PRC Research Results

​EAPC Basic Dataset

An international consensus has been reached regarding how to characterize a palliative care cancer population: The EAPC Basic Dataset. 

The paper by Katrin R Sigurdardottir et al could be accessed at Palliative Medicine Online

The work was performed as an extension of the project PRISMA (Reflecting the Positive Diversities of European Priorities for Research and Measuerment in End-of-Life Care) and in cooperation with the European Association for Palliative Care.

The PRC encourages researchers and clinicians to start using the EAPC Basic Dataset for characterizations of palliative care cancer populations! 

The EAPC Basic Dataset patient form could be downloaded here

The EAPC Basic Dataset personnel form could be downloaded here.

Pilot-testing of he EAPC Basic Dataset: In an international multi-centre study at palliative care units and hospices the EAPC Basic Dataset will be piloted in 2014-2015. Read more about the pilot-testing here

EPCRC guidelines

The European Palliative Care Research Collaborative (EPCRC) developed new guidelines for assessment and classification of pain, cachexia and depression. The guidelines are meant to aid clinicians across Europe in providing optimal palliative care. 

Patient friendly versions of the guidelines can be downloaded here:

Key Findings from the European Partnership for Action Against Cancer (EPAAC)

European Partnership Action Against CancerPRC and EAPC Research Network (EAPC RN) have participated in the joint action EPAAC since 2009.

The aim of EPAAC is to support European Countries in their efforts to prevent and control cancer. PRC and EAPC RN have contributed in Work Package 7 Healthcare, where one of the objectives is to improve treatment, symptom assessment and follow-up of palliative care through a standardised assessment methodology and evidence based guidelines.

In November 2013, the EPAAC publication Boosting Innovation and Cooperation in European Cancer Control: Key Findings from the European Partnership for Action Against Cancer (pdf) were launched.

In June 2014, an article which took a close look at EPAAC was published in Cancer World, the magazine of the European School of Oncoloy (ESO). The article addresses the following issues: Did EPAAC deliver on its aim of helping EU member states improve the way they organise and deliver cancer prevention, screening and care? What are the implications for collaborating over cancer in the future? The article is available here

The final EPAAC deliverables is available on the official EPAAC website.

Status for the EPCCS

Background

The prevalence rates of frequent cacner symptoms vary considerably across studies, with a range from 35 to 90% for pain as an example. These differences may in part be explained by different assessment tools, outcomes, design, population characteristics and study methods. It is also well-known that the delivery, quality, extent and degree of specialization in PC differ across countries. This, paired with the lack of agreed-upon, common criteria to describe a palliative care (PC) cancer population limit the possibility to design prospective randomized controlled treatment trials in palliative care, which is the optimal way to improve symptom management. To do this, a better understanding of how symptoms evolve and how they should be assessed and classified throughout the palliative care trajectory in large patient samples is important, paired with data on PC delivery and organization.

Objectives

The overall objective of the EPCCS is to extend the knowledge about the palliative care cancer population by collecting medical data and data on the prevalence and development of the most frequent symptoms over time. The secondary objective is to continue the work towards a standardised assessment and classification system for the most frequent cancer related symptoms, and the third aim is to relate data on symptoms and treatment to the organisational issues.

Methods

Design and methods: The EPCCS-study is a prospective, descriptive multicentre data collection exploring a brief set of medical variables and patient self-reported data on symptoms and functioning, using computers or paper forms. Prior to patient inclusion, all centres completed a web-based centre survey focusing on organisational, economic and palliative care related issues. Patient inclusion started in 2011 and continued until October 2013.

Patients: Inclusion criteria were wide; a verified cancer diagnosis, advanced disease, enrolled in a palliative care programme, >18 years, written informed consent, ability to complete the study and available for at least one follow-up registration after 1 month. Patients were recruited when coming to the participating centre for treatment or follow-up and followed on site for at least 3 months, or until death, with the following patient-reported outcomes; ESAS-r, the EORTC QLQ-PAL15, a few socio-demographic variables and a set of screening questions on pain (intensity, breakthrough, neuropathic), depression and appetite/cachexia. Objective registrations were recorded at the same time by the physician / study nurse; a brief set of medical data (diagnosis, stage of disease, height, weight, treatment etc.), cognitive status (MMSE, 4-item version), the Edmonton Classification System for Cancer Pain (ECS-CP), and Karnofsky performance status. All forms were in the local languages.

Results

Patients: The EPCCS gained widespread interest. Thirty centres from the following 12 countries participated; Australia, Belgium, Canada, Denmark, Georgia, Germany, Italy, Norway, Portugal, Spain, Switzerland, and UK, covering ten languages. 1739 patients (M/F: 50/50) with a median age of 66 (21-97) and median Karnofsky score of 70 (10-100) completed the baseline data. Gastrointestinal 30%, breast 16% and cancer in the respiratory organs 20%, were most common, and 83% had metastatic or disseminated disease. The majority of patients were included from oncology departments (34%) or hospital palliative units (45%) at baseline. Attrition was high, as expected, and 1242 completed the study forms after one month, and 641 after 3 months.

