The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 39
Slide Session
OS-ONC-09 Oncology
Current Status of Neuropathic Cancer Pain, Its Man- agement and Impact on Quality of Life in Korea; Kore- an Cancer Study Group Neuropathic Cancer Pain Sur- vey (kcsg Pc13-02)
So Yeon OH1, Sang Won SHIN2, Sun Jin SYM3, Sang-Young ROH4, Seung Sei LEE5, So Young YOON6, Sun Kyung BAEK7, Keon Uk PARK8, Sang Cheul OH9, Jung Lim LEE10, Jeanno PARK11, Jooseop CHUNG12, In Sil CHOI13, Dae-Sik HONG14, Hyun CHANG15, Seok Yun KANG16, Hyein KOH17, Ju Ho SIM18
Seoul Medical Center, Korea1, Korea University College of Medicine, Korea2, Gachon University Gil Med- ical Center, Korea3, Seoul St. Mary’s Hospital, The Catholic University of Korea, Korea4, Kangbuk Sam- sung Hospital, Korea5, Konkuk University College of Medicine, Korea6, Kyung Hee University Medical Center, Korea7, Dongsan Medical Center, Keimyung University, Korea8, Korea University Guro Hospital, Korea9, Fatima Hospital, Korea10, Bobath Memorial Hospital, Korea11, Pusan National University Hospital, Korea12, Seoul National University Boramae Medical Center, Korea13, Soonchunhyang University Bu- cheon Hospital, Korea14, Seoul National University Bundang Hospital, Korea15, Ajou University Hospital, Korea16, Pfizer Pharmaceutical Korea Ltd., Korea17, Primecore Consulting, Korea18
Background: Diagnosis and management of neuropathic cancer pain (NCP) is diffi cult and complicated. This study investigated current practice in the diagnosis and man- agement of NCP and its impact on quality of life (QoL).
Methods: Patients with cancer pain with visual analogue scales (VAS) =1 from 28 hospitals in Korea were enrolled in this cross-sectional observational study. If the pa- tient obtained a score =4 from neuropathic pain diagnostic questionnaire (DN4), he/
she was diagnosed with NCP. The clinical characteristics, pain severity measured by Brief Pain Inventory-Short Form (BPI-SF), and the QoL measured by EuroQoL EQ-5D Health Questionnaire were evaluated.
Results: Among 1,505 enrolled patients, 885 patients (58.8%) had moderate to se- vere pain (VAS=4). Neuropathic cancer pain (when DN4 =4) was identified in 556 patients (36.9%). Among those NCP patients, 254 patients (45.7%) were treated with NCP-targeted therapies (administering opioid or non-opioids analgesics with adjuvant analgesics). Among entire patients, opioids were used in 1,005 patients (66.8%) and 205 patients (13.6%) were not prescribed any analgesic. Anti-depressants and an- ti-convulsants were prescribed for 91 (6.0%) and 349 (23.2%) patients respectively.
Patients with NCP had more severe pain and their pain interference level with daily living was higher than those without NCP. The QoL measured by EQ-5D index score was signifi cantly worse in patients with NCP than those without NCP (Table 1).
Conclusions: This large-scaled survey shows that NCP has deteriorative effect on pain and QoL in patients having cancer pain. Current status of management for cancer pain is not satisfactory including NCP in Korea.
*This study was partially presented at the MASCC/ISOO International symposium on supportive care in cancer, 26 – 28 June 2014, Miami, USA.
OS-ONC-10 Palliative Care
Prevention of Chemotherapy Induced Nausea and Vom- iting (CINV) with Use of Aprepitant Combination Regi- mens (ACR): Meta Analysis in Adult Cancer Patients
Neha GUPTA1, Hassan HATOUM2, Omar Al USTWANI2, Pongwut DANCHAIVIJITR2, Katy WANG2, Roberto PILI2
State University of New York at Buffalo, USA1, Roswell Park Cancer Institute, USA2
Background: Various randomized controlled trials (RCTs) have shown improved out- comes with addition of aprepitant to standard antiemetic treatment (SAT) in prevent- ing CINV. We conducted a meta analysis to study the overall impact of ACR in CINV prevention in adults.
Methods: We searched Pubmed and Ovid databases, and American Society of Clinical Oncology meetings abstracts for RCTs using ACR with SAT for CINV prevention in adult cancer patients. Major study end points were complete response to treatment (CR;
defi ned as no emesis and no use of rescue medications) in overall phase (OP; 0- 120 hours of chemotherapy), acute phase (AP; 0 -24 hours) and delayed phase (DP; 24 - 120 hours). Additionally, we assessed the control of nausea and toxicity profi le (TP).
Stouffer’s Z -score method was used to calculate the overall effect.
Results: 16 RCTs (5,547 patients) were included. 11 trials (3,314 patients) involved highly emetogenic chemotherapy (HEC) and 5 trials (2,233 patients) involved moder- ately emetogenic chemotherapy (MEC). ACR increased CR in OP from 47% to 63%
(OR=0.52, CI=0.46 to 0.58; p<0.001), in AP from 73% to 81% (p<0.01), and in DP from 51% to 66% (p<0.001). Signifi cant increase in nausea control was seen in DP (p=0.03) but not in OP or AP. Incidence of various toxicities was statistically similar in both groups except slightly higher rate of fatigue (p=0.02) and hiccups (p<0.001), and lower rate of neutropenia (p=0.02) in ACR.
Conclusions: ACR is effective in CINV due to both HEC and MEC in adult cancer pa- tients. ACR improves the control of emesis in all phases, and nausea in delayed phase only. With the exception of causing more fatigue & hiccups, and lesser neutropenia, overall TP of ACR is similar to SAT.
OS-ONC-11 Palliative Care
Home Mortality and Need for End-of-Life Care Inte- gration in General Practice
Elena VVEDENSKAIA1, Lubov VARENOVA2, Larisa BYKOVA1 Regional AIDS Center, Russia1, Regional Medical Statistics Center, Russia2
Background: Defi ning the optimal organizational form of palliative care (PС) for pa- tients at the end of life requires adequate information, its analysis and further reason- able use. Meeting the patient’s desire to spend the last days of his/her life where he or she wants is a fundamental ethical principle of PC.
Methods: The data on the place of death from all causes and from cancer were derived from death registrations in the region between the years of 2006-2011. We examined the trends in home and hospital deaths of the elderly as well as adults for the whole region, for the city and for the rural area.
Results: The percentage of home deaths from all causes significantly increased:
from 55.67% to 73.68%, in rural areas from 60.10% to 82.12% and in the city from 30.32% to 66.37% (respectively 1.24, 1.37 and 2.19 times increase). The number of deaths from cancer remains high. 85.16% of all cancer deaths occurred at home.
The elderly comprise the majority of all deaths from all causes occurred at home and its share was 89.96% for the region, 90.69% for the city of Nizhny Novgorod, and 89.79% for the rural area. The number of home deaths of the retired age people from all causes exceeds the number of the working age people deaths respectively 9.0, 9.9 and 8.9 times.
Conclusions: High proportion of home deaths both from cancer and all causes to a certain extent is the result of reducing the hospital care supply and still demonstrates low availability of specialist inpatient palliative care. These fi ndings today highlight the need for community end-of-life care provision in the region. First of all this is the challenge for general practitioners.
