Prevalence of opioid misuse in patients with cancer: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: Long-term consequences of opioid consumption, such as misuse, have been a major concern in patients with chronic non-cancer pain. Potentially opioid misuse may also be a consequence in patients with cancer in opioid treatment which encouraged us to undertake this systematic review assessing the frequency of opioid misuse in this population. MATERIALS/METHODS: The search strategy comprised words related to cancer, opioid misuse, and frequency. PubMed, Embase, PsycInfo, and Cinahl were searched from inception to July 2023. Prospective studies were selected and analysed regarding frequency, study characteristics, and quality. A meta-analysis was possible to carry out for a sub-group (opioid misuse risk). RESULTS: From 585 abstracts screened, six articles were included. Only prevalence data were found. The prevalence of opioid misuse ranged from 5.7% to 84%, while the prevalence of opioid misuse risk varied from 2.4% to 35.4%. The pooled prevalence of opioid misuse risk was 12.3% (95% CI: 0.8-36.3; I2 = 98.4%, 95% CI: 97.2-99.1). The studies differed regarding, e.g., methods, misuse definitions, and assessment instruments. CONCLUSIONS: Few studies were identified and large differences in prevalence for opioid misuse and opioid misuse risk were observed. Methodological disparities and the studies quality underscore the importance of improved studies in the future.

Opioid use after surgical treatment in the Danish population-Protocol for a register-based cohort study.

BACKGROUND: Over the past 25 years, global opioid consumption has increased. Denmark ranks fifth in opioid use globally, exceeding other Scandinavian countries. Postsurgical pain is a common reason for opioid prescriptions, but opioid use patterns after patient discharge from the hospital are unclear. This study examines trends in opioid prescription among Danish surgical patients over a year. METHODS: This register-based cohort study will use data from Danish governmental databases related to patients undergoing the 10 most frequent surgical procedures in 2018, excluding cancer-related and minor procedures. The primary outcome will be the dispensed postoperative opioid prescriptions at retail pharmacies over four quarters. Secondary analyses will include associations with sex, age, education attainment, and oral morphine equivalent quotient. Surgical treatments and diagnoses will be identified using NOMESCO procedure codes and ICD-10 codes. Opioids will be identified by ATC codes N02A and R05DA04. Subjects will be classified as preoperative opioid consumers or non-opioid consumers based on opioid prescriptions redeemed in the 6 months before surgery. DISCUSSION: The study will use extensive national register-based data, ensuring consistent data collection and enhancing the generalizability of the findings to similar healthcare systems. The study may identify high-risk populations for long-term opioids and provide information to support opioid prescribing guidelines and public health policies.

European Respiratory Society clinical practice guideline: palliative care for people with COPD or interstitial lung disease.

There is increased awareness of palliative care needs in people with COPD or interstitial lung disease (ILD). This European Respiratory Society (ERS) task force aimed to provide recommendations for initiation and integration of palliative care into the respiratory care of adult people with COPD or ILD. The ERS task force consisted of 20 members, including representatives of people with COPD or ILD and informal caregivers. Eight questions were formulated, four in the Population, Intervention, Comparison, Outcome format. These were addressed with full systematic reviews and application of Grading of Recommendations Assessment, Development and Evaluation for assessing the evidence. Four additional questions were addressed narratively. An "evidence-to-decision" framework was used to formulate recommendations. The following definition of palliative care for people with COPD or ILD was agreed. A holistic and multidisciplinary person-centred approach aiming to control symptoms and improve quality of life of people with serious health-related suffering because of COPD or ILD, and to support their informal caregivers. Recommendations were made regarding people with COPD or ILD and their informal caregivers: to consider palliative care when physical, psychological, social or existential needs are identified through holistic needs assessment; to offer palliative care interventions, including support for informal caregivers, in accordance with such needs; to offer advance care planning in accordance with preferences; and to integrate palliative care into routine COPD and ILD care. Recommendations should be reconsidered as new evidence becomes available.

The impact of caring on caregivers of patients with life-threatening organ failure.

