TY - JOUR
T1 - Does a regional comprehensive palliative care program improve pain in outpatient cancer patients?
AU - Morita, Tatsuya
AU - Sato, Kazuki
AU - Miyashita, Mitsunori
AU - Yamagishi, Akemi
AU - Kizawa, Yoshiyuki
AU - Shima, Yasuo
AU - Kinoshita, Hiroya
AU - Suzuki, Satoshi
AU - Shirahige, Yutaka
AU - Yamaguchi, Takuhiro
AU - Eguchi, Kenji
PY - 2014/9
Y1 - 2014/9
N2 - Context: Pain is still a major problem for cancer patients, and the effect of a population-based approach on patients' experience of pain is not fully understood. Aims: The primary aim of this study was to clarify the changes in pain intensity in outpatients before and after a regional palliative care program. The secondary aim was to clarify the prevalence of patients who had unmet needs for pain treatment and to clarify the reasons for not wanting pain treatment. Subjects and methods: A regional palliative care program was implemented in four regions of Japan. A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings took part in questionnaire surveys before and after the regional intervention. Responses were obtained from 859 from 1,880 and 857 from 2,123 in the preintervention and postintervention surveys, respectively. Results: After a regional palliative care program, neither worst, average, nor least pain levels in outpatients changed significantly. A total of 134 patients (16%) reported that they needed more pain treatment. There were various reasons for not wanting pain treatment, namely, minimum interference with daily life, general nonpreference for medicines, longstanding symptoms before the diagnosis of cancer, concerns about tolerance and addiction, and experienced neuropsychiatric symptoms under current medications. Conclusion: The regional palliative care program failed to demonstrate improvement of the pain intensity of cancer outpatients. One possible interpretation is that they are less likely to be regarded as target populations and that the study population experienced generally well-controlled pain. Future study including patients with more severe pain is needed, but to improve pain levels of cancer outpatients, intensive, patient-directed intervention seems to be more promising than region-based intervention.
AB - Context: Pain is still a major problem for cancer patients, and the effect of a population-based approach on patients' experience of pain is not fully understood. Aims: The primary aim of this study was to clarify the changes in pain intensity in outpatients before and after a regional palliative care program. The secondary aim was to clarify the prevalence of patients who had unmet needs for pain treatment and to clarify the reasons for not wanting pain treatment. Subjects and methods: A regional palliative care program was implemented in four regions of Japan. A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings took part in questionnaire surveys before and after the regional intervention. Responses were obtained from 859 from 1,880 and 857 from 2,123 in the preintervention and postintervention surveys, respectively. Results: After a regional palliative care program, neither worst, average, nor least pain levels in outpatients changed significantly. A total of 134 patients (16%) reported that they needed more pain treatment. There were various reasons for not wanting pain treatment, namely, minimum interference with daily life, general nonpreference for medicines, longstanding symptoms before the diagnosis of cancer, concerns about tolerance and addiction, and experienced neuropsychiatric symptoms under current medications. Conclusion: The regional palliative care program failed to demonstrate improvement of the pain intensity of cancer outpatients. One possible interpretation is that they are less likely to be regarded as target populations and that the study population experienced generally well-controlled pain. Future study including patients with more severe pain is needed, but to improve pain levels of cancer outpatients, intensive, patient-directed intervention seems to be more promising than region-based intervention.
KW - Barrier
KW - Cancer
KW - Community
KW - Pain
KW - Palliative care
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U2 - 10.1007/s00520-014-2232-1
DO - 10.1007/s00520-014-2232-1
M3 - Article
C2 - 24705857
AN - SCOPUS:84906313295
SN - 0941-4355
VL - 22
SP - 2445
EP - 2455
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 9
ER -