Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer

• Published in: Annals of oncology Vol. 23; no. 8; pp. 2016 - 2020
• Main Authors: Bandieri, E., Sichetti, D., Romero, M., Fanizza, C., Belfiglio, M., Buonaccorso, L., Artioli, F., Campione, F., Tognoni, G., Luppi, M.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.08.2012; Oxford University Press
• Subjects: Aged; analgesic therapy; Analgesics - administration & dosage; Analgesics, Opioid - administration & dosage; Antineoplastic agents; Biological and medical sciences; Cross-Sectional Studies; Female; Health Care Surveys; Health Services Accessibility; Humans; Italy; Male; Medical sciences; Neoplasms - complications; Pain - drug therapy; Pain - etiology; Pain Management - methods; pain supportive care; palliative care; Palliative Care - methods; Pharmacology. Drug treatments; Italy; analgesic therapy; pain supportive care; palliative care; Human; Accessibility; Patient; Management; Malignant tumor; Analgesic; Clinical management; Pain; Treatment; Palliative care; Early; Supportive care; Cancer
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mds103

No study has so far addressed whether differences do exist in the management of cancer pain between patients receiving usual care by primary specialists and those receiving early palliative/supportive intervention. A multicentre cross-sectional study in 32 Italian Hospitals has included 1450 patients, receiving analgesic therapy for cancer pain: 602 with access to primary specialist alone (standard care, SC) and 848 with early access to a palliative/supportive care (ePSC) team, concomitant with primary oncology care. Statistically significant differences in the analgesic drug administration according to care model have been evident: non-opioids were more frequently used in SC (9.5 % versus 2 % ; P < 0.001), while strong opioids in ePSC group (80 % versus 63 % ; P < 0.001). The number of patients with severe pain was lower in ePSC compared with SC group (31 % versus 17 % ; P < 0.001). Results of multivariate analysis have shown that ePSC integrated with primary oncologic care (relative risk 0.69; 95 % confidence interval 0.48–0.99; P = 0.045) was an independent factor associated with a 31 % reduced risk of suffering from severe pain. An ePSC team provides the most effective standard of analgesic therapy for cancer pain. A randomized clinical trial is needed to confirm these findings.