Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

G. Apolone, O. Corli, A. Caraceni, E. Negri, S. Deandrea, M. Montanari, M. T. Greco

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61 of cases were received a WHO-level III opioid; 25.3 were classified as potentially undertreated, with wide variation (9.8-55.3) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients outcomes.

Original languageEnglish
Pages (from-to)1566-1574
Number of pages9
JournalBritish Journal of Cancer
Volume100
Issue number10
DOIs
Publication statusPublished - May 19 2009

Fingerprint

Quality of Health Care
Pain Management
Outcome Assessment (Health Care)
Italy
Analgesics
Logistic Models
Social Adjustment
Cancer Pain
Opioid Analgesics
Epidemiology
Guidelines
Pain
Pharmaceutical Preparations

Keywords

  • Cancer pain
  • Opioids
  • PMI
  • Quality

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group. / Apolone, G.; Corli, O.; Caraceni, A.; Negri, E.; Deandrea, S.; Montanari, M.; Greco, M. T.

In: British Journal of Cancer, Vol. 100, No. 10, 19.05.2009, p. 1566-1574.

Research output: Contribution to journalArticle

Apolone, G. ; Corli, O. ; Caraceni, A. ; Negri, E. ; Deandrea, S. ; Montanari, M. ; Greco, M. T. / Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group. In: British Journal of Cancer. 2009 ; Vol. 100, No. 10. pp. 1566-1574.
@article{a7e37e655f3c40ff837507a1102bbf75,
title = "Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group",
abstract = "Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61 of cases were received a WHO-level III opioid; 25.3 were classified as potentially undertreated, with wide variation (9.8-55.3) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients outcomes.",
keywords = "Cancer pain, Opioids, PMI, Quality",
author = "G. Apolone and O. Corli and A. Caraceni and E. Negri and S. Deandrea and M. Montanari and Greco, {M. T.}",
year = "2009",
month = "5",
day = "19",
doi = "10.1038/sj.bjc.6605053",
language = "English",
volume = "100",
pages = "1566--1574",
journal = "British Journal of Cancer",
issn = "0007-0920",
publisher = "Nature Publishing Group",
number = "10",

}

TY - JOUR

T1 - Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

AU - Apolone, G.

AU - Corli, O.

AU - Caraceni, A.

AU - Negri, E.

AU - Deandrea, S.

AU - Montanari, M.

AU - Greco, M. T.

PY - 2009/5/19

Y1 - 2009/5/19

N2 - Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61 of cases were received a WHO-level III opioid; 25.3 were classified as potentially undertreated, with wide variation (9.8-55.3) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients outcomes.

AB - Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61 of cases were received a WHO-level III opioid; 25.3 were classified as potentially undertreated, with wide variation (9.8-55.3) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients outcomes.

KW - Cancer pain

KW - Opioids

KW - PMI

KW - Quality

UR - http://www.scopus.com/inward/record.url?scp=67349137075&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67349137075&partnerID=8YFLogxK

U2 - 10.1038/sj.bjc.6605053

DO - 10.1038/sj.bjc.6605053

M3 - Article

C2 - 19401688

AN - SCOPUS:67349137075

VL - 100

SP - 1566

EP - 1574

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 10

ER -