3 results
Pain-related distress among patients referred to a community-based palliative care program
- Alexa Riggs, Brenda Breuer, Vaishali Patel, Joshua Harounian, Jack Chen, Lara Dhingra, Russell K. Portenoy, Helena Knotkova
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- Journal:
- Palliative & Supportive Care / Volume 17 / Issue 3 / June 2019
- Published online by Cambridge University Press:
- 26 June 2018, pp. 338-344
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Objective
Numerous studies have characterized the pain reported by patients with advanced illness in terms of descriptors such as severity, but few have measured pain-related distress. Distress may be important in the clinical approach to pain. To evaluate pain-related distress among adult patients with advanced illness and pain following enrollment in an urban, specialist-level, community-based palliative care program.
MethodIn a retrospective cross-sectional analysis, data were extracted from the electronic health records of all patients who were able to complete the pain item from the Condensed Memorial Symptom Assessment Scale at the start of care. Bivariate and multivariate analyses evaluated the associations between distress and both sociodemographics and disease-related information.
ResultsThe 506 patients completing the pain item had a mean (SD) age of 70.7 years (13.8); 64.2% were women, 32.1% were Hispanic, 32.6% were white, and 27.7% were black. Of the 503 patients who indicated some level of distress on a 0–4 scale, 221 (43.7%) had high distress, defined as a score ≥3 (“quite a bit” or “very much”). Cancer diagnosis and poor performance status (unable to care for self) were predictors of high pain-related distress (both p < 0.05).
Significance of resultsAmong patients with advanced illness who reported pain at the start of care by a specialist palliative care program, high pain-related distress was common, particularly among those with cancer or poor physical function. Further studies are needed to explore the extent to which pain-related distress should inform the assessment and management of pain.
Trajectories of caregiver burden in families of adult cystic fibrosis patients
- Ann Wojtaszczyk, Myra Glajchen, Russell K. Portenoy, Maria Berdella, Patricia Walker, Malcolm Barrett, Jack Chen, Amy Plachta, Julie Balzano, Ashley Fresenius, Kenya Wilder, Elinor Langfelder-Schwind, Lara Dhingra
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- Journal:
- Palliative & Supportive Care / Volume 16 / Issue 6 / December 2018
- Published online by Cambridge University Press:
- 17 October 2017, pp. 732-740
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Objectives:
Little is known about the experience of family caregivers of adults with cystic fibrosis (CF). This information is important for the identification of caregivers at risk for burden.
Methods:This was a longitudinal analysis of survey data obtained from caregivers of adult CF patients participating in an early intervention palliative care trial. Caregivers completed the validated Brief Assessment Scale for Caregivers (BASC) repeatedly over a 28-month period. Mixed-effects modeling evaluated multivariate associations with positive and negative caregiver perceptions over time.
Results:Of the 54 caregivers, 47.9% were spouses. The mean age was 50.9 years (SD = 13.2); 72.2% were women; 75.9% were married; and 63.0% were employed. At baseline, the BASC revealed large variations in positive and negative perceptions of caregiving. Although average scores over time were unchanging, variation was greater across caregivers than within caregivers (0.49 vs. 0.27, respectively). At baseline, the positive impact of caregiving in the sample was higher than the negative impact. Multivariate analysis revealed that patients' baseline pulmonary function and their full-time employment status predicted caregiver burden over time.
Significance of results:Caregivers of CF patients varied in their positive and negative caregiving experiences, although burden levels in individual caregivers were stable over time. When the disease was advanced, caregivers of CF patients experienced more overall burden but also more positive impact. This suggests that the role of caregivers may become more meaningful as disease severity worsens. In addition, full-time patient employment was associated with lower caregiver burden regardless of disease severity. This suggests that burden in CF caregivers may be predicted by financial strain or benefits conferred by patient employment. These associations require further investigation to determine whether highly burdened caregivers can be identified and assisted using tailored interventions.
22 - Cancer pain management in the chemically dependent patient
- from SECTION VIII - PAIN IN SPECIAL POPULATIONS
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- By STEVEN D. PASSIK, Memorial Sloan-Kettering Cancer Center, LARA K. DHINGRA, Beth Israel Medical Center and Albert Einstein College of Medicine, KENNETH L. KIRSH, University of Kentucky College of Pharmacy
- Edited by Eduardo D. Bruera, University of Texas, Houston, Russell K. Portenoy, Albert Einstein College of Medicine, New York
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- Book:
- Cancer Pain
- Published online:
- 06 July 2010
- Print publication:
- 12 October 2009, pp 423-432
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Summary
Introduction
There is a potential risk for substance use problems in cancer patients managed in the palliative care setting, the severity of which varies significantly across subgroups. The potential for substance use problems in cancer patients may be manifested in various case scenarios: Patients may increase their dosages of prescribed drugs without informing their physicians, or use their analgesics to treat symptoms other than those intended; other patients helpfully present to the palliative care team with a known history of, or current addiction to, illicit drugs or prescription medications. Accordingly, efforts to appropriately identify, assess, and clinically manage substance-related problems are critical to the optimal treatment of cancer patients in the palliative care setting. In this chapter, we discuss these important issues and describe how clinicians can assert control over opioid prescriptions by closely monitoring drug use and by using specific strategies to structure drug therapy. By implementing these strategies and methods, clinicians can help address substance use problems in cancer patients while ensuring that pain and other symptoms are not undertreated.
Prevalence rates of drug abuse and addiction: general U.S. population versus cancer population
In 2006, approximately 50% of people aged 12 and older in the United States reported using illegal drugs at some point in their lives, and between 6% and 15% have a current or past substance use disorder. Further, rates of controlled prescription drug abuse have risen dramatically in the United States, with rates nearly doubling between 1992 and 2003 from 7.8 million to 15.1 million.