Journal ArticleDOI
Randomized Clinical Trial of an Implantable Drug Delivery System Compared With Comprehensive Medical Management for Refractory Cancer Pain: Impact on Pain, Drug-Related Toxicity, and Survival
Thomas J. Smith,Peter S. Staats,Timothy Deer,Lisa Stearns,Richard L. Rauck,Richard L. Boortz-Marx,Eric Buchser,Elena Catala,David A. Bryce,Patrick J. Coyne,George E. Pool +10 more
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TLDR
IDDSs improved clinical success in pain control, reduced pain, significantly relieved common drug toxicities, and improved survival in patients with refractory cancer pain.Abstract:
PURPOSE: Implantable intrathecal drug delivery systems (IDDSs) have been used to manage refractory cancer pain, but there are no randomized clinical trial (RCT) data comparing them with comprehensive medical management (CMM). PATIENTS AND METHODS: We enrolled 202 patients on an RCT of CMM versus IDDS plus CMM. Entry criteria included unrelieved pain (visual analog scale [VAS] pain scores ≥ 5 on a 0 to 10 scale). Clinical success was defined as ≥ 20% reduction in VAS scores, or equal scores with ≥ 20% reduction in toxicity. The main outcome measure was pain control combined with change of toxicity, as measured by the National Cancer Institute Common Toxicity Criteria, 4 weeks after randomization. RESULTS: Sixty of 71 IDDS patients (84.5%) achieved clinical success compared with 51 of 72 CMM patients (70.8%, P = .05). IDDS patients more often achieved ≥ 20% reduction in both pain VAS and toxicity (57.7% [41 of 71] v 37.5% [27 of 72], P = .02). The mean CMM VAS score fell from 7.81 to 4.76 (39% reduction); f...read more
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NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines
TL;DR: Lymphedema is a common complication after treatment for breast cancer and factors associated with increased risk of lymphedEMA include extent of axillary surgery, axillary radiation, infection, and patient obesity.
Journal ArticleDOI
Recent Progress in Pancreatic Cancer
Christopher L. Wolfgang,Joseph M. Herman,Daniel A. Laheru,Alison P. Klein,Michael A. Erdek,Elliot K. Fishman,Ralph H. Hruban +6 more
TL;DR: In this paper, it is shown that multidisciplinary care that provides comprehensive and coordinated evaluation and treatment is the most effective way to manage patients with pancreatic cancer, and it is clear that multi-disciplinary care is the best way to care for patients.
Journal Article
Interventional Techniques: Evidence-based Practice Guidelines in the Management of Chronic Spinal Pain
Mark V. Boswell,Andrea M. Trescot,Sukdeb Datta,Sukdeb Datta,David M. Schultz,Hans Hansen,Salahadin Abdi,Nalini Sehgal,Rinoo V. Shah,Vijay Singh,Ramsin M Benyamin,Vikram B. Patel,Ricardo M. Buenaventura,James D. Colson,Harold Cordner,Richard S. Epter,Joseph F. Jasper,Elmer E. Dunbar,Sairam Atluri,Richard C. Bowman,Timothy R. Deer,John R. Swicegood,Peter S. Staats,Howard S. Smith,Allen W. Burton,David Kloth,James Giordano,Laxmaiah Manchikanti +27 more
TL;DR: These guidelines include the evaluation of evidence for diagnostic and therapeutic treatment recommendations for chronic spinal pain, and the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar and cervical facet joint pain, whereas, it is moderate in the Diagnostic Accuracy Studies.
Journal ArticleDOI
Evidence for Improving Palliative Care at the End of Life: A Systematic Review
Karl A. Lorenz,Joanne Lynn,Sydney M. Dy,Lisa R. Shugarman,Anne Wilkinson,Richard A. Mularski,Sally C. Morton,Ronda G. Hughes,Lara Hilton,Margaret Maglione,Shannon Rhodes,Cony Rolon,Virginia Sun,Paul G. Shekelle +13 more
TL;DR: This report focused on cancer, chronic heart failure, and dementia to illustrate differences in patient and caregiver experiences in the 3 characteristic trajectories of clinical and functional decline as they approach the end of life.
Journal ArticleDOI
Treatment of cancer pain
TL;DR: This review describes this framework, an approach to pain assessment, and widely accepted techniques to optimise the safety and effectiveness of opioid drugs and other treatments for palliative care in patients with active cancer.
References
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Journal ArticleDOI
Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale
TL;DR: Using a standard outcome across chronic pain studies would greatly enhance the comparability, validity, and clinical applicability of these studies, and the application of these results to future studies may provide a standard definition of clinically important improvement in clinical trials of chronic pain therapies.
Journal ArticleDOI
Pain and its treatment in outpatients with metastatic cancer.
Charles S. Cleeland,René Gonin,Alan K. Hatfield,John H. Edmonson,Ronald H. Blum,James A. Stewart,Kishan J. Pandya +6 more
TL;DR: The adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization was assessed, the factors that influenced whether analgesia was adequate were studied, and the effects of inadequate analgesia on the patients' perception of pain relief and functional status were determined.
Journal ArticleDOI
When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function.
TL;DR: In this paper, the authors explored the relationship between numerical ratings of pain severity and ratings of their interference with such functions as activity, mood, and sleep, and found optimal cutpoints that form 3 distinct levels of cancer pain severity that can be defined on a 0-10 point numerical scale.
Journal ArticleDOI
Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study.
TL;DR: Doctors are inaccurate in their prognoses for terminally ill patients and the error is systematically optimistic, which may be adversely affecting the quality of care given to patients near the end of life.
Journal Article
When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function.
TL;DR: The hypothesis was that mild, moderate, and severe pain would differentially impair cancer patients' function, and optimal cutpoints were found that form 3 distinct levels of pain severity that can be defined on a 0–10‐point numerical scale.
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