Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer

摘要

Background: No study has so far addressed whether differences do exist in the management of cancer pain between patients receiving usual care by primary specialists and those receiving early palliative/supportive intervention. Patients and methods: A multicentre cross-sectional study in 32 Italian Hospitals has included 1450 patients, receiving analgesic therapy for cancer pain: 602 with access to primary specialist alone (standard care, SC) and 848 with early access to a palliative/supportive care (ePSC) team, concomitant with primary oncology care. Results: Statistically significant differences in the analgesic drug administration according to care model have been evident: non-opioids were more frequently used in SC (9.5% versus 2%; P < 0.001), while strong opioids in ePSC group (80% versus 63%; P < 0.001). The number of patients with severe pain was lower in ePSC compared with SC group (31% versus 17%; P < 0.001). Results of multivariate analysis have shown that ePSC integrated with primary oncologic care (relative risk 0.69; 95% confidence interval 0.48-0.99; P = 0.045) was an independent factor associated with a 31% reduced risk of suffering from severe pain. Conclusions: An ePSC team provides the most effective standard of analgesic therapy for cancer pain. A randomized clinical trial is needed to confirm these findings.