Supportive treatment for cancer part 3:

Transcription

1 Supportive treatment for cancer part 3: Treatment of pain: most common practices Marijke Eyssen, Nadia Benahmed, Anja Desomer CA/RvB M. Eyssen

2 Rationale Cancer-specific guidelines: College of Oncology + KCE Supportive treatment: often not specific to one cancer type Series of generic reports: Part 1: Exercise treatment Part 2: Prevention & treatment of adverse events Part 3: Treatment of cancer pain 2

3 Cancer pain Reported in 53% at all stages 64% in advanced illness 33% in cancer survivors Due to cancer cancer treatment other co-existing conditions 3

4 Selected topics Adults All phases of disease, except terminal care Nine treatments: Drugs Paracetamol and NSAIDs Opioids Corticosteroids Antidepressants Anticonvulsants Bisphosphonates Other interventions Radiotherapy for painful bone metastases Radionuclides for painful bone metastases Celiac plexus block 4

5 Methods Systematic Review: SRs or RCTs, Quality appraisal GRADE: Levels of evidence KCE Grades of recommendation; wording Expert panel: Professionals Representatives of patient organisations Stakeholder panel: Representatives of professional organisations Representatives of patient organisations Patient CEBAM validation EBM Practicenet 5

6 Results: WHO Analgesic ladder 6

7 SCREEN Treatment Algorithm CICEPTIVE WHO : PARACETAMOL/NSAIDs OPIOIDS CORTICOSTEROIDS PAIN INTENSITY BONE PAIN CONSIDER ALSO: RADIOTHERAPY RADIONUCLIDES BISPHOSPHONATES RE-EVALUATE PAIN CONTROL? CELIAC PLEXUS BLOCK OTHER INTERVENTIONS NEUROPATHIC OR MIXED CONSIDER ALSO : ANTIDREPRESSANTS ANTICONSULSANTS 7

8 SCREEN Treatment Algorithm CICEPTIVE WHO : PARACETAMOL/NSAIDs OPIOIDS CORTICOSTEROIDS PAIN INTENSITY BONE PAIN CONSIDER ALSO: RADIOTHERAPY RADIONUCLIDES BISPHOSPHONATES RE-EVALUATE PAIN CONTROL? CELIAC PLEXUS BLOCK OTHER INTERVENTIONS NEUROPATHIC OR MIXED CONSIDER ALSO : ANTIDREPRESSANTS ANTICONSULSANTS 8

9 SCREEN Treatment Algorithm CICEPTIVE WHO : PARACETAMOL/NSAIDs OPIOIDS CORTICOSTEROIDS PAIN INTENSITY BONE PAIN CONSIDER ALSO: RADIOTHERAPY RADIONUCLIDES BISPHOSPHONATES RE-EVALUATE PAIN CONTROL? CELIAC PLEXUS BLOCK OTHER INTERVENTIONS NEUROPATHIC OR MIXED CONSIDER ALSO : ANTIDREPRESSANTS ANTICONSULSANTS 9

10 SCREEN Treatment Algorithm CICEPTIVE WHO : PARACETAMOL/NSAIDs OPIOIDS CORTICOSTEROIDS PAIN INTENSITY BONE PAIN CONSIDER ALSO: RADIOTHERAPY RADIONUCLIDES BISPHOSPHONATES RE-EVALUATE PAIN CONTROL? CELIAC PLEXUS BLOCK OTHER INTERVENTIONS NEUROPATHIC OR MIXED CONSIDER ALSO : ANTIDREPRESSANTS ANTICONSULSANTS 10

11 SCREEN Treatment Algorithm CICEPTIVE WHO : PARACETAMOL/NSAID s OPIOIDS CORTICOSTEROIDS PAIN INTENSITY BONE PAIN CONSIDER ALSO: RADIOTHERAPY RADIONUCLIDES BISPHOSPHONATES RE-EVALUATE PAIN CONTROL? CELIAC PLEXUS BLOCK OTHER INTERVENTIONS NEUROPATIC OR MIXED CONSIDER ALSO : ANTIDREPRESSANTS ANTICONSULSANTS 11

12 Limitations Evidence supporting recommendations mostly low or very low quality Consider medical needs but also psychosocial, emotional and spiritual needs Almost no publications on combined interventions Organisation of health services out of scope Encourage multidisciplinary approach 12

13 Policy recommendations College of Oncology Facilitator for implementation of guideline. New evidence is posted online, awaiting the guideline update (pre-assessment at least every 5 years). Scientific societies User friendly tools tailored to specific groups of health-care professionals Dissemination through websites, continuous medical education,... Research community High-quality studies 13

14 Colophon Author(s): Marijke Eyssen, Nadia Benahmed, Anja Desomer Publication date: 18 november 2013 Domain: Good Clinical Practice (GCP) MeSH: Neoplasms; Pain; Pain management; Analgesics; Radiotherapy NLM Classification: QZ 266 Language: English Format: Adobe PDF (A4) Legal depot: D/2013/10.273/84 Copyright: KCE reports are published under a by/nc/nd Creative Commons Licence This document is available on the website of the Belgian Health Care Knowledge Centre. 14

15 15 THANK YOU!