485O_PR - Characterisation and prognostication of pain in advanced cancer - An observational trial

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Supportive and palliative care
Topics Palliative Care
Presenter Rahul Arora
Citation Annals of Oncology (2016) 27 (suppl_9): ix157-ix160. 10.1093/annonc/mdw595
Authors R.D. Arora
  • Palliative Medicine, Tata Memorial Hospital Centre, 400012 - Mumbai/IN

Abstract

Background

Studies have shown that between 64 to 90 percent of advanced cancer patients report pain.

Methods

The Edmonton Classification System for Cancer Pain was used to characterise Baseline Pain. Episodes of Acute exacerbation of Pain (AEP) were described on the Alberta Breakthrough Pain Assessment tool. A Pain Education Booklet was provided for recording the Baseline Pain, number of episodes of AEP and Opioid related Adverse Effects daily.

Results

85 of 96 patients met the Inclusion criteria of Moderate Pain (≥ 4/10 on NRS) and estimated survival of more than 6 weeks on Palliative Prognostic Index (PPI≥4.5) . 45 patients were on Opioids.The Median MEDD was 45 mg. There was a statistically significant weak Positive correlation between PPI and Age, PPI and Pain Intensity, Number of Factors for Poor Prognostication on ECS-CP and MEDD, Number of Days on Opioids and Fatigue. There was weak positive correlation between Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio and Pain Intensity which did not attain statistical significance.

Conclusions

The use of ECS-CP provides a common language for Pain assessment, however it needs to be adapted to the Local setting. ABPAT can be used in its original version in the Outdoor Patient setting. A Composite Pain Assessment Tool comprising the ECS-CP, ABPAT and markers of Chronic Inflammation (NLR, PLR) along with Biochemical Parameters (Serum Creatinine, Total Platelet Count) which are pivotal in prescribing essential Pain medication needs to be formulated. Prognostication in Pain needs to be re-interpreted with an added emphasis on survival and etiopathogenesis. Potential solutions to Ethical and Logistical Issues inherent in Research in Advanced Cancer include a Detailed Informed Consent form (Allowing withdrawal at any given time during the trial), Structured Patient Oriented Community Outreach Program along with Multiple sites of Recruitment (including Home visits - to increase Accrual and decrease Attrition), Acknowledgement of Patient and Caregiver Willingness to Participate in Research (Overcome Gatekeeping), Implementation of Novel Trial Designs (N of one, Fast Track), and use of Advanced Statistical Methods (Imputation, Bootstrapping).

Clinical trial indentification

CTRI ID REF/2015/12/010267

Legal entity responsible for the study

Institutional Ethics Comittee, Tata Memorial Centre Hospital

Funding

Dept. of Palliative Medicine, Tata Memorial Centre Hospital

Disclosure

All authors have declared no conflicts of interest.