P-28 Opioid requirements and palliative pain management in young adult cancer patients at the end of life: a retrospective review at an Australian comprehensive cancer hospital
Notice bibliographique
Résumé
<h3>Introduction</h3> Young Adult cancer patients, aged 18–39 years, represent a unique demographic. Evidence from a limited body of international research indicates that these patients tend to experience a high symptom burden, particularly pain, during their final month of life1. In Australia, there is limited knowledge regarding their end-of-life symptoms and management strategies. <h3>Objective</h3> This study aimed to identify the prevalence, severity, mechanisms and the specialist palliative management of pain in young adult patients who received end-of-life care and died at the Chris O’Brien Lifehouse, an Australian comprehensive cancer hospital. Methods A retrospective design analysed the case notes of 72 eligible patients, aged 18–39 years at diagnosis, who died in the hospital between January 2017 and May 2024. Quantitative analysis was performed on the collected data. <h3>Results</h3> All patients had solid organ metastatic disease with the most common types being sarcoma (33%), lung (15%), and gynaecological cancer (10%). All patients received specialist palliative care input. The median length of hospitalisation to time of death was 17 days (SD 18.6 range 0–122). All patients experienced pain and received opioids. 87% of patient scored their pain on admission as moderate-severe on the Edmonton Symptom Assessment Scale (ESAS). The mean Oral Morphine Equivalent Dose (oMEDD) was 275 mg (SD 403.7, range 20- 2250) with 30 patients (41%) receiving more than 300 mg of OMEDD. 25 (35%) patients received methadone, 15 (20%) patients received infusion ketamine, 6 (8%) patients received infusion lignocaine and 7 (9%) patients underwent interventional pain procedure. 64 patients (89%) received benzodiazepine for agitation and/or anxiety. 4 patients (5%) had severe refractory pain requiring palliative sedation with levomepromazine and/or phenobarbitone. <h3>Discussion and Conclusion</h3> Our findings showed that complex pain is highly prevalent in young adult cancer patients at the end of life requiring opioids, adjuncts and interventional pain strategies for management. This may be explained by age specific tumour types and predilection for bone and pelvic pain syndromes. Our data offer important information to the limited existing information in this area. In comparison standard palliative care cohort, our data showed that a large proportion of young adult patients require high doses of opioids for analgesia defined as OMEDD of more 300 mg2. Despite this pain remained poorly controlled in some patients requiring benzodiazepine or palliative sedation at the end of life, suggestive of total pain phenomenon, similarly reflected in several case reports1. When required, these patients require high doses of sedatives. Future research is needed to identify tailored treatment regimens for young adults with cancer-related pain, focusing on psychological symptom profile encompassing total pain. <h3>References</h3> Abdelaal, <i>et al .</i> Palliative care for adolescents and young adults with advanced illness: a scoping review.<i> Palliative Medicine</i> 2023;<b>37</b>(1):88–107. Bercovitch, <i>et al.</i> High dose morphine use in the hospice setting. <i>Cancer</i> 2000;<b>86</b>(5):735–903.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».