Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 15 de 15
Filter
1.
Curr Opin Support Palliat Care ; 16(2): 55-59, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1874069

ABSTRACT

PURPOSE OF REVIEW: As our global population ages, cancer has become more prevalent. Thankfully, oncologic treatments are highly effective, leading to significantly improved rates of long-term survival. However, many of these therapies are associated with persistent pain syndromes. Clinicians caring for people with cancer must understand how the influence of the current epidemic of opioid misuse and the coronavirus disease 2019 (COVID-19) pandemic have complicated cancer pain management. Creative solutions can emerge from this knowledge. RECENT FINDINGS: Persistent pain due to cancer and its treatment can be managed through multimodal care, although efforts to mitigate the opioid misuse epidemic have created challenges in access to appropriate treatment. Isolation measures associated with the COVID-19 pandemic have limited access to nonpharmacologic therapies, such as physical therapy, and have exacerbated mental health disorders, including anxiety and depression. SUMMARY: Cancer pain treatment requires more nuanced assessment and treatment decisions as patients live longer. Societal factors multiply existing challenges to cancer pain relief. Research is needed to support safe and effective therapies.


Subject(s)
COVID-19 , Cancer Pain , Chronic Pain , Neoplasms , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , COVID-19/epidemiology , Cancer Pain/epidemiology , Cancer Pain/therapy , Chronic Pain/epidemiology , Chronic Pain/etiology , Chronic Pain/therapy , Humans , Neoplasms/complications , Neoplasms/drug therapy , Neoplasms/epidemiology , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/therapy , Pandemics
2.
J Hosp Palliat Nurs ; 24(2): 112-118, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1642434

ABSTRACT

Patients with cancer are living longer, and many experience pain secondary to tumor invasion or as a consequence of cancer-directed therapies. Opioid use disorders and associated morbidity and mortality have increased with dramatic rise during the SARS-CoV-2 pandemic. National and international stakeholders have developed clinical practice guidelines in an effort to curb opioid misuse and overdose-related death. However, to ensure that patients with cancer do not experience barriers to adequate pain management, most of these guidelines are not intended for patients with cancer-related pain or for those receiving palliative or hospice care. Oncology, palliative, and hospice care providers are increasingly tasked with the management of severe disease-related pain in the setting of coexisting opioid use disorder without research on the most effective risk and harm reduction strategies to guide care. Clinicians should be familiar with addiction medicine and chronic pain literature and be able to incorporate some of these best practices. This case study reviews the management of severe cancer-related pain in a patient with co-occurring opioid use disorder, utilizing many of the best practices in available clinical practice guidelines for the management of chronic non-cancer-related pain.


Subject(s)
COVID-19 , Cancer Pain , Chronic Pain , Neoplasms , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , COVID-19/complications , Cancer Pain/drug therapy , Chronic Pain/complications , Chronic Pain/drug therapy , Humans , Neoplasms/complications , Opioid-Related Disorders/complications , Opioid-Related Disorders/drug therapy , SARS-CoV-2
3.
Cancer Treat Res Commun ; 29: 100491, 2021.
Article in English | MEDLINE | ID: covidwho-1536506

ABSTRACT

INTRODUCTION: The growing interest on how peri-­operative interventions, especially regional anesthesia, during cancer surgery can alter oncological outcome increasing disease free survival is probably responsible for the birth of the new subspecialty called onco-anesthesia. A paradigm shift in the concept of anesthetic management has occurred recently owing to the innumerable diverse revelations from the ongoing research in this field. DISCUSSION: Long lasting but reversible epigenetic changes can occur due to surgical stress and perioperative anesthetic medications. The exact relationship between these factors and tumor biology is being studied further. A popular topic under research now is the influence of regional anesthesia on cancer recurrence. Combining nerve blocks with total intravenous anesthesia (TIVA) brings down the requirement of opioids and volatile anesthetic agents implicated in cancer recurrence. The study of mechanism of pain at the molecular level has led to the discovery of novel modes of prevention of chronic post-surgical pain. Newer combination aggressive treatment therapies -intraoperative chemotherapy and radiotherapy, isolated limb perfusion, photodynamic therapy and robotic surgery require specialized anesthetic management. The COVID pandemic introduced new guidelines for safe management of oncosurgical patients .Use of genomic mapping to personalize pain management will be the breakthrough of the decade. CONCLUSION: The discovery that anesthetic strategy could have significant oncological sequel is a quantum leap forward. Avoiding some anesthetic medications may decrease cancer recurrence. Comprehensive cancer care and translational research will pave the way to uncover safe anesthetic practices.