OBJECTIVES: This study aimed at characterizing 3 populations of family/friend caregivers of patients with different life-threatening organ failure regarding health-related quality of life, caregiver burden, and dyadic coping. METHODS: Three cross-sectional (population) studies were conducted at a tertiary hospital in Denmark (2019-2020). Patients with renal failure (RF), cystic fibrosis (CF), and intestinal failure (IF) were asked to designate the closest person with ≥18 years old involved in the care (caregiver) to participate in this study. Number of caregivers included were RF = 78, CF = 104, and IF = 73. Electronic questionnaires were filled in by caregivers to assess health-related quality of life and caregiver burden and by caregivers and respective patients to assess dyadic coping. RESULTS: The 3 caregiver groups had self-perception of poor health and energy; however, caregivers of CF patients perceived their physical role functioning better than those caregiving for RF and IF patients (p = 0.002). The level of caregiver burden was reported as not high, but caregivers used in average 13 hours/day for caring. Moreover, cleaning tasks (p = 0.005) and personal care (p = 0.009) were more demanding in RF and IF patients. Caregivers also did not differ regarding dyadic coping. When comparing patients and caregivers, stress communication by oneself and the partner differed (p < 0.001). SIGNIFICANCE OF RESULTS: Caregivers spent many hours in the care role, they reported poor health, and dyadic coping may be improved. Interventions in caregivers of patients with life-threatening organ failure could help to improve care management at home, caregiver's health, and dyadic coping between caregiver and patient and consequently reduce caregiver burden.

Combining subjective and objective appraisals of cognitive dysfunction in patients with cancer: a deeper understanding of meaning and impact on suffering?

PURPOSE: Patients with advanced cancer often experience cognitive dysfunction, which may influence decision making, self-perception, and existential well-being. However, there is little evidence regarding this issue. This study analysed associations between objective neuropsychological measures and patients' self-report of cognitive dysfunction interfering with everyday life, general well-being, and sense of existential value. METHODS: A mixed method study assessed 13 adult patients with advanced cancer with validated neuropsychological tests, which assessed sustained attention, psychomotor speed, memory/attention, mental flexibility, and a measure of global cognitive function. These were followed by semi-structured interviews focusing on subjective experiences of cognitive dysfunction. Agreement between subjective and objective measures were analysed by Cohen's Kappa (k). Thematic analysis explored associations with cognitive deficits. RESULTS: Poor cognitive performance on the neuropsychological tests was observed regarding sustained attention (n = 8), psychomotor speed (n = 1), memory/attention (n = 2), mental flexibility (n = 9), and global cognitive function (n = 3). Almost all patients (n = 12) had complaints of cognitive dysfunction. However, the agreement between the two assessments was weak (k ≤ 0.264). Cognitive dysfunction challenged the patients with regard to practice everyday life including their existential values related to meaning of life and well-being. Adjustment of the sense of living according to one's existential values and changes of self-perception were also related positively and negatively to existential well-being. CONCLUSION: Despite the weak agreement between objective and subjective measures of cognitive function, many of the patients reported experiences of cognitive dysfunction that had an impact on their daily life and existential well-being, adding to the suffering experienced.

Improvement of pain management in a comprehensive cancer center: a comparison of two cross-sectional studies 8 years apart.

CONTEXT: In 2011, a multidisciplinary palliative team (MPT) was established at Rigshospitalet (DK) and a cross-sectional study in inpatients was carried out at the Departments of Oncology and Hematology. High symptom burden, high prevalence of pain (64%), and insufficient analgesic treatment were demonstrated. In 2019, a similar study was carried out. OBJECTIVES: This study compares prevalence of symptoms including pain and analyzes analgesic treatment of adult in-patients in a comprehensive cancer center. METHODS: Two cross-sectional studies (May-Jun 2011; Feb-Sep 2019). INCLUSION CRITERIA: malignant diseases, age ≥ 18 y, able to understand Danish. EORTC QLQ-C30 and Brief Pain Inventory (BPI) were applied. RESULTS: A total of 134 and 183 inpatients were included in 2011 and 2019, respectively. Differences in the two populations were seen; in 2019 more patients had advanced disease (P = 0.0096), lower performance status (P = 0.0028), and a palliative treatment plan (P = 0.0034). The prevalence of impairments and symptoms was high and similar in the 2 years with exception of severe pain (P = 0.0143) and neuropathic pain (P < 0.0001) which increased in 2019. Moreover, pain relief significantly improved, and significantly fewer patients with pain were left untreated. Significant increase in opioid and adjuvant analgesic prescription in 2019. CONCLUSION: An overall unchanged high symptom burden was observed. However, improvement of pain management was observed in 2019. The establishment of a MPT may possibly have contributed to improved pain management.

