Journal of pain and symptom management
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J Pain Symptom Manage · Jan 2021
Multistate models for examining the progression of intermittently-measured patient-reported symptoms among cancer patients: the importance of accounting for interval censoring.
Patients with cancer in Ontario, Canada, receive symptom monitoring in a standardized fashion using the Edmonton Symptom Assessment System (ESAS). These measurements can be used to understand symptom progression during the cancer trajectory. ⋯ Our work demonstrates the use of multistate models and the importance of accommodating for intermittent observation when examining symptom progression using ESAS among patients with cancer. This work serves as a methodological guide for applied researchers interested in modeling disease progression under the presence of intermittent observation.
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J Pain Symptom Manage · Jan 2021
Meta AnalysisEfficacy and safety of opioids in treating cancer-related dyspnea: A systematic review and meta-analysis based on randomized controlled trials.
Dyspnea is one of the most distressing symptoms encountered by advanced cancer patients. In this study, we aimed to evaluate the role of opioids in the management of cancer-related dyspnea. ⋯ Our systematic review and meta-analysis indicated low quality evidence for a small positive effect of opioids in cancer-related dyspnea. Evidence for safety is insufficient as comprehensive adverse events were not adequately reported in studies.
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J Pain Symptom Manage · Jan 2021
Randomized Controlled TrialYokukansan for treatment of preoperative anxiety and prevention of postoperative delirium in cancer patients undergoing highly invasive surgery. J-SUPPORT 1605 (ProD Study): A randomized, double-blind, placebo-controlled trial.
No standard preventive or therapeutic methods have been established for preoperative anxiety and postoperative delirium in patients with cancer. ⋯ In patients with cancer undergoing highly invasive surgeries, yokukansan demonstrated no significant efficacy for the treatment of preoperative anxiety or the prevention of postoperative delirium. Yokukansan is already used in daily practice in Japan, but we should be careful with its future use.
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J Pain Symptom Manage · Jan 2021
Healthcare Provider Attitudes, Beliefs, and Perceived Confidence in Managing Patients with Cancer Pain and Nonmedical Opioid Use.
Health care provider education is an effective strategy to improve knowledge and competencies in opioid-prescribing practices. However, there are very few studies regarding this among providers of patients with cancer pain and nonmedical opioid use (NMOU). The aim of our study was to assess participants' attitudes, beliefs, and self-perceived confidence in caring for patients with cancer pain and NMOU before and after attending an opioid educational seminar on the use and nonmedical use of opioids in patients with cancer. ⋯ Most health care providers expressed concerns about underdetection of NMOU and undertreatment of pain among patients with cancer. Many self-reported knowledge and confidence deficits in caring for patients with cancer with NMOU. Seminar participation was associated with an increase in the number of participants with self-perceived knowledge and confidence. Future studies are needed to ascertain the impact of such opioid educational events on patient care practices.
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J Pain Symptom Manage · Jan 2021
The Palliative Care - Promoting Assessment and Improvement of the Cancer Experience (PC-PAICE) Project: A Multi-Site International Quality Improvement Collaborative.
Mentors at seven U. S. and Australian academic institutions initially partnered with seven leading Indian academic palliative care and cancer centers in 2017 to undertake a program combining remote and in-person mentorship, didactic instruction, and project-based learning in quality improvement (QI). From its inception in 2017 to 2020, the Palliative Care-Promoting Accesst and Improvement of the Cancer Experience Program conducted three cohorts for capacity building of 22 Indian palliative care and cancer programs. ⋯ EQuIP-India now leads ongoing Indian national collaboratives and training in QI and is integrated into India's National Cancer Grid. Palliative Care-Promoting Accesst and Improvement of the Cancer Experience demonstrates a feasible model of international collaboration and capacity building in palliative care and cancer QI. It is one of the several networked and blended learning approaches with potential for rapid scaling of evidence-based practices.