Subject(s)
Anesthesia/methods , Cancer Pain/therapy , Female , Humans , Male
4.
PLoS One ; 16(3): e0248589, 2021.
Article in English | MEDLINE | ID: covidwho-1456066

ABSTRACT

PURPOSE: To assess efficacy and safety of imaging-guided radiofrequency ablation (RFA) of Osteoid Osteoma (OO) in both typical and atypical sites. METHODS AND MATERIALS: Between January 2014 and March 2019, 102 consecutive percutaneous RFA were performed and retrospectively reviewed. The procedures were performed using a RFA bipolar ablation system (Covidien, exposed tip of 0.7-1cm), under Computed Tomography (CT) guidance or using a navigation system (Masmec) under CT and Cone Beam CT (CBCT) guidance. Patients were followed up over 24 months. Clinical success and recurrences were considered on the base of established criteria. In patients with clinical failure and/or imaging evidence of relapse, retreatment was considered. RESULTS: Administered power per-procedure was ≤8 W (mean temperature, 90°C). The pre-procedure average value of visual analog scale (VAS) was 8.33+/-0.91. Primary and secondary success rate 96.08% (98/102) and100% (102/102), respectively. No major complication was described. Technical success was proved in every patient by CT scan acquisition after needle positioning. Relapse and tumour location were significantly correlated (p-value = 0.0165). The mean dose-length product was 751.55 mGycm2. Advanced bone healing was noted in 68 lesions after 1y-follow up and in 86 lesions after 2y-follow up. CONCLUSION: Imaging-guided percutaneous RFA is a highly effective technique for OO, both in typical and atypical sites. CT or CBCT guidance, navigation systems and operator experience grant the technical success, which is the most crucial parameter affecting outcome.


Subject(s)
Bone Neoplasms/therapy , Cancer Pain/therapy , Neoplasm Recurrence, Local/epidemiology , Osteoma, Osteoid/therapy , Radiofrequency Ablation/methods , Adolescent , Adult , Bone Neoplasms/complications , Bone Neoplasms/diagnosis , Cancer Pain/diagnosis , Cancer Pain/etiology , Cone-Beam Computed Tomography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/prevention & control , Osteoma, Osteoid/complications , Osteoma, Osteoid/diagnosis , Pain Measurement/statistics & numerical data , Radiofrequency Ablation/statistics & numerical data , Retrospective Studies , Treatment Outcome , Young Adult
5.
Clin J Oncol Nurs ; 25(4): 361-362, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1315866

ABSTRACT

Now that the SARS-CoV-2 virus and its variants have altered clinical oncology practice as we know it, let's return to a familiar focus from the Core Curriculum for Oncology Nursing-pain management. Much has happened during the past two years that influences the effective management of pain in patients with cancer-not the least of which is a clinical environment that has been changed by the COVID-19 pandemic.


