Cancer patients and their caregivers in the face of opioid analgesic treatment — opportunities and threats to the treatment process

Failure to alleviate cancer pain may deteriorate mental functioning, increase depression symptoms, result in the clinical diagnosis of demoralization syndrome nonadherence of treatment, functioning discipline, which together, may precipitate desire for euthanasia. Increased incidence of pain in patients with advanced or terminal disease has been reported to range from 39% to 66.4% depending on the stage of the cancer being experienced. Further, the progressive aging of societies and increased life expectancy in cancer patients has changed the dynamics of modern treatment processes. Despite their efficacy, the use of opioids as an analgesic treatment during terminal disease has been affected by the quality, availability, and negative reputation of these scheduled drugs. This review aims to describe the specific factors and limitations of opioid pain management from the perspective of patients and their caregivers. Further, we aim to identify and discuss the key factors which determine the success or failure of opioid use for the treatment of pain with links to internationally recognized recommendations and current research

Between “opioidophobia” and the opioid crisis: a cross-sectional comparison of opinions on opioid analgesic treatment between palliative care patients with cancer and physicians in Poland

Introduction. Inadequate pain control may contribute to a desire to die. Early use of opioid analgesics could improve pain treatment. On the other hand, opioids are associated with risk of addiction. We aimed to compare the opinions on opioid analgesic use between palliative care patients and physicians.  Material and methods. Data on the opinions of hospice and palliative care patients (n = 104) and physicians of different specialties (n = 216) were collected using a survey with closed-ended questions scored on a 5-point Likert scale.  Results. The majority (87.5%) of cancer patients experienced pain during their illness (mean intensity: 7.01±2.44).More than half (53.3%) of physicians had concerns that patients overuse opioid drugs. Negative connotations associated with the word “morphine” were expressed in both study groups. Survey responses of both patients and physicians were consistent with the phenomenon of “opioidophobia”.  Conclusions. We found a high degree of consensus between cancer patients’ and physicians’ opinions on opioid analgesic use. However we also found some discrepancies in opinions and they were mostly related to medical knowledge, which may indicate poor patient education about opioid use and poor communication between patients and physicians. It is concerning to note these significant discrepancies concerning opioid use since patients considered opioids useful in ensuring pain relief and improving their quality of life. The majority (almost 90%) of patients surveyed struggled with pain over the course of their illness and treatment.

Pacjenci onkologiczni oraz ich opiekunowie wobec opioidowego leczenia przeciwbólowego — szanse i zagrożenia dla procesu leczenia

