Background
Capsaicin is a highly selective agonist of the transient receptor potential vanilloid 1. The adhesive capsaicin patch provides a high capsaicin concentration (8%) directly in the painful ...area – its efficacy in benign peripheral neuropathic pain (diabetic neuropathy or postherpetic neuralgia) has recently been described in the literature. However, there is scant evidence of its efficacy in chemotherapy-induced peripheral neuropathy (CIPN). This is a concern for patients with multiple myeloma, who suffer from peripheral neuropathic pain induced by first-line treatments (bortezomib or thalidomide).
Aim
To describe improved control of CIPN in patients with multiple myeloma using adhesive capsaicin 8% patch.
Methods
We opted for a retrospective observational case series. Between October 2017 and October 2020, we collected clinical data from adult multiple myeloma patients affected by CIPN who were administered the capsaicin 8% patch in our palliative care outpatient clinic. We compiled Numerical Pain Rating Scale (NPRS) scores, patients’ medication needs and performance status before and after patch application.
Results
Two women and five men with an average age of 62.85 years received bortezomib. Two patients (28.57% of the sample) also received thalidomide. The average NPRS score before patch application was 6.42/10. Five of the seven patients (71.42%) received a mean daily oral morphine dose of 52.85 mg/day, five (71.42%) received gabapentinoids and one (14.28%) received antidepressants. The average NPRS score decreased to 4/10 seven days after patch application, while the mean daily oral morphine dose remained stable. Performance status improved slightly in two patients (28.57%) and remained stable in the rest. One patient (14.28%) required an extra analgesic dose during patch application.
Conclusions
Capsaicin 8% patch application appears to reduce pain intensity in patients with multiple myeloma suffering from CIPN.
Introducción: La atención psicosocial de las personas con enfermedad oncológica y la familia debe formar parte de todo modelo integral de atención que pretenda reducir el impacto vital del cáncer. ...Las intervenciones psicosociales han probado su eficacia en la ayuda a pacientes y familiares para afrontar las situaciones de alta complejidad psicosocial emergentes a consecuencia de un diagnóstico de cáncer. Objetivo: Definir y explicar el modelo de Atención Psicosocial del Comité Psicosocial del Instituto Catalán de Oncología (ICO) utilizando criterios de vulnerabilidad, complejidad y derivación; enmarcado y basado en los valores del ICO (centrados en las necesidades de pacientes con cáncer y sus familias). Método: El modelo que se presenta en este documento consta de cinco pilares: 1) Principios de la Práctica Psicosocial en Oncología; 2) Áreas de actuación en la Atención Psicosocial del paciente con cáncer y la familia; 3) Cribado de malestar emocional y derivación del paciente con cáncer y la familia para una atención psicooncológica específica; 4) Comité Psicosocial: (objetivos; funciones; organización; composición; disciplinas participantes; criterios de derivación y niveles de complejidad; y procedimiento); y 5) Índice de productividad. Resultados: Pacientes y familiares atendidos por el CPS mostraron mejoría estadísticamente significativa en los niveles del malestar emocional, pasando de una media inicial de 8,12/10 (EVA/ ENV) a una media 6,27/10 (EVA/ENV). Asimismo, se constata que las intervenciones derivadas del comité psicosocial redujeron el porcentaje de casos iniciales de alta complejidad, pasando de un 69,3% a un 49,3%. Conclusiones: El abordaje de la complejidad psicosocial mediante un modelo basado en criterios multi e interdisciplinarios consensuados ayuda en la toma de decisiones sobre las acciones a seguir y en la mejora del malestar emocional y complejidad de los pacientes y la familia.
Background:
Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological ...malignancies.
Aim:
To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments.
Design:
Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240).
Data sources:
PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies.
Results:
The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as ‘miscellany’. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking.
Conclusion:
Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.
Evidence for the benefits of early palliative care (EPC) in patients with solid tumors is strong, but EPC has received scant attention in hematologic malignancies.
To assess the benefits of ...outpatient-based EPC for symptom control in patients with multiple myeloma.
Retrospective study of patients attending the Multiple Myeloma Palliative Care Clinic at our hospital in the year 2013 (February 1–December 31). The following symptoms were assessed at baseline and at three follow-up consultations using a Numerical Visual Scale (0 = no symptoms; 10 = worst possible): pain, anorexia, constipation, insomnia, nausea/vomiting, dyspnea, anxiety, and sadness. Physical and emotional symptom burden scores were calculated. Pain interference with general activity, sleep, and mood was also evaluated.
