Influence of Intensive Cancer Pain Management in the Development of Fatigue, Hallucination, and Sedation

2.50
Hdl Handle:
http://hdl.handle.net/10755/165407
Category:
Abstract
Type:
Presentation
Title:
Influence of Intensive Cancer Pain Management in the Development of Fatigue, Hallucination, and Sedation
Author(s):
Hwang, S.; Cogswell, J.; Morales, E.; Chang, V.; Alejandro, Y.; Osenenko, P.
Author Details:
S. Hwang, New Jersey Health Care System, East Orange, New Jersey, USA; J. Cogswell; E. Morales; V. Chang; Y. Alejandro; P. Osenenko
Abstract:
The purpose of this study was to identify independent predictors of clinically significant fatigue (usual fatigue => 3/10) and analgesic related CNS toxicity (hallucinations and sedation) 1 week after intensive opioid management. The study is based on a multidimensional biopsychosocial framework. One hundred and thirty eight(138) patients with worst cancer pain severity => 4/10 completed the Brief Pain Inventory, Brief Fatigue Inventory, and Memorial Symptom Assessment Scale-Short Form at baseline and week 1. Patient reported hallucinations, confusion, sedation and myoclonus were assessed at both time points. The median age was 67 years (43-86). At day 1, median KPS was 60(40-80), hemoglobin 11.8 mg/dL(6.8-16), usual fatigue severity 5(0-10) and worst pain severity 9(4-10) with morphine equivalent daily dose (MEDD) 20 mg( 0-3,120). At week 1, there was a significant improvement in KPS (median 70(20-90), p<0.0001) and in worst pain severity (6(0-10), p<0.0001). The MEDD was 90 mg (0-3,120) and the percentage of patients on opioids increased from 65% to 96%. CNS toxicity included greater sedation in 49 patients (28%), difficulty concentrating in 25 patients (19%), confusion in 28 patients (18%), myoclonus in 25 patients (17%) and hallucinations 18 patients (13.6%). However, only hallucinations (7% vs. 18%, p=0.007) and sedation (34% vs. 54%, p=0.001) showed a significantly higher incidence at week 1. Patients with hallucinations (RR=0.44, p=0.004) and sedation (RR=0.67, p=0.02) were at increased risk for poor pain outcome at week 1. By multidimensional multivariate logistic analysis, the presence of feeling confused, hemoglobin level, preexisting hallucinations and difficulty sleeping (p<0.0001 &=0.02, 0.03, 0.02 respectively) predicted hallucinations independently. Feeling drowsy, preexisting sedation, older age and KPS (p=0.001, 0.007, 0.005, 0.03 respectively) predicted sedation independently. Clinically significant fatigue was present in 71% of patients; feeling drowsy, feeling nervous, sedation and difficulty concentrating (p < 0.0001 & = 0.03, 0.05, 0.05 respectively) predicted clinically significant fatigue independently. Most patients required further fatigue management. MEDD did not predict hallucinations, sedation or fatigue in univariate analyses. In conclusion, patients with preexisting CNS symptoms, difficulty sleeping, older age, lower hemoglobin and poor KPS are at increased risk for developing hallucinations and sedation after intensive cancer pain management.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2003
Conference Name:
28th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Denver, Colorado, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleInfluence of Intensive Cancer Pain Management in the Development of Fatigue, Hallucination, and Sedationen_GB
dc.contributor.authorHwang, S.en_US
dc.contributor.authorCogswell, J.en_US
dc.contributor.authorMorales, E.en_US
dc.contributor.authorChang, V.en_US
dc.contributor.authorAlejandro, Y.en_US
dc.contributor.authorOsenenko, P.en_US
dc.author.detailsS. Hwang, New Jersey Health Care System, East Orange, New Jersey, USA; J. Cogswell; E. Morales; V. Chang; Y. Alejandro; P. Osenenkoen_US
dc.identifier.urihttp://hdl.handle.net/10755/165407-
dc.description.abstractThe purpose of this study was to identify independent predictors of clinically significant fatigue (usual fatigue =&gt; 3/10) and analgesic related CNS toxicity (hallucinations and sedation) 1 week after intensive opioid management. The study is based on a multidimensional biopsychosocial framework. One hundred and thirty eight(138) patients with worst cancer pain severity =&gt; 4/10 completed the Brief Pain Inventory, Brief Fatigue Inventory, and Memorial Symptom Assessment Scale-Short Form at baseline and week 1. Patient reported hallucinations, confusion, sedation and myoclonus were assessed at both time points. The median age was 67 years (43-86). At day 1, median KPS was 60(40-80), hemoglobin 11.8 mg/dL(6.8-16), usual fatigue severity 5(0-10) and worst pain severity 9(4-10) with morphine equivalent daily dose (MEDD) 20 mg( 0-3,120). At week 1, there was a significant improvement in KPS (median 70(20-90), p&lt;0.0001) and in worst pain severity (6(0-10), p&lt;0.0001). The MEDD was 90 mg (0-3,120) and the percentage of patients on opioids increased from 65% to 96%. CNS toxicity included greater sedation in 49 patients (28%), difficulty concentrating in 25 patients (19%), confusion in 28 patients (18%), myoclonus in 25 patients (17%) and hallucinations 18 patients (13.6%). However, only hallucinations (7% vs. 18%, p=0.007) and sedation (34% vs. 54%, p=0.001) showed a significantly higher incidence at week 1. Patients with hallucinations (RR=0.44, p=0.004) and sedation (RR=0.67, p=0.02) were at increased risk for poor pain outcome at week 1. By multidimensional multivariate logistic analysis, the presence of feeling confused, hemoglobin level, preexisting hallucinations and difficulty sleeping (p&lt;0.0001 &amp;=0.02, 0.03, 0.02 respectively) predicted hallucinations independently. Feeling drowsy, preexisting sedation, older age and KPS (p=0.001, 0.007, 0.005, 0.03 respectively) predicted sedation independently. Clinically significant fatigue was present in 71% of patients; feeling drowsy, feeling nervous, sedation and difficulty concentrating (p &lt; 0.0001 &amp; = 0.03, 0.05, 0.05 respectively) predicted clinically significant fatigue independently. Most patients required further fatigue management. MEDD did not predict hallucinations, sedation or fatigue in univariate analyses. In conclusion, patients with preexisting CNS symptoms, difficulty sleeping, older age, lower hemoglobin and poor KPS are at increased risk for developing hallucinations and sedation after intensive cancer pain management.en_GB
dc.date.available2011-10-27T12:17:59Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:17:59Z-
dc.conference.date2003en_US
dc.conference.name28th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationDenver, Colorado, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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