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Purpose Head-to-head comparison of reliability, validity and responsiveness of four patient-reported outcome measures (PROMS) suitable for assessing health-related quality of life (HRQOL) in palliative care settings: EORTC QLQ-C15-PAL, FACT-G7, FACIT-Pal and short-form FACIT-Pal-14. Methods Secondary analysis of two phase III randomised trials: ketamine for chronic cancer pain, octreotide for vomiting in inoperable malignant bowel obstruction. Sub-groups were defined by Australia-modified Karnofsky performance status (AKPS) and participants’ global impression of change (GIC). Two aspects of reliability were assessed: internal consistency (Cronbach alpha, α ); test–retest reliability (intra-class correlation coefficient (ICC)) of patients with stable AKPS and those who self-reported ‘no change’ on GIC. Construct validity was assessed via pre-determined hypotheses about sensitivity of PROM scores to AKPS groups and responsiveness of PROM change scores to GIC groups using analysis of variance. Results FACIT-Pal had better internal consistency ( α ranged 0.59–0.80, 15/18 ≥ 0.70) than QLQ-C15-PAL (0.51–0.85, 4/8 ≥ 0.70) and FACT-G7 (0.54–0.64, 0/2 ≥ 0.70). FACIT scales had better test–retest reliability (FACIT-Pal 11/27 ICCs ≥ 0.70, FACT-G7 2/3 ICCs ≥ 0.70) than QLQ-C15-PAL (2/30 ICCs ≥ 0.70, 18/30 ≤ 0.5). Four scales demonstrated sensitivity to AKPS: QLQ-PAL-15 Physical Functioning and Global QOL, FACT-G Functional Wellbeing and FACIT-Pal Trial Outcome Index (TOI). Nine scales demonstrated responsiveness: three in the ketamine trial population (QLQ-C15-PAL Pain, FACIT-Pal-14, FACT-G7), six in the octreotide trial population (QLQ-C15-PAL Fatigue; FACIT-Pal PalCare, TOI, Total; FACT-G Physical Wellbeing and Total). Conclusions No PROM was clearly superior, confirming that choosing the best PROM requires careful consideration of the research goals, patient population and the domains of HRQOL targeted by the intervention being investigated.

Context and objectives The present study examined the impact of an integrative oncology treatment program in the relief of pain in patients undergoing chemotherapy and/or palliative care. Methods In this pragmatic prospective controlled study, patients undergoing chemotherapy and/or palliative care were referred by their oncology healthcare providers to an integrative physician (IP) consultation, followed by weekly integrative treatments. Patients attending ≥ 4 sessions during the first 6 weeks of the study were considered to be highly adherent to integrative care (AIC). Pain was assessed at baseline and at 6 and 12 weeks using the ESAS (Edmonton Symptom Assessment Scale) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. Results Of 815 eligible patients, 484 (59.4%) were high-AIC and 331 low-AIC. Mean pain scores decreased significantly from baseline to 6 and 12 weeks in both groups. However, ESAS and EORTC pain scores improved significantly more in the high-AIC group at 6 weeks ( p = 0.008), though not at 12 weeks. Between-group analysis of participants undergoing adjuvant/neo-adjuvant chemotherapy showed higher pain reduction in the high-AIC group at 6 weeks (ESAS, p  = 0.006; EORTC, p  = 0.046), as was the case with patients receiving palliative care (ESAS p  = 0.04; EORTC p  = 0.056). Conclusions High adherence to integrative care was found to be associated with a greater effect on pain relief at 6 weeks but not at 12 weeks in patients undergoing chemotherapy and/or palliative care.

An evidence-practice gap exists for cancer pain management, and cancer pain remains prevalent and disabling. To evaluate the capacity of 3 cancer pain guideline implementation strategies to improve pain-related outcomes for patients attending oncology and palliative care outpatient services. A pragmatic, stepped wedge, cluster-randomized, nonblinded, clinical trial was conducted between 2014 and 2019. The clusters were cancer centers in Australia providing oncology and palliative care outpatient clinics. Participants included a consecutive cohort of adult outpatients with advanced cancer and a worst pain severity score of 2 or more out of 10 on a numeric rating scale (NRS). Data were collected between August 2015 and May 2019. Data were analyzed July to October 2019 and reanalyzed November to December 2021. Guideline implementation strategies at the cluster, health professional, and patient levels introduced with the support of a clinical champion. The primary measure of effect was the percentage of participants initially screened as having moderate to severe worst pain (NRS ≥ 5) who experienced a clinically important improvement of 30% or more 1 week later. Secondary outcomes included mean average pain, patient empowerment, fidelity to the intervention, and quality of life and were measured in all participants with a pain score of 2 or more 10 at weeks 1, 2, and 4. Of 8099 patients screened at 6 clusters, 1564 were eligible, and 359 were recruited during the control phase (mean [SD] age, 64.2 [12.1] years; 196 men [55%]) and 329 during the intervention phase (mean [SD] age, 63.6 [12.7] years; 155 men [47%]), with no significant differences between phases on baseline measures. The mean (SD) baseline worst pain scores were 5.0 (2.6) and 4.9 (2.6) for control and intervention phases, respectively. The mean (SD) baseline average pain scores were 3.5 (2.1) for both groups. For the primary outcome, the proportions of participants with a 30% or greater reduction in a pain score of 5 or more of 10 at baseline were similar in the control and intervention phases (31 of 280 participants [11.9%] vs 30 of 264 participants [11.8%]; OR, 1.12; 95% CI, 0.79-1.60; P = .51). No significant differences were found in secondary outcomes between phases. Fidelity to the intervention was low. A suite of implementation strategies was insufficient to improve pain-related outcomes for outpatients with cancer-related pain. Further evaluation is needed to determine the required clinical resources needed to enable wide-scale uptake of the fundamental elements of cancer pain care. Ongoing quality improvement activities should be supported to improve sustainability.