About 67 patients were included. The proportion of patients reporting moderate-to-severe pain (Numerical Visual Scale ≥5) decreased significantly from baseline to the final follow-up: worst pain decreased from 57% to 18% (P < 0.0001), whereas average pain fell from 24% to 2% (P < 0.0001). The percentage of patients reporting no pain interference increased significantly from baseline: general activity (52% vs. 82%; P = 0.0001), sleep (73% vs. 91%; P = 0.01), and mood (52% vs. 87.5%; P = 0.0001). Physical and emotional symptom burden also improved, with significantly fewer patients reporting depression (13% vs. 5%; P = 0.001). Most patients (86.6%) were alive and still attending the Multiple Myeloma Palliative Care Clinic at study end.
These findings indicate that EPC is feasible in patients with multiple myeloma. Pain and other symptoms were well controlled.
To assess emotional distress and complexity of patients referred to the Psychosocial Committee.
A pre-post single group study was performed in a sample of oncological patients. From the 144 patients ...referred to the committee, 27 were attended by psychosocial specialists. The patients' levels of emotional distress and psychosocial complexity were reviewed one month later.
After having been attended according to the committee's indications, the patients showed significant decreases in emotional distress. The initial mean of 8 points on the emotional distress scale decreased to 5.81 points after having been referred to the specialist. This decline was also observed in psychosocial complexity. Before attendance, 70.4% patients showed high levels of complexity, and 7.4% showed low levels. After attendance, the percentages of patients with high levels of psychosocial complexity reduced to 48.1% and patients with low complexity increased to 22.2%.
The committee provides an instrument to refer patients who show high levels of psychosocial complexity and require preferential and multidisciplinary attention. The committee optimizes resources due to its efficiency in resolving complex cases.
Context: Evidence for the benefits of early palliative care (EPC) in patients with solid tumors is strong, but EPC has received scant attention in hematologic malignancies. Objective: To assess the ...benefits of outpatient-based EPC for symptom control in patients with multiple myeloma. Methods: Retrospective study of patients attending the Multiple Myeloma Palliative Care Clinic at our hospital in the year 2013 (February 1-December 31). The following symptoms were assessed at baseline and at three follow-up consultations using a Numerical Visual Scale (0 = no symptoms; 10 = worst possible): pain, anorexia, constipation, insomnia, nausea/vomiting, dyspnea, anxiety, and sadness. Physical and emotional symptom burden scores were calculated. Pain interference with general activity, sleep, and mood was also evaluated. Results: About 67 patients were included. The proportion of patients reporting moderate-to-severe pain (Numerical Visual Scale ≥5) decreased significantly from baseline to the final follow-up: worst pain decreased from 57% to 18% (P < 0.0001), whereas average pain fell from 24% to 2% (P < 0.0001). The percentage of patients reporting no pain interference increased significantly from baseline: general activity (52% vs. 82%; P = 0.0001), sleep (73% vs. 91%; P = 0.01), and mood (52% vs. 87.5%; P = 0.0001). Physical and emotional symptom burden also improved, with significantly fewer patients reporting depression (13% vs. 5%; P = 0.001). Most patients (86.6%) were alive and still attending the Multiple Myeloma Palliative Care Clinic at study end. Conclusions: These findings indicate that EPC is feasible in patients with multiple myeloma. Pain and other symptoms were well controlled.