Identification of palliative care needs in hemodialysis patients: An update.

OBJECTIVE: End-stage kidney disease and hemodialysis (HD) treatment are associated with a high symptom burden in many patients. This study aimed at updating patient-reported outcomes concerning quality of life, fatigue, anxiety, and depression in HD patients treated in a single center in order to assess the need for palliative care provision. METHOD: A cross-sectional design, in which a sample of patients treated at a single HD department (Rigshospitalet, Denmark) between January and June 2019, was analyzed using the Kidney Disease Quality of Life Short Form, the Multidimensional Fatigue Inventory, and the Hospital Anxiety and Depression Scale. In addition, we compared the results with previously published data from the same department (2000) and with an age- and sex-matched sample from the Danish general population (1997/2014). Chi-square and t-tests were used for comparisons. RESULTS: Screened patients = 242, included = 141, analyzed = 131 (70.2% male, mean age = 61.3 years). HD patients reported low scores for quality of life, high scores for fatigue, and approximately 30% had anxiety/depression. Regarding quality of life, they had significantly lower scores on general health (P ≤ 0.000), vitality (P = 0.009), social functioning (P = 0.001), mental health (P = 0.007), and mental component (P = 0.005) compared with former data of HD patients. Moreover, they reported significantly poorer quality of life and worse fatigue compared with the general Danish population. SIGNIFICANCE OF RESULTS: In the patients undergoing HD, quality of life was poor and worsened when compared with former HD patients' data. Additionally, fatigue, depression, and anxiety in HD patients were prevalent. A clear need for palliative care provision was observed.

Chronic Pain, Opioid Therapy, Sexual Desire, and Satisfaction in Sexual Life: A Population-Based Survey.

OBJECTIVES: Associations between chronic pain, opioid use, and sexual problems are acknowledged, but population-based investigations are sparse. Our study aimed at investigating the associations between chronic noncancer pain (CNCP), opioid use, lack of/low sexual desire, and dissatisfaction with sexual life. SUBJECTS: In 2013, 11,517 randomly selected individuals of the Danish population (18-74 years old without cancer) completed a self-administered questionnaire. METHODS: We classified CNCP: pain lasting six months or longer, short-term opioid use: one or more prescriptions the previous year, long-term opioid use: one or more prescriptions per month for six months the previous year. Sexual problems were assessed by four closed-ended questions. Data on dispensed opioids were retrieved from the Danish National Prescription Registry. Multiple logistic regression analysis was used to examine associations between CNCP, opioid use, and lack of/low sexual desire, and dissatisfaction in sexual life, presented as odds ratios (95% confidence intervals [CIs]). RESULTS: Compared with individuals without CNCP, individuals with CNCP in the long-term and short-term opioid use group and in the nonopioid use group were more likely to report a lack of/low sexual desire (OR = 2.64, 95% CI = 1.80-3.88; OR = 1.82, 95% CI = 1.39-2.38; OR = 1.46, 95% CI = 1.28-1.67, respectively) and dissatisfaction with sex life (OR = 1.69, 95% CI = 1.07-2.67; OR = 1.35, 95% CI = 1.00-1.82; OR = 1.38, 95% CI = 1.22-1.58, respectively). Compared with CNCP patients not using opioids, long-term opioid users with CNCP had statistically significant higher odds of reporting a lack of/low sexual desire (OR = 1.81, 95% CI = 1.23-2.68). CONCLUSIONS: Long-term opioid therapy for CNCP requires special attention due to its potential in suppressing sexual desire.

