Barriers to Pain Management in a Community Sample of Chinese American Patients with Cancer

Barriers to cancer pain management can contribute to the undertreatment of cancer pain. No studies have documented barriers to cancer pain management in Chinese American patients. The purposes of this study in a community sample of Chinese Americans were to: describe their perceived barriers to cancer pain management; examine the relationships between these barriers and patients' ratings of pain intensity, pain interference with function, mood disturbances, education, and acculturation level; and determine which factors predicted barriers to cancer pain management. Fifty Chinese Americans with cancer pain completed the following instruments: Brief Pain Inventory (BPI), Karnofsky Performance Status (KPS) Scale, Barriers Questionnaire (BQ), Hospital Anxiety and Depression Scale (HADS), Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), and a demographic questionnaire. The mean total BQ score was in the moderate range. The individual barriers with the highest scores were: tolerance to pain medicine; time intervals used for dosage of pain medicine; disease progression; and addiction. Significant correlations were found between the tolerance subscale and least pain (r = 0.380) and the religious fatalism subscale and average pain (r = 0.282). These two subscales were positively correlated with anxiety and depression levels: (tolerance: r = 0.282, r = 0.284, respectively; religious fatalism: r = 0.358, r = 0.353, respectively). The tolerance subscale was positively correlated with pain interference (r = 0.374). Approximately 21% of the variance in the total BQ score was explained by patients' education level, acculturation score, level of depression, and adequacy of pain treatment. Chinese American cancer patients need to be assessed for pain and perceived barriers to cancer pain management to optimize pain management.     

Mobile health and supervised rehabilitation versus mobile health alone in breast cancer survivors: Randomized controlled trial

BackgroundSurvival rates in cancer are increasing exponentially, with a corresponding increase/influence in disability-adjusted life-years. Efforts should be made to explore the optimal balance between unsupervised/distance-based and supervised/onsite approaches to cancer care.ObjectiveThis study aimed to compare the clinical efficacy of the BENECA mobile Health (mHealth) lifestyle application combined with a supervised rehabilitation program (BENECA and supervised rehabilitation) versus the BENECA mHealth lifestyle application alone on quality of life (QoL) and functional outcomes of breast cancer survivors.MethodsThis randomized controlled trial included 80 survivors of breast cancer diagnosed at stage I–IIIA, who completed adjuvant therapy and were overweight or obese at diagnosis. Participants were randomly allocated (ratio 1:1, 3 waves) to BENECA mHealth and rehabilitation for 2 months (n = 40) or BENECA mHealth and usual care (BENECA mHealth alone; n = 40). Participants completed a questionnaire at baseline (T1), 8-weeks post-intervention (T2) and 6-month follow-up (T3). The primary outcome was QoL assessed with the EORT QLQ-C30. Secondary outcomes included upper-limb functionality and body composition. Statistical (between-group analyses of covariance) and clinical effects were analyzed by intention to treat.ResultsBoth groups showed improved outcomes, but global QoL was significantly better with BENECA mHealth and rehabilitation than BENECA mHealth alone (mean difference, 12.76; 95% confidence interval 4.85; 20.67; P = 0.004), with a moderate-to-large effect size (d = 72). The proportion of participants reporting reliable clinical improvement on global QoL at T2 was higher with BENECA mHealth and rehabilitation than BENECA mHealth alone (57.5% vs 26.3%, P = 0.008). Improvement in subjective and objective upper-limb functionality was also higher with BENECA mHealth and rehabilitation.ConclusionsThe BENECA mHealth lifestyle application with a supervised rehabilitation program had a statistically and clinically significant effect on QoL and upper-limb functionality in breast cancer survivors and is a unique and important promising new approach.     