Introduction: Psychosocial care for cancer patients and their families should be part of all comprehensive model of care that aims to reduce the life impact of cancer. Psychosocial interventions have ...proven to be effective in helping patients and families to cope with the highly complex psychosocial situations that arise as a result of a cancer diagnosis. Aim: To define and explain the model of Psychosocial Care in the Psychosocial Committee of the Catalan Institute of Oncology (ICO) using criteria of vulnerability, complexity and referral; framed and based on the values of the ICO (focused on patients and family's needs). Method: The model presented in this document consists of five pillars: 1) Principles of Psychosocial Practice in Oncology; 2) Areas of action in the Psychosocial Care of the cancer patient and family; 3) Screening for emotional distress and referral of the cancer patient and family for specific psycho-oncological care; 4) Psychosocial Committee: (objectives; functions; organization; composition; participating disciplines; referral criteria and levels of complexity; and procedure); and 5) Productivity index. Results: Patients and relatives who were attended by the CPS showed statistically significant improvement in the levels of emotional distress, going from an initial mean of 8.12 / 10 (VAS / ENV) to a mean of 6.27 / 10 (VAS / ENV). It also shows that the interventions derived from the psychosocial committee reduced the percentage of initial cases of high complexity, from 69.3% to 49.3%. Conclusions: Addressing psychosocial complexity by means of a model based on consensual multi- and interdisciplinary criteria helps in making decisions about the actions to be taken and in improving the emotional distress and complexity of the patients and the family. Keywords: Cancer; psycho-oncology; emotional distress; health professionals; psychosocial factors; complexity. Introduccion: La atencion psicosocial de las personas con enfermedad oncologica y la familia debe formar parte de todo modelo integral de atencion que pretenda reducir el impacto vital del cancer. Las intervenciones psicosociales han probado su eficacia en la ayuda a pacientes y familiares para afrontar las situaciones de alta complejidad psicosocial emergentes a consecuencia de un diagnostico de cancer. Objetivo: Definir y explicar el modelo de Atencion Psicosocial del Comite Psicosocial del Instituto Catalan de Oncologia (ICO) utilizando criterios de vulnerabilidad, complejidad y derivacion; enmarcado y basado en los valores del ICO (centrados en las necesidades de pacientes con cancer y sus familias). Metodo: El modelo que se presenta en este documento consta de cinco pilares: 1) Principios de la Practica Psicosocial en Oncologia; 2) Areas de actuacion en la Atencion Psicosocial del paciente con cancer y la familia; 3) Cribado de malestar emocional y derivacion del paciente con cancer y la familia para una atencion psicooncologica especifica; 4) Comite Psicosocial: (objetivos; funciones; organizacion; composicion; disciplinas participantes; criterios de derivacion y niveles de complejidad; y procedimiento); y 5) Indice de productividad. Resultados: Pacientes y familiares atendidos por el CPS mostraron mejoria estadisticamente significativa en los niveles del malestar emocional, pasando de una media inicial de 8,12/10 (EVA/ENV) a una media 6,27/10 (EVA/ENV). Asimismo, se constata que las intervenciones derivadas del comite psicosocial redujeron el porcentaje de casos iniciales de alta complejidad, pasando de un 69,3% a un 49,3%. Conclusiones: El abordaje de la complejidad psicosocial mediante un modelo basado en criterios multi e interdisciplinarios consensuados ayuda en la toma de decisiones sobre las acciones a seguir y en la mejora del malestar emocional y complejidad de los pacientes y la familia. Palabras clave: Cancer; psicooncologia; malestar emocional; profesionales sanitarios; factores psicosociales; complejidad.
To assess emotional distress and complexity of patients referred to the Psychosocial Committee.
A pre-post single group study was performed in a sample of oncological patients. From the 144 patients ...referred to the committee, 27 were attended by psychosocial specialists. The patients’ levels of emotional distress and psychosocial complexity were reviewed one month later.
After having been attended according to the Committee’s indications, the patients showed significant decreases in emotional distress. The initial mean of 8 points on the emotional distress scale decreased to 5.81 points after having been referred to the specialist. This decline was also observed in psychosocial complexity. Before attendance, 70.4% patients showed high levels of complexity, and 7.4% showed low levels. After attendance, the percentages of patients with high levels of psychosocial complexity reduced to 48.1% and patients with low complexity increased to 22.2%.
The Committee provides an instrument to refer patients who show high levels of psychosocial complexity and require preferential and multidisciplinary attention. The Committee optimizes resources due to its efficiency in resolving complex cases.
Evaluar el malestar emocional y nivel de complejidad de pacientes presentados al Comité Psicosocial.
Estudio pre-post con un solo grupo en pacientes con cáncer. De los 144 pacientes, 27 fueron derivados por el comité a especialistas del área psicosocial, y revisados sus niveles de malestar emocional y de complejidad un mes después.
Después de ser atendidos según indicaciones del Comité, los pacientes mostraron un descenso significativo de los valores en malestar emocional: la media inicial de 8 puntos en la escala visual analógica de malestar emocional descendía a 5.8 puntos. El descenso se reflejó también en los niveles de complejidad: antes de ser revisados, un 70.4% de los pacientes mostraba un alto nivel de complejidad y un 7.4%, nivel bajo. Después de ser atendidos, los porcentajes de pacientes con alta complejidad se redujeron al 48.1% en los enfermos con alta complejidad, y aumentaron al 22.3% los de baja complejidad.
El Comité ofrece un instrumento para derivar los casos de mayor complejidad que requieren de una atención preferente y multidisciplinar, permitiendo optimizar recursos, por su eficacia en la resolución de casos complejos.
J Maté-Méndez: Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat and Research Group on Stress and Health, Faculty of Psychology, Universität Autónoma de Barcelona, ...Bellaterra.
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