Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN).

Szczegóły
Abstrakt

Tytuł:: Cancer pain management in the emergency department: a multicenter prospective observational trial of the Comprehensive Oncologic Emergencies Research Network (CONCERN).
Autorzy:: Coyne CJ; Department of Emergency Medicine, University of California San Diego, 200 W. Arbor Dr. #8676, San Diego, CA, 92103, USA. .
Reyes-Gibby CC; Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Durham DD; The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Abar B; Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
Adler D; Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
Bastani A; Department of Emergency Medicine, William Beaumont Hospital - Troy Campus, Troy, MI, USA.
Bernstein SL; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
Baugh CW; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Bischof JJ; Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Grudzen CR; Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, NY, USA.
Henning DJ; Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
Hudson MF; Greenville Health System Cancer Institute, Greenville, SC, USA.
Klotz A; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Lyman GH; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Madsen TE; Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
Pallin DJ; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Rico JF; Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Ryan RJ; Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
Shapiro NI; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Swor R; Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
Thomas CR Jr; Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Sciences University, Portland, OR, USA.
Venkat A; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
Wilson J; Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Yeung SJ; Department of Emergency Medicine and Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Caterino JM; Departments of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Źródło:: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer [Support Care Cancer] 2021 Aug; Vol. 29 (8), pp. 4543-4553. Date of Electronic Publication: 2021 Jan 22.
Typ publikacji:: Journal Article; Multicenter Study; Observational Study
Język:: English
Imprint Name(s):: Original Publication: Berlin : Springer International, c1993-
MeSH Terms:: Analgesics/*therapeutic use
Cancer Pain/*drug therapy
Emergency Service, Hospital/*statistics & numerical data
Hospitalization/*statistics & numerical data
Pain Management/*methods
Adult ; Analgesics, Opioid/therapeutic use ; Cancer Pain/mortality ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Pain Management/mortality ; Pain Measurement ; Patient Readmission/statistics & numerical data ; Prospective Studies ; United States
References:: Barbera L, Taylor C, Dudgeon D (2010) Why do patients with cancer visit the emergency department near the end of life? Cmaj. 182(6):563–568. https://doi.org/10.1503/cmaj.091187. (PMID: 10.1503/cmaj.091187202313402845683)
Scarborough BM, Smith CB (2018) Optimal pain management for patients with cancer in the modern era. CA Cancer J Clin 68(3):182–196. https://doi.org/10.3322/caac.21453. (PMID: 10.3322/caac.21453296031425980731)
van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ (2016) Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage 51(6):1070–90.e9. https://doi.org/10.1016/j.jpainsymman.2015.12.340. (PMID: 10.1016/j.jpainsymman.2015.12.340)
Stockler MR, Wilcken NR (2012) Why is management of cancer pain still a problem? J Clin Oncol United States 30:1907–1908. (PMID: 10.1200/JCO.2011.41.3146)
Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330(9):592–596. https://doi.org/10.1056/nejm199403033300902. (PMID: 10.1056/nejm1994030333009027508092)
Todd KH, Ducharme J, Choiniere M, Crandall CS, Fosnocht DE, Homel P, Tanabe P, PEMI Study Group (2007) Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain 8(6):460–466. https://doi.org/10.1016/j.jpain.2006.12.005. (PMID: 10.1016/j.jpain.2006.12.00517306626)
Donovan E, Ranney ML, Reid AM, Baird J, Green TC. Chronic pain in the emergency department. R I Med J (2013). 2017;100(2):25–9.
Persson J (2016) Pain management in the emergency department—still a long way to go? Scand J Pain 13:144–145. https://doi.org/10.1016/j.sjpain.2016.09.007. (PMID: 10.1016/j.sjpain.2016.09.00728850519)
Marcus BS, Venkat A (2015) Ethical pain management in the emergency department: the canary in the coal mine. Pain Manag 5(4):251–260. https://doi.org/10.2217/pmt.15.18. (PMID: 10.2217/pmt.15.1826059387)
Fosnocht DE, Swanson ER, Barton ED (2005) Changing attitudes about pain and pain control in emergency medicine. Emerg Med Clin North Am 23(2):297–306. https://doi.org/10.1016/j.emc.2004.12.003. (PMID: 10.1016/j.emc.2004.12.00315829384)
Pollack CV Jr, Viscusi ER (2015) Improving acute pain management in emergency medicine. Hosp Pract (1995) 43(1):36–45. https://doi.org/10.1080/21548331.2015.1000794. (PMID: 10.1080/21548331.2015.1000794)
Lee P, Le Saux M, Siegel R, Goyal M, Chen C, Ma Y et al (2019) Racial and ethnic disparities in the management of acute pain in US emergency departments: meta-analysis and systematic review. Am J Emerg Med 37(9):1770–1777. https://doi.org/10.1016/j.ajem.2019.06.014. (PMID: 10.1016/j.ajem.2019.06.01431186154)
Tamayo-Sarver JH, Hinze SW, Cydulka RK, Baker DW (2003) Racial and ethnic disparities in emergency department analgesic prescription. Am J Public Health 93(12):2067–2073. https://doi.org/10.2105/ajph.93.12.2067. (PMID: 10.2105/ajph.93.12.2067146523361448154)
Controlled prescription drug abuse at epidemic level. J Pain Palliat Care Pharmacother. 2006;20(2):61–4.
Brady KT, McCauley JL, Back SE (2016) Prescription opioid misuse, abuse, and treatment in the United States: an update. Am J Psychiatry 173(1):18–26. https://doi.org/10.1176/appi.ajp.2015.15020262. (PMID: 10.1176/appi.ajp.2015.1502026226337039)
Paice JA (2018) Cancer pain management and the opioid crisis in America: how to preserve hard-earned gains in improving the quality of cancer pain management. Cancer. 124(12):2491–2497. https://doi.org/10.1002/cncr.31303. (PMID: 10.1002/cncr.3130329499072)
