor do Câncer/epidemiologia , Dor do Câncer/etiologia , Dor do Câncer/psicologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
Tumori ; 106(1): 25-32, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31456509

RESUMO

BACKGROUND: Several approaches towards pain control for admitted cancer patients have been suggested by the literature without achieving satisfactory results. In this quality improvement project, we proposed a multicomponent intervention. MEASURES: A set of indicators was established for each component of the project. The feasibility of both the intervention and its evaluation system was measured. According to the literature review and the analysis of the local context, 5 active components were identified, piloted, and assessed: training of ward professionals, education of patients and nonprofessional caregivers, regular pain assessment, specialist-level pain consultation procedures, and involvement of hospital management. RESULTS: Multiprofessional training programs with daily discussions, daily pain assessment, and a readily available specialized palliative care service seem to be the active components of this complex intervention. The quality improvement project achieved 2 years sustainability. CONCLUSION: Consolidated educational and organizational methodologies support the feasibility of this complex intervention.


Assuntos
Dor do Câncer/epidemiologia , Pacientes Internados , Manejo da Dor , Medição da Dor , Melhoria de Qualidade , Dor do Câncer/diagnóstico , Dor do Câncer/terapia , Cuidadores , Gerenciamento Clínico , Feminino , Seguimentos , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Modelos Teóricos , Avaliação de Resultados em Cuidados de Saúde , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor/métodos , Medição da Dor/normas , Educação de Pacientes como Assunto , Encaminhamento e Consulta
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...