Cancer Pain, Cancer Related Pain, Pain, Chronic
Conditions
Keywords
telemedicine, cancer pain, Pain management, Health equity, Cost-effectiveness analysis, Therapeutic equivalence, Palliative care
Brief summary
Cancer is the second leading cause of death worldwide, with approximately 18.1 million new cases and 9.6 million deaths reported in 2018. Cancer-related pain is experienced by 50-70% of patients, with a higher prevalence at advanced disease stages (66.4%). Since the development of WHO's cancer pain guidelines, several studies have reported good relief of symptoms and suffering for a majority of patients. Recent reports suggest that up to 50% of patients still report insufficient pain control. Patients with cancer often present with multiple symptoms and functional decline. Evidence supports multidisciplinary approaches to address symptoms and suffering, including early palliative care referral From review literatures we found that the telemedicine group had significantly higher quality of life than the usual care group. In addition, the telemedicine group had lower anxiety and depression scores than the usual care group. Therefore, we will conduct the non-randomized controlled study of using telemedicine comparing to conventional in-person at OPD in hospitalized cancer pain patients. The purpose of this study is to assess the pain interference by using the Brief Pain Inventory (BPI) and to compare between the in-person group and the telemedicine group. To assess the cost-effectiveness of telemedicine for reducing symptoms associated with cancer and its treatment.
Detailed description
The pain interference will be assessed and compared using Brief Pain Inventory from 0-70 between In-person group and telemedicine group at 1 month.
Interventions
OTHERTelemedicine
Telemedicine
OTHERIn-person
In-person
Sponsors
Mahidol University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age older than 18 years old * Cancer patients who new visit as out patient at pain clinic, Siriraj hospital
Exclusion criteria
* Cannot read and write * Confusion * Unable to use the 0-10 Numerical Rating Scale (NRS) to rate pain intensity. * Unstable clinical presentation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain interference | at 1 month | The pain interference will be assessed and compared using Brief Pain Inventory from 0-70 between In-person group and telemedicine group. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity | at 1 month, 2 months and 3 months | The pain intensity from BPI (Brief Pain Inventory), including worst, least, average, and current pain reduction, will be assessed and compared using the numerical rating (NRS) from 0-10; 0 designating "no pain" and 10 designating " worst possible pain" scale between the in-person group and the telemedicine group. |
| Quality of life (QoL) | at 1 month | The quality of life will be assessed and compared using EuroQoL 5D5L between In-person group and telemedicine group. |
| Functional status | At baseline, 1 month, 2 month, 3 month | Functional status evaluated using Palliative Performance Status Score |
| Opioid consumption | At baseline, 1 month, 2 month and 3 month | Opioid consumption is recorded using the Morphine Equivalent Daily Dosage |
| Economic study | At Baseline, 1 month, 2 month and 3 month | We conducted an economic study evaluation from the patient and caregiver perspective. Costs analyzed included direct medical costs, direct non-medical costs (such as transportation and food), and indirect costs (total productivity loss). We calculated the Incremental Cost-Effectiveness Ratio (ICER) to determine the economic value of telemedicine relative to in-person care. The ICER was defined as the incremental difference in total direct costs divided by the incremental difference in clinical effectiveness across multiple outcomes, including EQ-5D-5L utility, EQ-VAS, PPS, total BPI reduction, and avoided increases in MEDD. The results were further visualized on a cost-effectiveness plane. |
| Medication adverse effects | At baseline, 1-month, 2-month and 3-month | Medication adverse effects such as sedation, constipation and nausea and vomiting were evaluated using the sedation score, Rome IV, and 4 point scale of nausea and vomiting. |
Countries
Thailand
Contacts
STUDY_DIRECTORSuratsawadee Wangnamthip, M.D.
Mahidol University
Outcome results
None listed