Effects of a Full-Body Massage on Pain Intensity,Anxiety, and Physiological Relaxation in Taiwanese Patients with Metastatic Bone Pain: A Pilot Study

Bone involvement, a hallmark of advanced cancer, results in intolerable pain, substantial morbidity, and impaired quality of life in 34%–45% of cancer patients. Despite the publication of 15 studies on massage therapy (MT) in cancer patients, little is known about the longitudinal effects of MT and safety in cancer patients with bone metastasis. The purpose of this study was to describe the feasibility of MT and to examine the effects of MT on present pain intensity (PPI), anxiety, and physiological relaxation over a 16- to 18-hour period in 30 Taiwanese cancer patients with bone metastases. A quasi-experimental, one-group, pretest-post-test design with repeated measures was used to examine the time effects of MT using single-item scales for pain (PPI-visual analog scale [VAS]) and anxiety (anxiety-VAS), the modified Short-Form McGill Pain Questionnaire (MSF-MPQ), heart rate (HR), and mean arterial pressure (MAP). MT was shown to have effective immediate [t(29) = 16.5, P = 0.000; t(29) = 8.9, P = 0.000], short-term (20–30 minutes) [t(29) = 9.3, P = 0.000; t(29) = 10.1, P = 0.000], intermediate (1–2.5 hours) [t(29) = 7.9, P = 0.000; t(29) = 8.9, P = 0.000], and long-term benefits (16–18 hours) [t(29) = 4.0, P = 0.000; t(29) = 5.7, P = 0.000] on PPI and anxiety. The most significant impact occurred 15 [F = 11.5(1,29), P < 0.002] or 20 [F = 20.4(1,29), P < 0.000] minutes after the intervention. There were no significant time effects in decreasing or increasing HR and MAP. No patient reported any adverse effects as a result of MT. Clinically, the time effects of MT can assist health care providers in implementing MT along with pharmacological treatment, thereby enhancing cancer pain management. Randomized clinical trials are needed to validate the effectiveness of MT in this cancer population.     

“Rolling Refreshers”: A novel approach to maintain CPR psychomotor skill competence

ObjectivesHigh quality CPR skill retention is poor. We hypothesized that “just-in-time” and “just-in-place” training programs would be effective and well-accepted to maintain CPR skills among PICU staff.Methods“Rolling Refreshers”, a portable manikin/defibrillator system with chest compression sensor providing automated corrective feedback to optimize CPR skills, were conducted daily in the PICU with multidisciplinary healthcare providers. Providers practiced CPR until skill success was attained, prospectively defined as <3 corrective prompts within 30 s targeting chest compression (CC) rate 90–120/min, CC depth >38 mm during continuous CPR. Providers completing ≥2 refreshers/month (Frequent Refreshers [FR]) were compared to providers completing <2 refreshers/month (Infrequent Refreshers [IR]) for time to achieve CPR skill success. Univariate analysis performed using non-parametric methods. Following actual cardiac arrests, CPR providers were surveyed for subjective feedback on training approach efficacy (5-point Likert scale; 1 = poor to 5 = excellent).ResultsOver 15 weeks, 420 PICU staff were “refreshed”: 340 nurses, 34 physicians, 46 respiratory therapists. A consecutive sample of 20 PICU staff was assessed before subsequent refresher sessions (FREQ n = 10, INFREQ n = 10). Time to achieve CPR skill success was significantly less in FREQ (median 21 s, IQR: 15.75–30 s) than in INFREQ (median 67 s, IQR: 41.5–84 s; p < 0.001). Following actual resuscitations, CPR providers (n = 9) rated “Rolling Refresher” training as effective (mean = 4.2; Likert scale 1–5; standard deviation 0.67).ConclusionsA novel “Rolling Refresher” CPR skill training approach using “just-in-time” and “just-in-place” simulation is effective and well received by PICU staff. More frequent refreshers resulted in significantly shorter times to achieve proficient CPR skills.     