Failure of pain treatment may cause worsening of mental functioning, increase in depression symptoms and clinical diagnosis of demoralization syndrome (ICD-10, category R45.4 Demoralization and apathy), inhibiting obeying the treatment and functioning discipline, which may lead to the risk of desiring euthanasia. According to a research review carried out in 2016, the incidence of pain in the group of patients with advanced or terminal disease amounted to 66.4% (in comparison to 64% in 2007), 55% (in comparison to 59% in 2007) during anti-cancer treatment and 39.3% (in comparison to 33% in 2007) in the group of patients after completing the treatment. The aging of societies and increasing life expectancy in cancer patients change the dynamics and length of treatment processes. The paper described specific limitations in opioid pain treatment on the side of patients and their caregivers: concern not to distract the doctor’s focus on the cancer treatment, concern for obtaining an opinion from a difficult, complaining patient, a conviction that pain is significant information about the course of the disease, vital for the treatment of fatalistic attitude towards the pain alleviation. The lack of current knowledge, false convictions, negative attitude concerning opioid pain treatment are indicated in many studies as common for patients, caregivers and doctors. Convictions most frequent in these groups include the concern for addiction, developing tolerance and side effects. The paper indicated the distinguished factors deciding about the effect of treatment, such as the ability to build, correct and maintain the cooperation between a doctor and a patient in the treatment process, which may last many years or decades. It refers to guidelines and recommendations, which are a detailed source of knowledge concerning opioid pain treatment.Niepowodzenie w leczeniu bólu może być przyczyną pogorszenia funkcjonowania psychicznego, nasilenia objawów depresji czy klinicznego syndromu demoralizacji (w ICD-10, kategoria R45.3 Demoralizacja i apatia) uniemożliwiających utrzymanie się w rygorze leczenia i funkcjonowania, które może prowadzić do ryzyka pragnienia eutanazji. Według przeglądu badań z 2016 roku częstość występowania bólu w grupie pacjentów w zaawansowanej lub terminalnej chorobie wyniosła 66,4% (wobec 64% w 2007 roku), podczas leczenia przeciwnowotworowego 55% (wobec 59% w 2007 roku), a w grupie chorych po przebytym leczeniu 39,3% (wobec 33% w 2007 roku). Proces starzenia się społeczeństw oraz wydłużający się okres przeżycia w chorobach nowotworowych zmieniają dynamikę i długość procesów leczenia. W pracy omówiono specyficzne bariery skutecznego opioidowego leczenia przeciwbólowego u pacjentów i ich opiekunów: obawy przed rozpraszaniem skupienia lekarza na leczeniu choroby nowotworowej, przed otrzymaniem opinii trudnego czy skarżącego się pacjenta, przekonanie, że ból jest ważną informacją o przebiegu choroby niezbędną do jej leczenia, czy fatalistyczne nastawienie do możliwości uśmierzenia bólu. Brak aktualnej wiedzy, fałszywe przekonania, negatywne nastawienie dotyczące opioidowego leczenia przeciwbólowego są w wielu badaniach wskazywane jako wspólne dla pacjentów, opiekunów i lekarzy. Najczęstsze w tych grupach przekonania to obawa przed uzależnieniem, rozwijanie tolerancji i skutki uboczne. Praca wskazuje wyróżniane czynniki decydujące o powodzeniu leczenia, takie jak umiejętność budowania, korygowania i utrzymania relacji współpracy lekarza z pacjentem w kilku lub kilkudziesięcioletnim procesie leczenia. Zawiera odniesienia do wytycznych i zaleceń będących szczegółowym źródłem wiedzy dotyczącej opioidowego leczenia bólu

COVID-19 Pandemic Influence on Healthcare Professionals

During the pandemic, many healthcare professionals (HCPs) are overburdened by work and stress. The aim of the study was to examine alcohol intake, sleep disorders, and depressive symptoms of HCPs during the pandemic in comparison with the pre-pandemic period. Another goal was to indicate risk factors for mental state deterioration and an increase in alcohol use. A cross-sectional survey study was conducted from 1 April to 15 May 2020. HCPs (n = 158) completed questionnaires that probed for symptoms during and prior to the pandemic, including the Beck depression inventory (BDI), Social Support Scale (MOS-SSS), Athens insomnia scale (AIS), and Alcohol Timeline Followback (TLFB) calendar of alcohol consumption. Gender, age, education, marital status, work situation, income, participants’ and relatives’ COVID-19 diagnosis as correlates were analyzed. Depressive symptoms and insomnia became more severe during the pandemic among HCPs, while social support increased. The increase in depressive symptoms was even higher among women (OR 2.78, 95% CI 1.05–7.36; p = 0.04) and was also positively correlated with work reduction (p = 0.02); the presence of sleep disorders was correlated with female gender. Alcohol consumption increased during the pandemic, and was correlated with both more time spent at work and income increase. HCPs involved in the treatment of COVID-19 need support and attention due to the excessive stress load during pandemics, resulting in depression, insomnia, and increased alcohol intake

Analysis of the Relationship among Cognitive Impairment, Nutritional Indexes and the Clinical Course among COVID-19 Patients Discharged from Hospital—Preliminary Report