Subject(s)
Analgesics, Opioid/adverse effects , Analgesics, Opioid/therapeutic use , COVID-19/epidemiology , Cancer Pain/drug therapy , Medical Oncology/standards , Oncology Nursing/standards , Opioid-Related Disorders/epidemiology , Pain Management/standards , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Practice Guidelines as Topic , SARS-CoV-2 , United States/epidemiology
6.
Int J Environ Res Public Health ; 18(11)2021 06 03.
Article in English | MEDLINE | ID: covidwho-1266731

ABSTRACT

BACKGROUND: mobile applications (apps) facilitate cancer pain ecological momentary assessment (EMA) and provide more reliable data than retrospective monitoring. The aims of this study are (a) to describe the status of persons with cancer pain when assessed ecologically, (b) to analyze the utility of clinical alarms integrated into the app, and (c) to test the feasibility of implementing an app for daily oncological pain monitoring. METHODS: in this feasibility study, 21 patients (mean age = 56.95 years, SD = 10.53, 81.0% men) responded to an app-based evaluation of physical status (baseline and breakthrough cancer pain (BTcP)) and mental health variables (fatigue, mood, and coping) daily during 30 days. RESULTS: cancer pain characterization with the app was similar to data from the literature using retrospective assessments in terms of BTcP duration and perceived medication effectiveness. However, BTcP was less frequent when evaluated ecologically. Pain, fatigue, and mood were comparable in the morning and evening. Passive coping strategies were the most employed daily. Clinical alarms appear to be useful to detect and address adverse events. App implementation was feasible and acceptable. CONCLUSION: apps reduce recall bias and facilitate a rapid response to adverse events in oncological care. Future efforts should be addressed to integrate EMA and ecological momentary interventions to facilitate pain self-management via apps.


Subject(s)
Cancer Pain , Mobile Applications , Neoplasms , Cancer Pain/diagnosis , Cancer Pain/therapy , Ecological Momentary Assessment , Feasibility Studies , Female , Humans , Male , Middle Aged , Neoplasms/complications , Retrospective Studies , Smartphone
9.
Anticancer Res ; 41(4): 1971-1974, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1168333

ABSTRACT

BACKGROUND/AIM: Oncological care has faced several challenges during the COVID-19 pandemic, e.g. treatment delay and worsening symptoms. Patient-reported anxiety, depression and sleep quality might have changed due to these special circumstances. Therefore, we analyzed the symptom burden of patients treated with palliative radiotherapy at our center. PATIENTS AND METHODS: A retrospective study was performed of 50 consecutive patients and the results were compared to those obtained in a previous pre-COVID study. The Edmonton Symptom Assessment Scale was employed to assess the preradiotherapy symptoms. RESULTS: The highest mean scores were reported for pain in activity (3.2) and dry mouth (3.1). Regarding anxiety, sadness/depression and sleep, the corresponding scores were 1.5, 1.2 and 2.7, respectively. Compared to the previous study, no significant increases were found. Most items had numerically lower mean values, e.g. anxiety (1.5 vs. 2.7). Both study populations had comparable median age (70.5 vs. 70 years), gender distribution and proportion of patients with bone metastases. However, there were two significant imbalances, namely a lower proportion of patients with prostate cancer (12 vs. 30%, p=0.02) and breast cancer (0 vs. 12%, p=0.02). CONCLUSION: In patients who showed up for radiation treatment planning, the suspected increase in anxiety, sadness/depression and sleep disturbance was not demonstrable. It is not known whether or not patients with substantial worries chose to decline referral to palliative radiotherapy. Therefore, comprehensive large-scale studies of patterns of care are needed to fully understand the impact of COVID-19-related measures.


Subject(s)
COVID-19/epidemiology , Cost of Illness , Neoplasms/radiotherapy , Palliative Care/methods , Pandemics , Aged , Aged, 80 and over , Anxiety/epidemiology , Anxiety/etiology , Bone Neoplasms/epidemiology , Bone Neoplasms/secondary , Cancer Pain/diagnosis , Cancer Pain/epidemiology , Cancer Pain/etiology , Depression/epidemiology , Depression/etiology , Female , Humans , Male , Middle Aged , Neoplasms/complications , Neoplasms/epidemiology , Neoplasms/pathology , Norway/epidemiology , Retrospective Studies , SARS-CoV-2/physiology , Survival Analysis , Symptom Assessment
12.
Ann Acad Med Singap ; 49(9): 669-673, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-972919