Consistent and Breakthrough Pain in Diverse Advanced Cancer Patients: A Longitudinal Examination

Although cancer pain, both consistent and breakthrough pain ([BTP]; pain flares interrupting well-controlled baseline pain), is common among cancer patients, its prevalence, characteristics, etiology, and impact on health-related quality of life (HRQOL) are poorly understood. This longitudinal study examined the experience and treatment of cancer-related pain over six months, including an evaluation of ethnic differences. Patients with Stage III or IV breast, prostate, colorectal, or lung cancer, or Stage II–IV multiple myeloma with BTP completed surveys on initial assessment and at three and six months. Each survey assessed consistent pain, BTP, depressed affect, active coping ability, and HRQOL. Among the respondents (n = 96), 70% were white, 66% were female, and had a mean age of 56 ± 10 years. Nonwhites reported significantly greater severity for consistent pain at its worst (P = 0.009), least (P ≤ 0.001), on average (P = 0.004), and upon initial assessment (P = 0.04), and greater severity for BTP at its worst (P = 0.03), least (P = 0.02), and at initial assessment (P = 0.008). Women also had higher levels of some BTP measures. Ethnic disparities persisted when data estimation techniques were used. Examined longitudinally, consistent pain on average and several BTP measures reduced over time, although not greatly, indicating the persistence of pain in the cancer experience. These data provide evidence for the significant toll of cancer pain, while demonstrating further health care disparities in the cancer pain experience.     

Effect of a high-intensity interval training on serum microRNA levels in women with breast cancer undergoing hormone therapy. A single-blind randomized trial

BackgroundThe role of microRNAs (miRs) in hormone therapy (HT) is of keen interest in developing biomarkers and treatments for individuals with breast cancer. Although miRs are often moderate regulators under homeostatic conditions, their function is changed more in response to physical activity.ObjectiveThis single-blind randomized trial aimed to explore the effect of high-intensity interval training (HIIT) on serum levels of miRs in individuals with early-stage breast cancer undergoing HT.MethodsHormone receptor-positive women with breast cancer and healthy women were randomly assigned to a healthy control group (n = 15), healthy group with HIIT (n = 15), breast cancer group with HT (HT, n = 26), and breast cancer group with HT and HIIT (HT + HIIT, n = 26). The exercise groups underwent interval uphill walking training on a treadmill 3 times a week for 12 weeks. At the end of the study, we analyzed changes in levels of cancer-related miRs (oncomiRs) and tumour suppressor miRs (TSmiRs) in response to the HT and HIIT.ResultsIn women with breast cancer versus healthy controls, the expression of some oncomiRs was significantly increased — miR-21 (P < 0.001), miR-155 (P = 0.001), miR-221 (P = 0.008), miR-27a (P < 0.001), and miR-10b (P = 0.007) — and that of some TSmiRs was significantly decreased — miR-206 (P = 0.048), miR-145 (P = 0.011), miR-143 (P = 0.008), miR-9 (P = 0.020), and let-7a (P = 0.005). Moreover, HT considerably downregulated oncomiRs and upregulated TSmiRs. HIIT for 12 weeks with HT significantly decreased the expression of the oncomiRs and significantly increased that of the TSmiRs as compared with HT alone.ConclusionsHITT could amplify the decrease and/or increase in expression of miRs associated with HT in women with breast cancer. A prospective trial could determine whether the use of circulating miRs for monitoring treatment can be useful in therapy decisions.Trial registrationIranian Registry of Clinical Trials (No.: IRCT201202289171N1).     

Development and preliminary validation of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS)