Yanni LM, McKinney-Ketchum JL, Harrington SB, Huynh C, Amin Bs S, Matsuyama R et al (2010) Preparation, confidence, and attitudes about chronic noncancer pain in graduate medical education. J Grad Med Educ 2(2):260–268. https://doi.org/10.4300/jgme-d-10-00006.1. (PMID: 10.4300/jgme-d-10-00006.1219756312930316)
Breuer B, Fleishman SB, Cruciani RA, Portenoy RK (2011) Medical oncologists’ attitudes and practice in cancer pain management: a national survey. J Clin Oncol 29(36):4769–4775. https://doi.org/10.1200/jco.2011.35.0561. (PMID: 10.1200/jco.2011.35.056122084372)
Krauss BS, Calligaris L, Green SM, Barbi E (2016) Current concepts in management of pain in children in the emergency department. Lancet. 387(10013):83–92. https://doi.org/10.1016/s0140-6736(14)61686-x. (PMID: 10.1016/s0140-6736(14)61686-x26095580)
Gleason LJ, Escue ED, Hogan TM (2018) Older adult emergency department pain management strategies. Clin Geriatr Med 34(3):491–504. https://doi.org/10.1016/j.cger.2018.04.009. (PMID: 10.1016/j.cger.2018.04.00930031429)
Wedmore I, Young S, Franklin J (2015) Emergency department evaluation and management of foot and ankle pain. Emerg Med Clin North Am 33(2):363–396. https://doi.org/10.1016/j.emc.2014.12.008. (PMID: 10.1016/j.emc.2014.12.00825892727)
Lash RS, Bell JF, Reed SC, Poghosyan H, Rodgers J, Kim KK, Bold RJ, Joseph JG (2017) A systematic review of emergency department use among cancer patients. Cancer Nurs 40(2):135–144. https://doi.org/10.1097/ncc.0000000000000360. (PMID: 10.1097/ncc.0000000000000360269259985001935)
Caterino JM, Adler D, Durham DD, Yeung SJ, Hudson MF, Bastani A et al (2019) Analysis of diagnoses, symptoms, medications, and admissions among patients with cancer presenting to emergency departments. JAMA Netw Open 2(3):e190979. https://doi.org/10.1001/jamanetworkopen.2019.0979. (PMID: 10.1001/jamanetworkopen.2019.0979309010496583275)
Brown J, Grudzen C, Kyriacou DN, Obermeyer Z, Quest T, Rivera D, Stone S, Wright J, Shelburne N (2016) The emergency care of patients with cancer: setting the research agenda. Ann Emerg Med 68(6):706–711. https://doi.org/10.1016/j.annemergmed.2016.01.021. (PMID: 10.1016/j.annemergmed.2016.01.021269219695001927)
Richards CT, Gisondi MA, Chang CH, Courtney DM, Engel KG, Emanuel L, Quest T (2011) Palliative care symptom assessment for patients with cancer in the emergency department: validation of the screen for palliative and end-of-life care needs in the emergency department instrument. J Palliat Med 14(6):757–764. https://doi.org/10.1089/jpm.2010.0456. (PMID: 10.1089/jpm.2010.0456215487903107583)
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008. (PMID: 10.1016/j.jclinepi.2007.11.008)
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010. (PMID: 10.1016/j.jbi.2008.08.01018929686)
Woo A, Lechner B, Fu T, Wong CS, Chiu N, Lam H, Pulenzas N, Soliman H, DeAngelis C, Chow E (2015) Cut points for mild, moderate, and severe pain among cancer and non-cancer patients: a literature review. Ann Palliat Med 4(4):176–183. https://doi.org/10.3978/j.issn.2224-5820.2015.09.04. (PMID: 10.3978/j.issn.2224-5820.2015.09.0426541396)
Chang AK, Bijur PE, Esses D, Barnaby DP, Baer J (2017) Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial. Jama. 318(17):1661–1667. https://doi.org/10.1001/jama.2017.16190. (PMID: 10.1001/jama.2017.16190291148335818795)
Patel PM, Goodman LF, Knepel SA, Miller CC, Azimi A, Phillips G, Gustin JL, Hartman A (2017) Evaluation of emergency department management of opioid-tolerant cancer patients with acute pain. J Pain Symptom Manag 54(4):501–507. https://doi.org/10.1016/j.jpainsymman.2017.07.013. (PMID: 10.1016/j.jpainsymman.2017.07.013)
Fortner BV, Okon TA, Portenoy RK (2002) A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain. J Pain 3(1):38–44. (PMID: 10.1054/jpai.2002.27136)
Zaza C, Baine N (2002) Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manag 24(5):526–542. https://doi.org/10.1016/s0885-3924(02)00497-9. (PMID: 10.1016/s0885-3924(02)00497-9)
Clark D (1999) ‘Total pain’, disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Soc Sci Med 49(6):727–736. https://doi.org/10.1016/s0277-9536(99)00098-2. (PMID: 10.1016/s0277-9536(99)00098-210459885)
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449. https://doi.org/10.1093/annonc/mdm056. (PMID: 10.1093/annonc/mdm056)
Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 32(36):4149–4154. https://doi.org/10.1200/jco.2014.56.0383. (PMID: 10.1200/jco.2014.56.038325403222)
Kwon JH (2014) Overcoming barriers in cancer pain management. J Clin Oncol 32(16):1727–1733. https://doi.org/10.1200/jco.2013.52.4827. (PMID: 10.1200/jco.2013.52.482724799490)
Rhiner MI, von Gunten CF (2010) Cancer breakthrough pain in the presence of cancer-related chronic pain: fact versus perceptions of health-care providers and patients. J Support Oncol 8(6):232–238. (PMID: 10.1016/j.suponc.2010.10.006)
Calcaterra S, Glanz J, Binswanger IA (2013) National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999–2009. Drug Alcohol Depend 131(3):263–270. https://doi.org/10.1016/j.drugalcdep.2012.11.018. (PMID: 10.1016/j.drugalcdep.2012.11.018232947653935414)
Alford DP, Carney BL, Brett B, Parish SJ, Jackson AH (2016) Improving residents’ safe opioid prescribing for chronic pain using an objective structured clinical examination. J Grad Med Educ 8(3):390–397. https://doi.org/10.4300/jgme-d-15-00273.1. (PMID: 10.4300/jgme-d-15-00273.1274134434936858)
Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ (2017) Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35(1):96–112. https://doi.org/10.1200/jco.2016.70.1474. (PMID: 10.1200/jco.2016.70.147428034065)
Massie MJ, Holland JC (1992) The cancer patient with pain: psychiatric complications and their management. J Pain Symptom Manag 7(2):99–109. https://doi.org/10.1016/0885-3924(92)90121-w. (PMID: 10.1016/0885-3924(92)90121-w)
Green CR, Hart-Johnson T, Loeffler DR (2011) Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer. 117(9):1994–2003. https://doi.org/10.1002/cncr.25761. (PMID: 10.1002/cncr.2576121509777)
Contributed Indexing:: Keywords: Acute care; ED; Emergency department; Pain management; Palliative care
Substance Nomenclature:: 0 (Analgesics)
0 (Analgesics, Opioid)
Entry Date(s):: Date Created: 20210123 Date Completed: 20210709 Latest Revision: 20210709
Update Code:: 20240105
DOI:: 10.1007/s00520-021-05987-3
PMID:: 33483789
: Czasopismo naukowe