Assessment of cognitive function in patients with metastatic cancer: Are we using the right tools?

OBJECTIVE: This study aimed at analyzing the validity and reliability of the continuous reaction time (CRT) test, the finger-tapping test (FTT), the Digit Span Test (DST), the Trail Making Test - part B (TMTB), and the Mini-Mental State Examination (MMSE) in patients with metastatic cancer. METHOD: Eighty adult patients and 81 healthy controls were assessed between July of 2010 and November of 2015. The neuropsychological tests were analyzed regarding construct/discriminant/criterion validity and reliability. RESULTS: In terms of construct validity, it was not possible to estimate a model for the MMSE because of a skewed response distribution. For discriminant validity, patients were slower on two measures of the CRT (p = 0.00483, p = 0.00030) and FTT dominant hand (p = 0.00306). Regarding sensitivity and specificity, only the DST and TMTB seemed to predict cognitive deficit; however, the ROC curve areas were ≤ 0.73. In terms of criterion validity, there were few significant correlations between the tests and the sociodemographic and clinical variables, and for the most part were very weak. Reliability was deemed to be adequate for the TMTB, DST, and FTT. SIGNIFICANCE OF RESULTS: The findings of the full validation analyses were not clear-cut. However, CRT test, DST, FTT, and TMTB demonstrated partial positive results, indicating that these tests have good potential for use in clinical settings and require further study.

Identification of the predictors of cognitive impairment in patients with cancer in palliative care: a prospective longitudinal analysis.

PURPOSE: Studies with neuropsychological assessments in patients with cancer are sparse, and the evidence is very limited regarding their status of cognitive function over time. This study aimed at assessing the prevalence and predictors of cognitive impairment in patients with cancer in palliative care. METHODS: Prospective longitudinal investigation derived from the European Palliative Care Cancer Symptom study (2011-2013) including patients with cancer in palliative care, ≥18 years, and with at least one assessment post-inclusion. For cognitive assessment, a 4-item version of the Mini Mental State Examination was applied at inclusion and after 4 to 16 weeks. Logistic regression model with multiple imputations was applied. RESULTS: The sample consisted of 1568 patients (50% male, mean age 65.5, 42% with 10-12 years schooling, mean Karnofsky Performance Status-KPS 68%). Longitudinal analysis of the patients with complete MMSE at both assessments (n = 801) showed that 64.5% were not impaired, 12.5% remained cognitively impaired, 11.4% developed impairment, and 11.6% improved. Those who improved cognitively also reported reduced pain intensity and increased appetite. The predictive model (n = 1351) showed that those with low KPS (OR = 1.6, 95% CI 1.0-2.5) most often developed cognitive impairment, while patients with breast cancer (OR = 0.4, 95% CI 0.2-0.7) had lower odds for impairment. CONCLUSIONS: During palliative care, a substantial number of patients remained cognitively impaired or developed cognitive impairment; however, it is noteworthy that improvement was also observed. Physical performance and cancer type may predict cognitive impairment.

Minimally invasive procedures for the management of vertebral bone pain due to cancer: The EAPC recommendations.

BACKGROUND: Image-guided percutaneous ablation methods have proved effective for treatment of benign bone tumors and for palliation of metastases involving the bone. However, the role of these techniques is controversial and has to be better defined in the setting of palliative care. METHODS: A systematic review of the existing data regarding minimally invasive techniques for the pain management of vertebral bone metastases was performed by experts of the European Palliative Care Research Network. RESULTS: Only five papers were taken into consideration after performing rigorous screening according to inclusion and exclusion criteria (low number of patients, retrospective series, proceedings). DISCUSSION: According to the present data a recommendation should be made to perform kiphoplasty in patients with vertebral tumors or metastases. However, the strength of this recommendation was based on one randomized controlled study. Several weaknesses and low quality of study design were observed with other techniques. CONCLUSION: Further randomized controlled trials are required to improve the strength of evidence available to suggest these procedures on large scale. Until then, the balance of evidence favors the use of these procedures in a small select cohort of patients with severe and disabling back pain refractory to medical therapy.