Numerous data indicate the presence of cognitive impairment in people who have undergone COVID-19, often called COVID Fog (CF). This phenomenon persists even 6 months after infection, and its etiology and pathogenesis are not fully known. The aim of this article was to analyze the relationship among cognitive functioning, clinical data and nutrition indexes in patients discharged from the COVID-19 hospital of the Military Institute of Medicine, Warsaw, Poland. The sample comprised 17 individuals—10 women and 7 men, with ages of 65 ± 14 years. Cognitive impairment was measured with the use of the Montreal Cognitive Assessment (MoCA). The nutrition parameters included: hemoglobin, red blood cells, total cholesterol and its fractions, triglycerides, total protein, albumin, urea, creatinine, phosphates, calcium and sodium. The analysis showed that albumin concentration significantly correlated with the total MoCA score and especially with the short-term memory test score. Conversely, total cholesterol, and especially LDL concentrations, were highly and negatively associated with the MoCA score. In conclusion: markers of nutritional status are correlated with the severity of CF. Individuals with malnutrition or risk of malnutrition should be screened for CF. Further studies need to be performed in this area

Mast Cells and Histamine: Do They Influence Placental Vascular Network and Development in Preeclampsia?

The physiological course of pregnancy is closely related to adequate development of the placenta. Shallow invasion of trophoblast as well as decreased development of the placental vascular network are both common features of preeclampsia. To better understand the proangiogenic features of mast cells, in this study we aim to identify the potential relationship between the distribution of mast cells within the placenta and vascular network development. Material and Methods. Placentas from preeclampsia-complicated pregnancies (=11) and from physiological pregnancies (=11) were acquired after cesarean section. The concentration of histamine was measured, and immunohistochemical staining for mast cell tryptase was performed. Morphometric analysis was then performed. Results. We noticed significant differences between the examined groups. Notably, in the preeclampsia group compared to the control group, we observed a higher mean histamine concentration, higher mast cell density (MCD), lower mean mast cell (MMCA) and lower vascular/extravascular (V/EVT) index. In physiological pregnancies, a positive correlation was observed between the histamine concentration and V/VEVT index as well as MCD and the V/VEVT index. In contrast, a negative correlation was observed between MMCA and the V/EVT index in physiological pregnancies. Conclusions. Based on the data from our study, we suggest that a differential distribution of mast cells and corresponding changes in the concentration of histamine are involved in the defective placental vascularization seen in preeclamptic placentas

Acute Kidney Injury and Chronic Kidney Disease and Their Impacts on Prognosis among Patients with Severe COVID-19 Pneumonia: An Expert Center Case–Cohort Study

Background: Acute kidney injury (AKI) is associated with substantial mortality. In this case–control study, we analyzed the impacts of AKI and chronic kidney disease (CKD) on outcomes in a group of 323 patients with severe COVID-19. The correlation of clinical and laboratory data with AKI and CKD was also analyzed. Methods: A retrospective case–control study was conducted among AKI, CKD, and normal kidney function (NKF) groups hospitalized in a COVID-19 center in 2021. Results: AKI patients had higher in-hospital mortality (55.2 vs. 18.8%, p p p p p p = 0.013); however, transfers from the HDU to ICU were not more frequent (16.0 vs. 12.9%, p = 0.753). Conclusions: AKI among COVID-19 patients was correlated with more ICU transfers, higher morbidity, and greater markers of severe disease. Patients with CKD had a higher mortality; however, the rate of ICU transfer was not substantially higher due to their poor prognosis

Noninvasive ventilation in COVID-19 patients aged ≥ 70 years : a prospective multicentre cohort study

Background: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods: This is a substudy of COVIP study-an international prospective observational study enrolling patients aged >= 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). Conclusions: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV

Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19

Purpose The number of patients >= 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (+/- 2 years), Sequential Organ Failure Assessment (SOFA) score (+/- 2 points), clinical frailty scale (+/- 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear

The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Auteurs : COVIP study groupInternational audienceBackground The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Methods A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. Results The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients ( p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival. Conclusion Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020