Full Text Finder

Purpose: Many patients with cancer seek care for pain in the emergency department (ED). Prospective research on cancer pain in this setting has historically been insufficient. We conducted this study to describe the reported pain among cancer patients presenting to the ED, how pain is managed, and how pain may be associated with clinical outcomes.
Methods: We conducted a multicenter cohort study on adult patients with active cancer presenting to 18 EDs in the USA. We reported pain scores, response to medication, and analgesic utilization. We estimated the associations between pain severity, medication utilization, and the following outcomes: 30-day mortality, 30-day hospital readmission, and ED disposition.
Results: The study population included 1075 participants. Those who received an opioid in the ED were more likely to be admitted to the hospital and were more likely to be readmitted within 30 days (OR 1.4 (95% CI: 1.11, 1.88) and OR 1.56 (95% CI: 1.17, 2.07)), respectively. Severe pain at ED presentation was associated with increased 30-day mortality (OR 2.30, 95% CI: 1.05, 5.02), though this risk was attenuated when adjusting for clinical factors (most notably functional status).
Conclusions: Patients with severe pain had a higher risk of mortality, which was attenuated when correcting for clinical characteristics. Those patients who required opioid analgesics in the ED were more likely to require admission and were more at risk of 30-day hospital readmission. Future efforts should focus on these at-risk groups, who may benefit from additional services including palliative care, hospice, or home-health services.

Informacja