Background Liver transplantation for patients with non‐resectable colorectal liver metastases offers increased survival, with median overall survival of more than 5 years. The aim of this study was to compare quality of life before and up to 3 years after liver transplantation for colorectal liver metastases. Methods Quality of life was assessed using the European Organisation for Research and Treatment of Cancer QLQ‐C30 questionnaire version 3.0. The patients received the questionnaire before and up to 3 years after liver transplantation. Results Some 23 patients were included in the analysis. Three months after liver transplantation they reported reduced quality of life (global health status scale), physical function and role function, and increased dyspnoea. At 6 months, global health status, physical function and role function had returned to pretransplant values. Three years after liver transplantation all symptom and function scores were comparable to baseline values. Patients with high scores for fatigue, pain and appetite loss at baseline had reduced 3‐year overall survival. Conclusion Patients with non‐resectable colorectal liver‐only metastases receiving liver transplantation had good long‐term quality of life. Patients with high symptom scores before transplantation had reduced 3‐year overall survival. Patients with non‐resectable liver‐only metastases receiving liver transplantation had good long‐term quality of life with values comparable to baseline levels. Patients with high symptom scores before transplantation had reduced 3‐year overall survival. Good QOL in highly selected patients

Purpose Breast cancer survivors may experience pain, fatigue, or psychological distress as a result of the treatment. These symptoms may co-occur and form a cluster. However little is known about symptom clusters (SCs) in long-term breast cancer survivors. This study aimed to identify subgroups of breast cancer survivors with the SC of pain, fatigue, and psychological distress, and to examine sociodemographic and clinical characteristics associated with this SC. Methods Data were obtained from a nationwide survey of breast cancer survivors ( N  = 834). Exhaustive enumeration of possible combination of the three binary variables (pain, fatigue, psychological distress) was conducted. They were identified using the recommended threshold for the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire, and a score of one or more on a numeric rating scale for pain. The SC was defined to include all the three variables, all other combinations were defined as no SC. Logistic regression analyses were conducted to examine the association between sociodemographic and clinical variables and the SC. Results Of the 834 survivors, 13% had the SC. Younger age (OR 2.3, 95% CI 1.3–4.1, p  = 0.003), lymphedema (OR 1.9, 95% CI 1.1–3.2, p  = 0.02), working part-time (OR 2.9, 95% CI 1.6–5.3, p  < 0.001), or being disabled (OR 4.1, 95% CI 2.2–7.8, p  < 0.001) were all associated with the SC. Conclusion Thirteen percent of the survivors experienced the SC. It appears that premenstrual women are at greater risk, than postmenopausal women. Having this SC might have an impact on the survivors’ ability to work.

Cancer-related pain, reported by more than 70% of patients, is one of the most common and troublesome symptoms affecting patients with cancer. Despite the availability of effective treatments, cancer-related pain may be inadequately controlled in up to 50% of patients. With the growing focus on 'value' (healthcare outcomes achieved per dollar spent) in healthcare, the management of cancer-related pain has assumed novel significance in recent years. Data from initiatives that assess the quality of pain management in clinical practice have shown that effective management of cancer-related pain improves patient-perceived value of cancer treatment. As a result, assessment and effective management of cancer-related pain are now recognized as important measures of value in cancer care.

