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Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic
- Marvin Omar Delgado-Guay, Gary Chisholm, Janet Williams, Susan Frisbee-Hume, Andrea O. Ferguson, Eduardo Bruera
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- Journal:
- Palliative & Supportive Care / Volume 14 / Issue 4 / August 2016
- Published online by Cambridge University Press:
- 20 October 2015, pp. 341-348
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- Article
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Objective:
Regular assessments of spiritual distress/spiritual pain among patients in a supportive/palliative care clinic (SCPC) are limited or unavailable. We modified the Edmonton Symptom Assessment Scale (ESAS) by adding spiritual pain (SP) to the scale (0 = best, 10 = worst) to determine the frequency, intensity, and correlates of self-reported SP (≥1/10) (pain deep in your soul/being that is not physical) among these advanced cancer patients.
Method:We reviewed 292 consecutive consults of advanced cancer patients (ACPs) who were evaluated at our SCPC between October of 2012 and January of 2013. Symptoms were assessed using the new instrument (termed the ESAS–FS).
Results:The median age of patients was 61 (range = 22–92). Some 53% were male; 189 (65%) were white, 45 (15%) African American, and 34 (12%) Hispanic. Some 123 of 282 (44%) of ACPs had SP (mean (95% CI) = 4(3.5–4.4). Advanced cancer patients with SP had worse pain [mean (95% CI) = 5.3(4.8, 5.8) vs. 4.5(4.0, 5.0)] (p = 0.02); depression [4.2(3.7, 4.7) vs. 2.1(1.7, 2.6), p < 0.0001]; anxiety [4.2(3.6, 4.7) vs. 2.5(2.0, 3.0), p < 0.0001]; drowsiness [4.2(3.7, 4.7) vs. 2.8(2.3, 3.2), p < 0.0001]; well-being [5.4(4.9, 5.8) vs. 4.5(4.1, 4.9), p = 0.0136]; and financial distress (FD) [4.4(3.9, 5.0) vs. 2.2(1.8, 2.7), p < 0.0001]. Spiritual pain correlated (Spearman) with depression (r = 0.45, p < 0.0001), anxiety (r = 0.34, p < 0.0001), drowsiness (r = 0.26, p < 0.0001), and FD (r = 0.44, p < 0.0001). Multivariate analysis showed an association with FD [OR (95% Wald CI) = 1.204(1.104–1.313), p < 0.0001] and depression [1.218(1.110–1.336), p < 0.0001]. The odds that patients who had SP at baseline would also have SP at follow-up were 182% higher (OR = 2.82) than for patients who were SP-negative at baseline (p = 0.0029). SP at follow-up correlated with depression (r = 0.35, p < 0.0001), anxiety (r = 0.25, p = 0.001), well-being (r = 0.27, p = 0.0006), nausea (r = 0.29, p = 0.0002), and financial distress (r = 0.42, p < 0.0001).
Significance of results:Spiritual pain, which is correlated with physical and psychological distress, was reported in more than 40% of ACPs. Employment of the ESAS–FS allows ACPs with SP to be identified and evaluated in an SCPC. More research is needed.
24 - Managing cancer pain in the elderly
- from SECTION VIII - PAIN IN SPECIAL POPULATIONS
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- By MARVIN OMAR DELGADO-GUAY, The University of Texas M. D. Anderson Cancer Center, DAVID WOLLNER, Metropolitan Jewish Health System
- 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 444-454
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- Chapter
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Summary
Introduction
Western populations are experiencing a progressive increase in median life span, and it is predicted that the percentage of individuals aged 60 years and older will reach 15.2% in 2030. With aging, there is a decline of organ reserves and functional impairment, contributing to a decreased adaptability to both disease and its treatment. The aging of the population and advances in modern medicine have resulted in chronicity of some illnesses, such as cancer, end-stage heart and lung diseases, and renal insufficiency. Older cancer patients may experience a number of devastating physical and psychosocial symptoms before they die. When symptoms are not recognized and treated appropriately, there is an increase in suffering among elderly patients and their primary caregivers. Cancer pain management in the elderly is truly a public health and quality-of-care issue. Pain in cancer patients is not yet treated effectively.– Most of the cancer patients and cancer survivors are 65 years old or older. Approximately 60% of the estimated 10.8 million cancer survivors in the United States today are older than 65 years. Multidisciplinary evaluation of the malignancy and its distressing symptoms and an interdisciplinary approach to the host's symptoms, including pain, constitute the most effective approach to assessing and treating elderly cancer patients to maximize the best possible quality of life. This book chapter highlights the important issues concerning pain management in elderly cancer patients, the appropriate assessment tools and therapeutic options, and their impact on quality of life.
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