ABSTRACT

Since the coronavirus disease 2019 (COVID-19) was deemed a pandemic on 11 March 2020, we have seen exponential increases in the number of cases and deaths worldwide. The rapidly evolving COVID-19 situation requires revisions to clinical practice to defer non-essential clinical services to allocate scarce medical resources to the care of the COVID-19 patient and reduce risk to healthcare workers. Chronic pain patients require long-term multidisciplinary management even during a pandemic. Fear of abandonment, anxiety and depression may increase during this period of social isolation and aggravate pain conditions. Whilst physical consults for chronic pain patients were reduced, considerations including continuity of support and analgesia, telemedicine, allied health support and prioritising necessary pain services and interventions, were also taken to ensure biopsychosocial care for them. Chronic pain patients are mostly elderly with multiple comorbidities, and are more susceptible to morbidity and mortality from COVID-19. It is imperative to review pain management practices during the COVID-19 era with respect to infection control measures, re-allocation of healthcare resources, community collaborations, and analgesic use and pain interventions. The chronic pain patient faces a potential risk of functional and emotional decline during a pandemic, increasing healthcare burden in the long term. Clinical decisions on pain management strategies should be based on balancing the risks and benefits to the individual patient. In this commentary, we aim to discuss the basis behind some of the decisions and safeguards that were made at our tertiary pain centre over the last 6 months during the COVID-19 outbreak.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Analgesics, Opioid/therapeutic use , Anesthesiologists/supply & distribution , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19 , Chronic Pain/therapy , Delivery of Health Care/methods , Cancer Pain/therapy , Humans , Pain Clinics , Pain Management , Primary Health Care/methods , Singapore , Telemedicine/methods
15.
Oncology (Williston Park) ; 34(8): 317-319, 2020 08 12.
Article in English | MEDLINE | ID: covidwho-713075

ABSTRACT

A 78-year-old man had a medical history of hypertension, atrial fibrillation, chronic kidney disease, and metastatic castration-resistant prostate cancer (CRPC). He had progressed to first-line therapy for CRPC with abiraterone plus androgen-deprivation therapy (ADT) and as second-line therapy he was being treated with docetaxel, with biochemical progression in his last prostate specific antigen measurement. He was admitted to the hospital on April 2020, in the middle of the coronavirus disease 2019 (COVID-19) pandemic, because of painful bone lesions and deterioration of renal function.


Subject(s)
Anticoagulants/therapeutic use , Bone Neoplasms/drug therapy , Coronavirus Infections/therapy , Palliative Care , Pneumonia, Viral/therapy , Prostatic Neoplasms, Castration-Resistant/drug therapy , Respiratory Insufficiency/therapy , Aged , Androgen Antagonists/therapeutic use , Androstenes/therapeutic use , Antineoplastic Agents/therapeutic use , Betacoronavirus , Bone Density Conservation Agents/therapeutic use , Bone Neoplasms/complications , Bone Neoplasms/secondary , COVID-19 , Cancer Pain/complications , Cancer Pain/therapy , Coronavirus Infections/complications , Disease Progression , Docetaxel/therapeutic use , Drug Combinations , Eligibility Determination , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Intensive Care Units/supply & distribution , Lopinavir/therapeutic use , Male , Oxygen Inhalation Therapy , Pandemics , Pneumonia, Viral/complications , Prostatic Neoplasms, Castration-Resistant/complications , Prostatic Neoplasms, Castration-Resistant/pathology , Renal Insufficiency , Respiratory Insufficiency/etiology , Reverse Transcriptase Polymerase Chain Reaction , Ritonavir/therapeutic use , SARS-CoV-2 , Severity of Illness Index , Zoledronic Acid/therapeutic use
SELECTION OF CITATIONS
SEARCH DETAIL