Purpose Pain, fatigue and depression are common sequelae of a cancer diagnosis. The extent to which these occur together in prostate cancer survivors is unknown. We (i) investigated prevalence of the pain-fatigue-depression symptom cluster and (ii) identified factors associated with experiencing the symptom cluster among prostate cancer survivors. Methods Men in Ireland diagnosed with prostate cancer 2–18 years previously were identified from population-based cancer registries and sent postal questionnaires. Cancer-related pain and fatigue were measured using the EORTC QLQ-C30 and depression using the DASS-21. Cut-offs to define ‘caseness’ were pain ≥ 25, fatigue ≥ 39 and depression ≥ 10. Associations between survivor-related factors, clinical variables and specific prostate cancer physical symptoms and the symptom cluster were assessed using multivariate logistic regression. Results A total of 3348 men participated (response rate = 54%). Twenty-four percent had clinically significant pain, 19.7% had clinically significant fatigue, and 14.4% had depression; 7.3% had all three symptoms. In multivariate analysis, factors significantly associated with the symptom cluster were living in Northern Ireland, experiencing back pain at diagnosis and being affected by incontinence, loss of sexual desire, bowel problems, gynecomastia and hot flashes post-treatment. There was a strong association between the cluster and health-related quality of life. Conclusions The pain-fatigue-depression symptom cluster is present in 1 in 13 prostate cancer survivors. Physical after-effects of prostate cancer treatment are associated with this cluster. More attention should be paid to identifying and supporting survivors who experience multiple symptoms; this may help health-related quality of life improve among the growing population of prostate cancer survivors.

Pain is one of the most common symptoms that people with cancer experience. Identification of demographic, physiologic, and behavioral correlates of pain among cancer survivors could help identify subgroups most in need of pain management. We analyzed data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System Cancer Survivorship Optional Module, which was completed by 18 states and territories, to describe demographic and physiologic characteristics of cancer survivors reporting physical pain caused by cancer or cancer treatment. Adjusted and unadjusted population-based estimates and 95% confidence intervals were calculated. Of 12,019 cancer survivor respondents, 9.5% reported current pain related to cancer or cancer treatment. Current pain differed significantly by sex, race/ethnicity, age, and cancer type. Current pain was reported most often among survivors with more than 3 chronic diseases (16.7%) compared with survivors with none (8.1%) or 1 or 2 (10.0%). Pain was higher among survivors reporting fair or poor general health (18.0%) than among survivors reporting otherwise, and higher among survivors reporting more than 14 days of poor physical health (16.6%) or poor mental health (14.8%) compared with less than 14 days (in the past 30 days). Our results suggest that approximately 10% of cancer survivors in the United States are experiencing pain that may have persisted for years after their initial diagnosis and may not be adequately controlled. Increasing knowledge of the most appropriate pain management planning and strategies for controlling short- and long-term chronic pain among cancer survivors could help reduce the prevalence of pain.

In Sri Lanka, cancer is a significant contributor to both morbidity and mortality rates. In 2022, 33,243 new cancer cases were reported, resulting in an age- standardized incidence rate of 106.9 per 100,000 individuals. The overall experience of cancer pain reflects patients' needs and concerns. Therefore, a thorough understanding of the patient's needs and concerns is crucial to implementing satisfactory pain outcomes. This study aims to explore the needs and concerns of patients with cancer pain in Sri Lanka. This study employed a descriptive qualitative approach among purposively selected patients with cancer and registered at the pain management unit. Participants recruited were 18 years or older with cancer-related pain. Noncancerous pain and those with psychological disorders, and brain metastases were excluded. Twenty-one semi-structured interviews were conducted until data saturation using a semi-structured interview guide, each lasting 30-60 minutes. Data were analyzed by Graneheim and Lundman's content analysis method. The study primarily involved participants aged 51-60 Sinhalese Buddhists. It highlighted two main themes: 'Changes in normal lifestyle' and 'Needs and expectations'. The 'Changes in normal lifestyle' theme included subthemes like 'Functional limitations', 'Emotional reactions', 'altered interpersonal relationships', and 'Socio-financial problems'. The 'Needs and expectations' theme covered desires for a 'Pain-free life', a return to a 'Normal lifestyle', and the 'Need for a caregiver'. The findings emphasize that the most significant issue for cancer patients is the disruption to their normal lifestyle due to various challenges, while their primary need is to live without pain. 'Life without pain' is a cancer sufferer's greatest need while 'changes in normal lifestyle' owing to bio-psycho-social-spiritual problems is their primary concern.

Background National studies reporting the prevalence of cannabis use have focused on individuals with a history of cancer without distinction by their treatment status, which can impact symptom burden. While pain is a primary motivation to use cannabis in cancer, the magnitude of its association with cannabis use remains understudied. Methods We examined cannabis use and pain management among 5523 respondents of the Behavioral Risk Factor Surveillance System with a cancer history. Survey-weighted prevalence proportions of respondents’ cannabis use are reported, stratified on cancer treatment status. Regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of cancer-related pain and cannabis use. Results Cannabis use was slightly more prevalent in those undergoing active treatment relative to those who were not undergoing active treatment (9.3% vs. 6.2%; P =0.05). Those under active treatment were more likely to use cannabis medicinally (71.6% vs. 50.0%; P =0.03). Relative to those without cancer-related pain, persons with pain under medical control (OR 2.1, 95% CI, 1.4–3.2) or uncontrolled pain were twice as likely to use cannabis (OR 2.0, 95% CI, 1.1–3.5). Conclusions Use of cannabis among cancer patients may be related to their treatment and is positively associated with cancer-related pain. Future research should investigate the associations of cannabis use, symptom burden, and treatment regimens across the treatment spectrum to facilitate interventions.