Barriers and Adherence to Pain Management in Advanced Cancer Patients
palliative care; barriers; cancer pain; opioids; adherence to medication
AIM: To assess patients' barriers to pain management and analgesic medication adherence in advanced cancer patients METHODS: Prospective cross-sectional study in advanced cancer patients receiving chronic opioid therapy. Age, gender, cancer diagnosis, Karnofsky level, and educational status were recorded. collected. These included age, gender, cancer diagnosis, Karnofsky level, and educational status. The Brief Pain Inventory (BPI), the Edmonton Symptom Assessment Scale (ESAS), the Memorial Delirium Assessment Scale (MDAS), the Barriers Questionnaire II (BQ-II), medication Adherence Rating Scale (MARS), and Hospital Anxiety and Depression Scale (HADS) were measured. RESULTS: One-hundred-thirteen patients were analyzed. The mean age was 68 (± 13) years and 59 (52%) were males. The mean Karnofsky status was 51.4 (SD 11.5). The mean value of BQ-II items was 1.77 (SD 0.7). BQ-II was independently related with HADS-D (p=0.033), and with total HADS (p=0.049). Negative side-effects and attitudes to psychotropic medication globally prevailed among MARS items. These items were independently associated with gender (P=0.030), pain (; p=0.003), and depression (p= 0.047). CONCLUSION: Barriers to pain management were mild. Psychological factors such as depression were the main factor associated with barriers. Poor adherence to analgesic medication was mostly manifested as negative side-effects and attitudes to psychotropic medication, was more frequent observed in females and was associated with ESAS items pain and depression.
Mercadante S; Adile C; Tirelli W; Ferrera P; Penco I; Casuccio A
Pain Practice
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/papr.12965" target="_blank" rel="noreferrer noopener">10.1111/papr.12965</a>
Methadone response in advanced cancer patients with pain followed at home
Female; Humans; Male; Pain; Pain Measurement; Analgesics; Prospective Studies; Middle Aged; Sex Factors; Neoplasms/physiopathology; Methadone/administration & dosage/adverse effects/therapeutic use; Opioid/administration & dosage/adverse effects/therapeutic use; home care services; Intractable/drug therapy
Concerns about the safety of therapy with methadone, which may arise because of its pharmacokinetic characteristics and inappropriate dosing, may deter clinicians from using this drug, especially in elderly patients. Experience is accumulating that the drug may be used safely and successfully if low doses are given initially and care is taken in the titration of the dose against the pain. A prospective study was carried out in a consecutive sample of 45 advanced cancer patients followed at home, who had never received other strong opioids for their pain. Patients were treated with an oral liquid preparation of methadone, which was administered 2-3 times daily, according to need. Doses were kept as low as possible and were titrated to achieve acceptable analgesia with minimal adverse effects. The methadone starting dose (MSD) at referral, the maximum dose of methadone (MMD), the days of methadone treatment, the use of other nonopioid analgesics, symptoms associated with methadone therapy, pain intensity, and pain mechanism were recorded. Methadone escalation index percentage (MEI%) and methadone escalation index in mg (MEI mg) were calculated from these parameters. No correlations between age and gender, and MSD, MMD, days on methadone, VAS and symptoms were found. No significant differences were found in pain mechanisms, age, and other parameters, including methadone-related symptoms. Treatment of pain with methadone provides important support to patients with cancer followed at home and the risks are low with individually titrated doses, even in older patients or in the presence of a neuropathic pain mechanism.
1999
Mercadante S; Casuccio A; Agnello A; Barresi L
Journal Of Pain And Symptom Management
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0885-3924(99)00048-2" target="_blank" rel="noreferrer">10.1016/s0885-3924(99)00048-2</a>
Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study
Female; Humans; Male; Analgesics; Prospective Studies; Middle Aged; Drug Administration Schedule; Non-U.S. Gov't; Research Support; Administration; Oral; Pain/drug therapy; Neoplasms/complications; Methadone/administration & dosage/pharmacology; Morphine/adverse effects/pharmacology; Opioid/administration & dosage/adverse effects/pharmacology
PURPOSE: To evaluate the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. PATIENTS AND METHODS: Fifty-two consecutive cancer patients receiving oral morphine but with uncontrolled pain and/or moderate to severe opioid adverse effects were switched to oral methadone administered every 8 hours using different dose ratios. Intensity of pain and adverse effects were assessed daily, and the symptom distress score (DS) was calculated before and after switching. RESULTS: Data were analyzed for 50 patients. Switching was considered effective in 80% of the patients; results were achieved in an average of 3.65 days. In the 10 patients who switched to methadone because of uncontrolled pain, a significant reduction in pain intensity (P <.005) and an average of a 33% increase in methadone doses necessary (P <.01) were found after an average of 3.5 days. DS significantly decreased from an average of 8.4 to 4.5 (P <.0005). In the 32 patients switching because of uncontrolled pain and morphine-related adverse effects, significant improvement was found in pain intensity (P <.0005), nausea and vomiting (P <.03), constipation (P <.001), and drowsiness (P <.01), but a significant increase in the methadone dose of an average of 20% (P <.004) was required. CONCLUSION: In most patients with cancer pain referred for poor pain control and/or adverse effects, switching to oral methadone is a valid therapeutic option. In the clinical setting of poor pain control, higher doses of methadone are necessary with respect to the equianalgesic calculated dose ratios previously published.
2001
Mercadante S; Casuccio A; Fulfaro F; Groff L; Boffi R; Villari P; Gebbia V; Ripamonti C
Journal Of Clinical Oncology
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1200/jco.2001.19.11.2898" target="_blank" rel="noreferrer">10.1200/jco.2001.19.11.2898</a>