BackgroundSeveral pain scales are available for neonates, but, unfortunately they are only rarely used in clinical practice. To help with the current situation of unrecognized and under-treated pain in neonatal intensive care units (NICUs), we developed an assessment tool in close collaboration with clinical staff.ObjectivesTo develop a multidimensional scale, NIAPAS (the Neonatal Infant Acute Pain Assessment Scale), that is sensitive to the needs of infants in neonatal intensive care units, and to test the validity, reliability, feasibility and clinical utility of the scale for this population.DesignInstrument development and psychometric analysis.MethodsPain assessments (n = 180) were made of 34 neonates born between 23 and 42 weeks gestational age who were undergoing 60 painful procedures (heel lance 77%, tracheal suctioning 23%) in the NICU. Using bedside video recordings, each neonate was observed through three phases of the procedure: 1 min before the procedure, during the procedure (lasting from 0.6 to 11.2 min, mean 2.6), and 1 min after the procedure. In addition, an expert panel (n = 5) and nurses (n = 26) participated in the validation of the scale.ResultsA pool of 8 pain indicators (5 behavioral and 3 physiological indicators), including the gestational age of neonates as a contextual factor, was identified based on the nurses’ expertise in neonatal intensive care. Scores on the NIAPAS changed significantly across the phases (p < 0.001), indicating a good construct validity of the scale. Correlations between the NIAPAS and NIPS (the Neonatal Infant Pain Score) were high (0.751–0.873). The study also demonstrated high coefficients for inter-rater (r = 0.991–0.997) and intra-rater reliability (r = 0.992–1.00), with an internal consistency of 0.723. The content validity was very good (Mean I-CVI 1.00), as evaluated by the expert group. The nurses agreed that the scale was easy to administer and that it helped decision-making in the pain management of infants.ConclusionsThe NIAPAS was shown to be a valid and reliable scale for assessing acute pain in preterm and full-term infants in the NICU. It allows nurses to evaluate infants’ acute pain especially during painful procedures and help to provide pain relief for the infants.     

Validation of a French version of Roland–Morris questionnaire in chronic low back pain patients

ObjectiveTo validate a French version of the Roland–Morris Disability Questionnaire (RMDQ) in patients with chronic low back pain (LBP).Material and methodsFifty-eight patients due to participate in a functional rehabilitation programme for chronic low back pain were included prospectively. The RMDQ, the Quebec Back Pain Disability Scale (QBPDS) and the “daily activities” subscale of the Dallas Pain Questionnaire (DPQ) were administered. The RMDQ was assessed for internal consistency, reliability, criterion validity and sensitivity to change.ResultsCronbach's alpha for the RMDQ was 0.84. The intraclass correlation coefficient [95% confidence interval] was 0.89 [0.83–0.93]. The RMDQ score was correlated with the QBPDS score (r = 0.713) and the DPQ's “daily activities” subscore (r = 0.514). The results of assessments before and after functional rehabilitation showed that the French version of the RMDQ had very high sensitivity to change (effect size: 1.49) and was more sensitive than the QBPDS and the DPQ's “daily activities” subscore.ConclusionsOur study validated the French version of the RMDQ in patients suffering from chronic low back pain. Furthermore, we highlighted the questionnaire's very high sensitivity to change.     

Patient internet use surrounding cancer clinical trials: Clinician perceptions and responses

Clinician perceptions of patient internet use related to clinical trials are not well documented. This exploratory study surveyed how cancer care providers at one NCI-designated cancer center viewed patient internet use surrounding cancer trials, including whether it affected patient decision making regarding trial enrollment. The sample included 20 oncologists (59%) and 14 (41%) nurses (n = 34). Most clinicians (n = 26; 76%) perceived the internet as having an effect on whether or not patients decided to enroll in a cancer trial. Two thirds (n = 17; 65%) felt that this effect was positive, including in terms of enhancing patient knowledge of, access to, and enrollment in trials. Clinicians were asked if they ever discussed with their patients the topic of going online to find out more about cancer trials. Over half (n = 18; 58%) who responded (n = 31) to this item said yes; the rest (n = 13; 42%) said no. The majority (n = 10; 77%) in the “no” category were among those who reported that the internet had an effect on patient decision making. These data provisionally suggest that clinicians may see the internet as having mostly a positive effect on patient decision making about cancer trials, but that their communication efforts with patients do not always logically follow from this perception. Provider–patient discussion about internet use may be an opportunity for clinicians to contribute to improved patient knowledge of and enrollment in cancer trials. More research is needed to confirm and explain the gap between clinician perception and communication regarding trial-related internet use by cancer patients.     

Pain Catastrophizing and Pain-Related Fear in Osteoarthritis Patients: Relationships to Pain and Disability

This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps ≤ 0.05) of variance in measures of pain (partial r² [pr²] = 0.10), psychological disability (pr² = 0.20), physical disability (pr² = 0.11), and gait velocity at normal (pr² = 0.04), fast (pr² = 0.04), and intermediate speeds (pr² = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr² = 0.07) and walking at a fast speed (pr² = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.     

