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Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer,10.1038/sj.bjc.6601810,British Journal of Cancer,M Di M

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer   (Citations: 21)
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M Di Maio, C Gridelli, C Gallo, L Manzione, L Brancaccio, S Barbera, S F Robbiati, G P Ianniello, F Ferraù, E Piazza, L Frontini, F Rosettihttp://academic.research.microsoft.com/io.ashx?type=5&id=28782518&selfId1=0&selfId2=0&maxNumber=12&query=
Pain is a highly distressing symptom for patients with advanced cancer. WHO analgesic ladder is widely accepted as a guideline for its treatment. Our aim was to describe pain prevalence among patients diagnosed with advanced non-small-cell lung cancer (NSCLC), impact of pain on quality of life (QoL) and adequacy of pain management. Data of 1021 Italian patients enrolled in three randomised trials of chemotherapy for NSCLC were pooled. QoL was assessed by EORTC QLQ-C30 and LC-13. Analgesic consumption during the 3 weeks following QoL assessment was recorded. Adequacy of pain management was evaluated by the Pain Management Index (PMI). Some pain was reported by 74% of patients (42% mild, 24% moderate and 7% severe); 50% stated pain was affecting daily activities (30% a little, 16% quite a bit, 3% very much). Bone metastases strongly affected presence of pain. Mean global QoL linearly decreased from 64.9 to 36.4 from patients without pain to those with severe pain (P<0.001). According to PMI, 616 out of 752 patients reporting pain (82%) received inadequate analgesic treatment. Bone metastases were associated with improved adequacy and worst pain with reduced adequacy at multivariate analysis. In conclusion, pain is common in patients with advanced NSCLC, significantly affects QoL, and is frequently undertreated. We recommend that: (i) pain self-assessment should be part of oncological clinical practice; (ii) pain control should be a primary goal in clinical practice and in clinical trials; (iii) physicians should receive more training in pain management; (iv) analgesic treatment deserves greater attention in protocols of anticancer treatment.
Journal: British Journal of Cancer - BRIT J CANCER , vol. 90, no. 12, pp. 2288-2296, 2004
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    • ...Cancer pain during and following treatment has been correlated with increased morbidity, reduced performance status, increased anxiety and depression, and diminished quality of life [5, 12, 40]...
    • ...Multicenter studies indicate that 40– 80% of patients with cancer pain are not prescribed analgesics appropriate to the severity of their pain, with additional patients not receiving sufficient dosing of the analgesic prescribed [8, 9, 12]...

    Dena J. Fischeret al. Anxiety, depression, and pain: differences by primary cancer

    • ...Di Maio et al.[22] conducted a survey of 1,021 patients with advanced non-small-cell lung cancer and found that patients in their sample frequently experienced pain that significantly affected their QOL...

    Nanako Tamiyaet al. Collaboration between physicians and a hospital-based palliative care ...

    • ...SIGN, 2008), undertreatment is well documented and can reach 82% of patients in some settings (...

    G Apoloneet al. Pattern and quality of care of cancer pain management. Results from th...

    • ...prevalence in patients with non-small-cell lung cancer undergoing three different protocols of chemotherapy, 82% had negative scores and were considered poorly managed, according to the class drug–pain intensity ratio [8]...

    Sebastiano Mercadanteet al. Prevalence and treatment of cancer pain in Italian oncological wards c...

    • ...It occurs in 60 to 90% of patients with advanced cancer, and 24 to 30% of patients present moderate or intense pain during the treatment [4, 10, 34, 39]...
    • ...However, 25 to 82% of the patients are not adequately treated with respect to analgesia [10, 39]...
    • ...providers’ knowledge and perception about analgesic drugs and barriers to the optimal management of cancer pain [6, 35, 58]; one, a multicenter study organized by Ventaffrida et al. was not accessible [50]; four because these were answers to Jadad, Browman’s literature review [20, 33, 47 51], and two because these were multicenter studies that evaluated the adequacy of analgesic treatment of pain by the Pain Management Index (PMI) [10, ...
    • ...Some studies (Table 2) used drugs other than those recommended by WHO guidelines [55, 56], such as dipyrone [metamizol] [15–17, 29, 37, 38, 42, 59] and flurbiprofen [15–17, 29,42, 59] in the first step; oxycodone [44, 48] and tilidine [15, 16, 59] in the second step, although oxycodone was considered a third-step drug in the WHO ladder [56]; fentanyl [10, 27, 41, 59], ketobemidon [41], piritramide [15], and sufentanil [41 ]i n the third ...
    • ...The choice of the measure can influence the proportion of patients with adequate analgesia, because the proportion of inadequately treated patients varied extremely amongthesemeasures[9].Asthesescalesconsideronlypain intensity, they were criticized [9, 10]...

    Karine Azevedo São Leão Ferreiraet al. The WHO analgesic ladder for cancer pain control, twenty years of use....

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