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. 2019 Jan 11;11(1):79.
doi: 10.3390/cancers11010079.

Effect of Early Management on Pain and Depression in Patients with Pancreatobiliary Cancer: A Randomized Clinical Trial

Sang Myung Woo  1 , Mi Kyung Song  2   3 , Meeyoung Lee  4 , Jungnam Joo  5 , Dae Hyun Kim  6 , Jong-Heun Kim  7 , Sung-Sik Han  8 , Sang-Jae Park  9 , Tae Hyun Kim  10 , Woo Jin Lee  11
Affiliations

Effect of Early Management on Pain and Depression in Patients with Pancreatobiliary Cancer: A Randomized Clinical Trial

Sang Myung Woo et al. Cancers (Basel). .

Abstract

Background: The present study assessed whether early palliative care (EPC) targeting pain and depression and automated symptom monitoring could improve symptoms in patients with advanced pancreatobiliary cancer. Methods: Patients diagnosed with pathologically confirmed locally advanced or metastatic pancreatic or biliary tract cancer who had cancer-related pain (brief pain inventory (BPI) worst pain score >3) and/or depression (Center for Epidemiological Studies-Depression Scale (CES-D) >16) were randomized within 8 weeks after diagnosis to receive EPC or on-demand palliative care (n = 144 each). EPC included (1) nursing assessment of pain and depression, (2) pain control based on National Comprehensive Cancer Network guidelines, (3) depression control by psychoeducation and/or consultation with a psychiatric specialist, and (4) patient education. The primary end points were ≥50% reductions from baseline to week 4 in pain and depression scores. Results: The proportion of patients in the EPC and usual care groups with ≥50% reductions in pain (29.5% vs. 25.2%; p = 0.4194) and depression (30.8% vs. 36.8%; p = 0.5732) scores from baseline to week 4 did not differ significantly. The proportion of patients with BPI worst pain score ≤3 was significantly higher (51.1% vs. 38.9%, p = 0.0404) and the reduction in pain intensity score significantly greater (1.5 vs. 1.0 points, p = 0.0318) in the EPC than in the usual care group. At 4 weeks, patients in the EPC group reported significant increases in global health status, role of functioning, nausea and vomiting, and pain scores on the European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) general questionnaire. Conclusions: Although the primary outcome was not met, this trial indicates that EPC may improve early pain relief in patients with advanced pancreatobiliary cancers.

Keywords: biliary tract cancer; depression; pain; palliative care; pancreatic cancer.

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Conflict of interest statement

The authors indicated no potential conflicts of interest.

Figures

Figure 1
Figure 1
Trial profile. EPADE: Effect of Early Management on PAin and DEpression in Patients With PancreatoBiliary Cancer
Figure 2
Figure 2
Mean changes in (A) pain scores and (B) depression scores among patients in the EPC (blue) and UOC (red) groups. EPC: Early palliative care, UOC: Usual oncology care.
Figure 3
Figure 3
Box plot of differences of quality of life between baseline and 4 weeks.
See this image and copyright information in PMC

References

    1. Smyth E.N., Bapat B., Ball D.E., Andre T., Kaye J.A. Metastatic pancreatic adenocarcinoma treatment patterns, health care resource use, and outcomes in France and the United Kingdom between 2009 and 2012: A retrospectivesStudy. Clin. Ther. 2015;37:1301–1316. doi: 10.1016/j.clinthera.2015.03.016. - DOI - PubMed
    1. Tsuji T., Hiraoka T., Kanemitsu K., Takamori H., Tanabe D., Tashiro S. Lymphatic spreading pattern of intrahepatic cholangiocarcinoma. Surgery. 2001;129:401–407. doi: 10.1016/S0039-6060(01)49159-8. - DOI - PubMed
    1. American Academy of Hospice and Palliative Medicine. Center to Advance Palliative Care. Hospice and Palliative Nurses Association. Last Acts Partnership. National Hospice and Palliative Care Organization National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for quality palliative care, executive summary. J. Palliat. Med. 2004;7:611–627. doi: 10.1089/jpm.2004.7.611. - DOI - PubMed
    1. Temel J.S., Greer J.A., Muzikansky A., Gallagher E.R., Admane S., Jackson V.A., Dahlin C.M., Blinderman C.D., Jacobsen J., Pirl W.F., et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N. Engl. J. Med. 2010;363:733–742. doi: 10.1056/NEJMoa1000678. - DOI - PubMed
    1. Temel J.S., Greer J.A., El-Jawahri A., Pirl W.F., Park E.R., Jackson V.A., Back A.L., Kamdar M., Jacobsen J., Chittenden E.H., et al. Effects of early integrated palliative care in patients with lung and gastrointestinal cancer: A randomized clinical trial. J. Clin. Oncol. 2017;35:834–841. doi: 10.1200/JCO.2016.70.5046. - DOI - PMC - PubMed

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