The impact of health literacy on health outcomes in individuals with chronic pain: a cross-sectional study

ObjectiveTo establish if health literacy (HL) is linked to poorer outcomes and behaviours in patients with chronic pain.DesignA prospective cross-sectional observational study.SettingMultidisciplinary out-patient pain clinics in three university teaching hospitals.PatientsNew patients (n = 131) referred to the pain clinic with a history of chronic pain (>12 weeks).MethodsA questionnaire was distributed to chronic pain patients attending their first appointment. Those eligible for inclusion were newly referred patients who had pain lasting longer than three months. The questionnaire comprised the following sections: demographics, chronic pain status and disease-related knowledge, quality of life (SF-36), beliefs (Beliefs About Pain Control Questionnaire), and a validated HL tool (Newest Vital Sign).ResultsOf the 131 participants recruited, 54% had inadequate HL. The group was subsequently stratified according to HL level. In bivariate analysis, inadequate HL was associated with older age (p < 0.001), being unemployed or retired (p = 0.005), less education (p < 0.001), lower income, increased comorbidities (p = 0.038), being less likely to utilise allied health services (p = 0.001), poorer disease-related knowledge (p = 0.002), and poorer beliefs about pain (p < 0.05). In multivariate analysis, disease-related knowledge (OR 2.5, 95%CI 1.0 to 6.3, p = 0.05) and beliefs about pain (B = −2.3, S.E = 0.9, p = 0.01) remained independently associated with HL.ConclusionInadequate HL is prevalent in chronic pain patients, and may impact on the development of certain characteristics necessary for effective self-management.     

Reduced version of the Activity Measure for Post-Acute Care (AM-PAC) for inpatients, “6-clicks”: Brazilian-Portuguese cross-cultural adaptation and measurement properties

BackgroundThe “6-clicks” is the reduced version of the Activity Measure for Post-Acute Care for inpatients that assesses limitations in basic mobility, daily activity, and applied cognitive, simply and quickly.ObjectiveCross-culturally adapt the “6-clicks” into Brazilian-Portuguese and verify its measurement properties.MethodsCross-cultural adaptation followed recommendations from international guidelines. Reliability indices, standard error of measurement and minimum detectable difference were calculated. Participants included 13 professionals, 13 patients and 13 companions. Test of measurement properties involved 101 patients’ of both sexes, hospitalized in the infirmary, under physical therapy care, able to understand and respond to commands and with no discharge expectation. Their 30 companions were also included.ResultsMinor changes implemented to the original version. The three domains showed adequate internal consistency (α > 0.65). Inter-rater reliability (n = 50) and test–retest reliability, when administer to patients (n = 51) and to companions (n = 30), showed good for basic mobility domain (ICC_2.1 = 0.81, 0.83 and 0.82, respectively), good to moderate for daily activity (ICC_2.1 = 0.78 and ICC_3.1 = 0.71 and 0.82, respectively) and moderate to poor for applied cognitive (ICC_2.1 = 0.64, 0.36 and ICC_3.1 = 0.63), respectively. The highest agreements among patients/companions were also in basic mobility. Standard error of measurement ranged from 2.03 to 2.64 while the minimum detectable difference ranged from 5.63 to 7.32.ConclusionTranslated and adapted Brazilian version of the “6-clicks” showed acceptable measurement properties. The functional data provided by the instrument could be used to enhance care and help treatment follow-up.     