Classification of a palliative care population in a comprehensive cancer centre.

PURPOSE: The purposes of the present study were to classify the palliative care population (PCP) in a comprehensive cancer centre by using information on antineoplastic treatment options and to analyse associations between socio-demographic factors, cancer diagnoses, treatment characteristics and receiving specialist palliative care (SPC). METHODS: This is a cross-sectional screening study of patients with cancer in the Department of Oncology, Rigshospitalet, Copenhagen University Hospital for 6 months. Patients were assessed to be included in the DOMUS study: a randomised controlled trial of accelerated transition to SPC at home (NCT01885637). The PCP was classified as patients with incurable cancer and limited or no antineoplastic treatment options. Patients with performance status 2-4 were further classified as the essential palliative care population (EPCP). RESULTS: During the study period, 3717 patients with cancer were assessed. The PCP comprised 513 patients yielding a prevalence of 14 %. The EPCP comprised 256 patients (7 %). The EPCP was older, more likely inpatients, had a higher comorbidity burden and 38 % received SPC. Women, patients without caregivers and patients with breast cancer were more likely to receive SPC. CONCLUSIONS: By using objective criteria from clinical data and systematic screening, the observed prevalence of the PCP of 14 % may be generalisable to comprehensive cancer centres with similar composition of cancer diagnoses.

Home-based specialized palliative care in patients with advanced cancer: A systematic review.

OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included. METHOD: A PICO process search strategy consisting of terms related to cancer, palliation, and home care was employed. The search was conducted in PubMed, EMBASE, and Cochrane from January 1, 2000, to January 27, 2015. A hand search of the reference lists of the included studies was also performed. RESULTS: A total of 5 articles (out of 2080 abstracts) were selected for analysis. Three additional studies were added by the hand search. Six observational and two interventional studies were evaluated. In all of these studies, the description of the SPC service was limited to the composition of the staff-no other organizational aspects were detailed. From 44 to 90% of the patients receiving home-based SPC died at home. Studies including survival and quality of life had divergent outcomes, and overall performance status did not improve. However, symptom control did improve over time. SIGNIFICANCE OF RESULTS: There is a lack of controlled clinical trials and organizational descriptions regarding home-based SPC for patients with advanced cancer, resulting in poor information and a lack of evidence. Generally, home-based SPC seems to have some positive effect on pain and dyspnea, but more high-quality studies are required.

Pain management in cancer survivorship.

BACKGROUND: The number of patients surviving cancer disease has increased in last decades. Consequently, an emerging population with different needs due to long-term or late effects of cancer disease and/or treatment, e.g. chronic pain, is of major concern. EPIDEMIOLOGY: Chronic pain is one of the main problems in this population and prevalence varies between 16% and 50%. Most information derives from breast cancer patients assessed by surveys from national or local institutional databases. A Danish population-based survey estimated that 41.5% of all cancer survivors reported chronic pain. PAIN ETIOLOGY: Neuropathic pain seems to be the major pain etiology in cancer survivors and therefore adjuvant analgesics should be the first choice of analgesic treatment. CONTEXT: This article addresses the central aspects of pain epidemiology, mechanisms and the frequent pain syndromes met in cancer survivors. Pain management strategies are discussed according to the biopsychosocial model and with the rapidly growing number of cancer survivors the establishment of multidisciplinary clinics as a part of comprehensive cancer centers are proposed.

Quality of life and symptoms in patients with malignant diseases admitted to a comprehensive cancer centre.

