Transcript Bone Pain Palliation with 153-Sm

BONE PAIN PALLIATION:
SUPPORTING ROLE OF STAFF
DURING THE RADIONUCLIDE TREATMENT
East Tallinn Central Hospital,
Department of Nuclear Medicine,
Tallinn, Estonia
GALINA SHAMARINA
EVE PALOTU
The World – small or big?
PAIN
• Pain is one of the main
factors which is affecting
the quality of life
• Pain has a complex
nature and different
factors contribute to the
patient’s perception of
pain
Symptoms of debility
Side-effects of therapy
Noncancer pathology
Cancer
SOMATIC SOURCE
Loss of social position
Bureaucratic bungling
Loss of income
Loss of role of family
Friends who are don’t visit
DEPRESSION
ANGER
Delays in diagnosis
Insomnia
Sense of helplessness
Disfigurement
TOTAL PAIN
Unavailable doctors
Irritability
Therapeutic failure
ANXIETY
Fear of hospital or nursing home
Worry about family
Fare of death
control
Spiritual unrest
Fear of pain
Family finances
Loss of dignity and bodily
Uncertainty about future
Reproduced from A.J.McEwan “ Palliation of bone pain”
BONE METASTASES AFFECT
QUALITY OF LIFE
Pain
Pathologic fractures - immobility
Hypercalciemia
Neurological problems
Anxiety
Depression
BONE SCINTIGRAPHY
Normal scan
Multiple bone metastases
RELIEF OF PAIN - GOAL IN
TREATMENT OF BONE METASTASES
relieving pain
improve patient mobility
improve patient function
improve quality of life
QUALITY OF LIFE - HEALTH-RELATED
QUALITY
CRITICAL PARAMETERS:
1. Physical functioning
2. Disease- and treatment-related symptoms
3. Psychological/emotional symptoms
4. Social interactions
The "Palliative Care Quality of Life Instrument (PQLI)" in terminal cancer patients. Kyriaki
Mystakidou, Eleni Tsilika, Vassilios Kouloulias. Health and Quality of Life Outcomes.
http://www.hqlo.com/content/2/1/8
THE AIM OF THE STUDY
Describe and analyse the aspects of the
activities
• nuclear medicine staff taking care of
patients during the pain palliation with
radioisotopes
• patients participate in their treatment to get
a sense of control over their disease
METHODS FOR EVALUATION OF
QUALITY OF LIFE
Specifically for cancer patients are suitable:
 Karnofski ja WHO daily diaries questionary
 Pain descriptor scale PDC
 Patient’s analgetic use (opioid)
 Personal’s global assessment PGA
 Othes aspects of quality of life (patient’s daytime
discomfort , quality of sleep etc)
DIARY OF PAIN ASSESSMENT
Patient assesses daily his/her intensity of
pain and completes the diary in 10 point
scale - APS
According to the APS the efficiency of
treatment is evaluated and also to
compare the different methods of therapy
ASSESSMENT OF PAIN RELIEF USING
ANALOGUE PAIN SCALE
No
pain
0
1
2
3
4
5
6
7
8
Pain relief
Changes in APS
Complete
Substantial
Minimal
No response
80% and more
30-79%
10-29%
9% and less
9
10
Max
pain
PERSONAL’S GLOBAL ASSESSMENT
1. Condition is worse, patient feels more pain
2. Condition has not changed
3. Condition slightly better, slight relief of pain
4. Condition is moderatly better, moderate relief of pain and
discomfort
5. Condition is much better, marked relief of pain and less
discomfort
6. Condition is good, complete relief of pain and no discomfort
during the daily performances
ANALGETIC USE
• Prior the start of treatment all the doses of
medications are recorded (24h)
• All the doses are converted to morphine equivalents
• During the treatment patient records all the doses of
medications
• Change in opiod analgetic use gives information of
the treatment efficacy
TREATMENT ROOM
CHARACTERISATION OF PATIENT
POPULATION
1995-2004 with bone pain due to
metastatic breast (MBC) or prostate cancer (MPC)
Median Age (y)
MPC
66 (40-79)
MBC
53 (36-68)
Total
NSAID
39 (73%)
Narcotics
13 (27%)
Total
52
22 (75%)
8 ( 25%)
30
61 (74%)
21 (26%)
82
23
Single BM
59
Multiple BM
BONE PAIN RESPONSE TO
THERAPY
17%
Complete
Substantial
Minimal
No
15
43
10
14
(18%)
(53%)
(12%)
(17%)
18%
Complete
Substantial
12%
Minimal
No
53%
82 patients
Time of response 1 - 2 weeks after treatment
 Duration of response - 4 - 24 weeks

BONE PAIN RESPONSE
TO THERAPY
0%
5%
0%
24%
Complete
48%
54%
17%
Multiple Mts
Complete
Substantial
Minimal
No
52%
Substantial
Minimal
No
Single Mts
15
3
12
43
32
11
10
10
0
14
14
0
82
59
23
CONCLUSIONS
• Treatment with radioisotopes is an effective
method for the palliation of metastatic pain
providing relief in majority of our patients
• As the therapy affects the site of pain
without affecting central nervous system
the patients really feel the improvement of
their QoL
CONCLUSIONS
• Patients want a voice in
their life care, and
participation in
treatment, this would
give them a sense of
control over their
disease
• It is hightly
depended of staff
management quality
YOU CAN’T STOP THE CLOCK,
BUT
YOU CAN CONTROL THE PAIN