Quantification of upper limb electromyographic measures and dysfunction of breast cancer survivors during performance of functional dynamic tasks

BackgroundUpper limb morbidities within the breast cancer population can interfere with completing daily life activities. Current knowledge of upper limb capabilities is limited; previous increases in muscle activation on the affected cancer side suggest this population works at a higher fraction of their capability. The purposes of this study were to describe upper limb capabilities and dysfunction of breast cancer survivors through muscle activation monitoring via surface electromyography and muscle-specific strength tests during functional tasks.MethodsFifty survivors performed 88 dynamic tasks (divided into range of motion-reach or rotate, activities of daily life and work tasks). Muscle activation was examined for functional and strength testing tasks.FindingsTotal muscle effort (summation of integrated electromyography across measured muscles) was up to 5.1% greater on the affected side during work tasks (p = 0.0258). Increased activations existed in posterior deltoid, supraspinatus, upper trapezius and serratus anterior (p < 0.05) for several tasks, including daily living tasks. Reduced activation occurred in affected pectoralis major sternal during all tasks (p < 0.0001–0.0032), and affected infraspinatus in all but daily living tasks (p = 0.0002–0.0328). The affected side infraspinatus, supraspinatus and upper trapezius muscles demonstrated significant reductions in targeted strength testing (p = 0.0001–0.0057).InterpretationBoth primary and secondary muscles (outside surgery and radiation fields) were affected. In general, this population works at higher levels of muscle effort for the affected side yet demonstrates weakness in strength testing, which may reflect tissue damage. Strengthening exercises for the posterior rotator cuff and upper trapezius may be the most beneficial.     

Presurgery Psychological Factors Predict Pain,Nausea, and Fatigue One Week After Breast Cancer Surgery

Before scheduled surgery, breast cancer surgical patients frequently experience high levels of distress and expect a variety of postsurgery symptoms. Previous literature has supported the view that presurgery distress and response expectancies are predictive of postsurgery outcomes. However, the contributions of distress and response expectancies to postsurgical side effect outcomes have rarely been examined together within the same study. Furthermore, studies on the effects of response expectancies in the surgical setting have typically focused on the immediate postsurgical setting rather than the longer-term setting. The purpose of the present study was to test the contribution of presurgery distress and response expectancies to common postsurgery side effects (pain, nausea, and fatigue). Female patients (n = 101) undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery pain severity (P < 0.05) and fatigue (P < 0.003) one week after surgery. Response expectancies uniquely contributed to pain severity (P < 0.001), nausea (P < 0.012), and fatigue (P < 0.010) one week after surgery. Sobel tests indicated that response expectancies partially mediated the effects of distress on pain severity (P < 0.03) and fatigue (P < 0.03). Response expectancies also mediated the effects of age on pain severity, nausea, and fatigue. Results highlight the contribution of presurgery psychological factors to postsurgery side effects, the importance of including both emotional and cognitive factors within studies as predictors of postsurgery side effects, and suggest presurgical clinical targets for improving patients' postoperative experiences of side effects.     

Survival after Public Access Defibrillation in Stockholm,Sweden – A striking success

BackgroundIn Stockholm, a first responder system and a Public Access Defibrillation (PAD) program has been implemented. Additionally, the number of “unregulated” public Automated External Defibrillators (AEDs) sold “over-the-counter” has increased. The aim of this study was to evaluate the impact on survival from different defibrillation strategies in cases of out-of-hospital cardiac arrest (OHCA) available for PAD.Methods and ResultsDesign: Retrospective study of all OHCAs in Stockholm, 2006–2012. Witnessed OHCAs occurring outside home with cardiac origin and ventricular fibrillation were considered subjects for PAD. The sites within the PAD program increased from 60 to 135 while the number of unregulated AEDs outside the PAD program increased from 178 to 5016.Of 6532 OHCAs, 7% (n = 474) were defined as subjects for PAD. Of these, 69% (n = 326) were defibrillated by the EMS, 11% (n = 53) by first responders and 16% (n = 74) by public AEDs. Survival to one month was 31% (n = 101) for cases defibrillated by the EMS, 42% (n = 22) when defibrillated by first responders and 70% (n = 52) when defibrillated by a public AED. The AEDs within the PAD program constituted 2.6% of all public AEDs and were used in 28% (n = 21) of cases when a public AED was used.ConclusionsIn OHCAs available for PAD, 70% of patients survived if a public AED was used. Both the structured AED program as well as the spread of unregulated AEDs was associated with very high survival rates, but the structured approach was more efficient in relation to the number of AEDs used.