PURPOSE: Quality of life and symptomatology in patients with malignancies admitted to comprehensive cancer centres are rarely investigated. Thus, this study aimed to investigate symptomatology and health-related quality of life of inpatients with cancer. METHODS: A prospective, cross-sectional study was carried out on two occasions 5 weeks apart in haematology and oncology departments at a comprehensive cancer centre. Assessment included demographic data, WHO performance status (PS), EORTC QLQ-C30 and pain scales of brief pain inventory. Comparisons were analysed using Wilcoxon two-sample test, rank tests and Fisher's exact test. RESULTS: One hundred twenty-four patients were analysed, mean age=59 years (SD=13.7), 42% admitted to haematological department; lung cancer was the most frequent diagnosis (15%). Low health-related quality of life and severe symptom burden, especially fatigue and appetite loss, were observed among the inpatients. In addition, role and social functions appeared to be more impaired in haematology patients than in those admitted to oncology (P=0.0372 and 0.0167, respectively). On the other hand, pain and constipation were more severely affected in oncology patients (P=0.0194 and 0.0064, respectively). CONCLUSIONS: Patients in the wards of haematology and oncology had pronounced symptomatology and low quality of life. A more systematic focus on the amelioration of problems with functioning and symptoms among inpatients with malignant diseases is warranted.

The DOMUS study protocol: a randomized clinical trial of accelerated transition from oncological treatment to specialized palliative care at home.

BACKGROUND: The focus of Specialized Palliative Care (SPC) is to improve care for patients with incurable diseases and their families, which includes the opportunity to make their own choice of place of care and ultimately place of death. The Danish Palliative Care Trial (DOMUS) aims to investigate whether an accelerated transition process from oncological treatment to continuing SPC at home for patients with incurable cancer results in more patients reaching their preferred place of care and death. The SPC in this trial is enriched with a manualized psychological intervention. METHODS/DESIGN: DOMUS is a controlled randomized clinical trial with a balanced parallel-group randomization (1:1). The planned sample size is 340 in- and outpatients treated at the Department of Oncology at Copenhagen University Hospital. Patients are randomly assigned either to: a) standard care plus SPC enriched with a standardized psychological intervention for patients and caregivers at home or b) standard care alone. Inclusion criteria are incurable cancer with no or limited antineoplastic treatment options. DISCUSSION: Programs that facilitate transition from hospital treatment to SPC at home for patients with incurable cancer can be a powerful tool to improve patients' quality of life and support family/caregivers during the disease trajectory. The present study offers a model for achieving optimal delivery of palliative care in the patient's preferred place of care and attempt to clarify challenges. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01885637.

When and how to stop palliative antineoplastic treatment and to organise palliative care for patients with incurable cancer.

BACKGROUND: Improving the organisational aspects of the delivery of palliative care in order to support patients throughout their disease trajectory has received limited attention. AIM: To investigate the opportunities and barriers related to organising palliation for people with terminal cancer and their families. METHODS: An explorative interview study was conducted among 31 nurses and three physicians concerning an intervention facilitating a fast transition from treatment at a cancer centre at a university hospital to palliation at home. A thematic analysis was conducted. FINDINGS: This article presents three out of seven themes: 1) improvement in the cessation of antineoplastic treatment in palliation; 2) improvement in organisations delivering palliation; and 3) improvement in multidisciplinary and cross-sectoral collaboration. CONCLUSIONS: The results demonstrate the demand for flexible, family-centred and integrated palliation at all levels, from communication and the collaborative relationship between healthcare professionals and families to service sectors.

Home-Based Specialized Pediatric Palliative Care: A Systematic Review and Meta-Analysis.

CONTEXT: Although specialized pediatric palliative care (SPPC) teams increasingly provide home-based care, the evidence of its impact has not yet been systematically evaluated. OBJECTIVES: To examine the impact of home-based SPPC in children and adolescents with life-limiting conditions, regarding place of death, quality of life and symptom burden. METHODS: We searched Medline, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus for studies comparing children and adolescents with life-limiting conditions receiving home-based SPPC with children and adolescents not receiving home-based SPPC, or studies reporting before-and-after measurements. We included studies that reported on place of death, quality of life and/or symptoms. Two authors independently screened the articles, extracted data, and assessed quality. Results were synthesized as a systematic narrative synthesis and meta-analysis, using a random-effects model. RESULTS: We included five studies, which reported on 392 children and adolescents. Meta-analysis showed that receiving home-based SPPC was associated with a more than fourfold increased likelihood of home death (risk ratio 4.64, 95% confidence interval 3.06-7.04; 3 studies; n=296). Most studies reported improved quality of life and reduced symptom burden. The included studies were of low to moderate quality with a high risk of bias. CONCLUSION: This systematic review suggests that home-based SPPC is associated with increased likelihood of home death, and might be associated with improved quality of life and reduced symptom burden. The small number of studies and an overall high risk of bias, however, makes the overall strength of evidence low.