Organizational issues: Most of the participating centres had a combination of an urban and rural catchment areas. The majority (79%) had both in-patient and out-patient PC units and 61% provided in-hospital PC service. 79% provided chemo- and radiotherapy as part of the PC programme, more often in cancer centres and teaching hospitals. The percentage of cancer patients cared for in the PC units ranged from 80-100. The professional background of the head of the units was predominantly physicians.

Publication issues

The main publication from the EPCCS study has been submitted for publication. Another 11 proposals for journal articles from the collaborating centres have been approved by the scientific committee. These publication proposals focus on the following subjects:

cachexia (1), cognitive function over time (1), integration of oncology/palliative care (1), various aspects of depression (3), predictive factors for bone pain (1), symptom burden in relation to transitions between care settings (1), symptom burden/prevalence in relation to socio-demographic factors (1), breathlessness (1) and a comparison between a palliative care consultant team and a hospice setting (1).

EAPC Opioid Guidelines 2012

The new EAPC recommendations on the use of opioids for cancer pain have been published in Lancet Oncology (Feb 2012).

The updated EAPC guidelines on use of opioid analgesics in the treatment of cancer pain are outcomes of the EU collaborative EPCRC.

The content of the guidelines was defined by topics, and a systematic review was conducted within each topic. The recommendations were thereafter developed by a writing committee, resulting in 16 evidence-based guidelines for using opiods when treating cancer pain.

A webversion of the guidelines is available through http://www.eapcnet.eu/Themes/Research/Publications/EAPCOpioidGuidelines2012.aspx

European Pharmacogenetic Opioid Study (EPOS)

The EPOS study has examined symptoms, pharmacogenetics and pharmacology related to the use of opioids. The international cooperation is fascilitated by the participation in the study by the EAPC-RN. The study has successfully recruited 2305 patients from 17 centres in 11 European countries. 

For the 12th Congress of the European Association for Palliative Care in Lisbon in May 2011, a folder with highlights from the study was made. This folder can be downloaded here.

The primary aim of the project was to study genetic variation that influcence the efficacy of opioid used for treatment of cancer pain. In addition the study have started to analyse other issues related to palliative medicine such as genetics and adverse effects, opioids and pharmacokinetics, pain classification, cognitive function, patient barriers towards pain treatment, sleep and cachexia. Read more about the study here.

Participants:

Principle investigator: Pål Klepstad (pal.klepstad@ntnu.no)
Genetic laboratory: Frank Skorpen
Pharmacological laboratory: Ola Dale
Statistician: Peter Fayers

Patients

2294 cancer patients using an opioid for moderate or severe
pain:
  • Morphine 827
  • Oxycodone 445
  • Fentanyl 695
  • Other WHO step III opioids 327
Age 62 ± 12, Karnofsky 59 ± 17, MMSE 27 ± 3,
82% hospitalized
 

Pain

 

The EPOS study shows that a large part of cancer patients
have unacceptable high pain intesity.

 

Opioid doses

 

The high number of patients with pain was present despite that many patients received high opioid doses.

Selected publications from EPOS

Klepstad et al. The influence from genetic variability on opioid use for cancer pain. A European study of 2294 cancer pain patients. Pain 2011; 152: ,1139-1145.
The largest study to date on the relationship between known gene candidates and opioid efficacy in cancer pain patients.

Kurita et al. Prevalence and predictors of cognitive dysfunction in opioid treated cancer patients. A multinational study. J Clin Oncol 2011; 29:1297-1303.
A large survey of incidence and risk factors for cognitive failure in cancer pain patients.

Galvan et al. Genome-wide association identifies multiple loci modulating opioid therapy response for cancer pain. Clin Cancer Res July 1, 2011 17;4581-7
A genome wide analysis identifying new gene candidates influencing pain relief from opioids.

Knudsen et al. Which variables are associated with pain intensity and treatment response in advanced cancer patients? – Implications for a future classification system for cancer pain. Eur J Pain. 2011; 15:320-317
Part of the EPCRC development for classification of cancer pain.

Laugsand et al. Clinical and genetic factors associated with nausea and vomiting in cancer patients receiving opioids. Eur J Cancer. 2011 Jul;47(11):1682-91
Comprehensive analysis of genetic predictors of nausea and vomiting in cancer pain patients.

Utne et al. Differences in the Use of Pain Coping Strategies Between Oncology Inpatients With Mild versus Moderate to Severe Pain. J Pain Symptom Manage 2009; 38; 717-726.
One of several papers on hope and coping strategies in cancer pain patients.

Andreassen et al. Influences on pharmacokinetics of oxycodone – A multicentre cross-sectional study in 439 adult cancer patients. Eur J Clin Pharmacol 2011; 67: 493-506.
One of several papers on oxycodone pharmacology and pharmacogenetics.

Laugsand et al. Inadequate symptom control in advanced cancer patients across Europe. Supp Care Cancer. 2011 Dec;19(12):2005-14. 
About treatment of adverse symptoms in cancer pain patients.

For a complete EPOS publication list and information about planned analyses, please contact the PRC.