Bandieri, E., Sichetti, D., Romero, M., Fanizza, C., Belfiglio, M., Buonaccorso, L., . . . Luppi, M. (2012). Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer. Annals of Oncology, 23, 2016–2020.

To investigate the impact of early integration of palliative and supportive care on pain management

Patients involved in the palliative care group were seen within two to three weeks of the cancer diagnosis. Services provided by the palliative and supportive care team were individualized, but included comprehensive symptom management, psychosocial, spiritual, and emotional support to patients and families, as well as assistance with treatment choice and coping. Patients in the comparison group received standard care provided by primary specialists. Data were collected from medical records. Patients were interviewed by a pharmacist regarding perception of pain control and pain intensity on a verbal rating scale.

• The study reported on a sample of 1,450 patients.
• Mean patient age was 65.05 years.
• The sample was 56% male and 44% female.
• Of the sample, 81% had metastatic disease. Specific sites were not described.
• A significantly larger percentage of patients receiving palliative care were receiving opioids and strong opioids for pain.

• Multisite
• Inpatient setting
• Italy

The study has clinical applicability for palliative care.

A descriptive, two-group comparison design was used.

Verbal rating scale (five-point)

Use of morphine and oxycodone were higher in the palliative care group (p < 0.0001). Transdermal fentanyl was used more often in the usual care group (p < 0.0001). Results from the interview showed that the percentage of patients with no pain and mild pain were significantly higher in the palliative care group (p < 0.0001). Care model and gender were the only predictive variables for pain outcomes, with male patients reporting lower pain severity (p = 0.003). Type of analgesics used was not a significant predictor of pain scoring results.

Findings suggest that provision of early palliative and supportive care is associated with lower pain severity than provision of standard care. There were significant differences in the types of analgesics used between care models, but this factor was not predictive of measured pain severity.

• The study has baseline sample and group differences of import.  
• The study has risk of bias due to no control group, no blinding, no random assignment, and no appropriate attentional control condition.
• Measurement validity and reliability are questionable.
• Pain was measured at only a single time point.
• Duration of palliative care and time since diagnosis for the entire sample are not described.
• There is limited information about content of standard care as well as overall pain management approaches in all patients.

This study design is associated with multiple limitations and threats to validity, so results cannot be seen as conclusive. Findings do suggest that an integrated care delivery model, incorporating holistic palliative and supportive care that is initiated early in the course of cancer care, may be associated with greater control of cancer-related pain.