Increasing prevalence of chronic non-cancer pain in Denmark from 2000 to 2017: A population-based survey.

BACKGROUND: This investigation comprised information from the Danish population to analyse the development of chronic non-cancer pain (CNCP) prevalence according to sex, age, physical job demand and educational level. METHODS: Data derives from the Danish Health and Morbidity Surveys based on random samples of adults living in Denmark. The analysed samples were composed by 10,457 in 2000 (response rate: 62.7%), 5686 in 2005 (52.1%), 15,165 in 2010 (60.1%), 14,265 in 2013 (57.1%) and 14,022 in 2017 (56.1%). CNCP was defined as pain lasting 6 months or more. Individuals with a self-reported history of cancer were excluded. Calibration weighting was applied to reduce the impact of potential non-response bias. The Relative and the Absolute Concentration Index were calculated to measure educational inequalities. RESULTS: CNCP prevalence has increased 8.3 percentage points during 2000-2017 (19.5%-27.8%) and is highest among women (22.1% to 30.8%). Higher CNCP prevalence among men aged 45-64 years exceeded the men aged >65 years in 2017 (31.9% and 29.8%, respectively). There was a continuous increase in CNCP prevalence in individuals with sedentary work or low physical demand at job from 2000 to 2017; among those with moderate or high physical demand at job the prevalence increased sharply from 2000 to 2010 after which the prevalence remained stable. Higher CNCP prevalence persisted among individuals with lower level of education regardless of gender and the inequalities remained stable over time. CONCLUSION: The Danish prevalence of chronic pain has increased in the last two decades and higher numbers are observed in some sociodemographic groups. SIGNIFICANCE: This study provides an overview of the development of chronic non-cancer pain in a country and analyses the trends with socioeconomic inequalities. The continuous increasing prevalence may have huge social and economic implications. This study reveals an urgent need for measures to attenuate the increasing prevalence, which should be a priority for public health policy.

Development of a systematic multidisciplinary clinical and teaching model for the palliative approaches in patients with severe lung failure.

Palliative medicine has traditionally focused on people affected by cancer with rapidly advancing disease progression. However, as more people live longer time with serious illnesses, including lung diseases, the need of palliative care for these patients if also increasing. There is a lack of research and clinical knowledge about what palliative care is for people affected by chronic obstructive pulmonary disease and interstitial lung disease. The aim of this paper is to describe the development process of an easy to use and clinically relevant model for the palliative care approach in people affected by severe illnesses. The developed model consists of four components, which originated the title" 4,2,4,2 model". Each number has a specific meaning: the first 4 = the four disease trajectories that patients may experience; 2 = the two forms of knowledge, objective, and intuitive that must be achieved by the health professionals to gain an understanding of the situation; 4 = the four dimensions of suffering physically, mentally, socially and existentially/spiritually; and 2 = the two roles that health-care professionals must be able to take in when treating patients with serious illnesses. The 4-2-4-2 model proposes an easy-to-use and clinically relevant model for palliative approach and integration of PC and pulmonary medicine. Another important purpose of this model is to provide HPs with different educational backgrounds and from different medical fields with a 'golden standard approach' to enhance the focus of the palliative approach in both the clinic and teaching. The effect and consequences of the use of the 4-2-4-2 model should be explored in future clinical trials. Furthermore, it should be investigated whether teaching the model creates a change in clinical approach to patients with serious illnesses as well as whether these changes are long-lasting.