AIP: Prospective Validation of a Prediction Tool for Identifying Patients at High Risk for Chemotherapy-Induced Nausea and Vomiting
Original Research
Prospective Validation of a Prediction Tool for Identifying Patients at High Risk for Chemotherapy-Induced Nausea and Vomiting
George Dranitsaris, BPharm, PhD,
Nathaniel Bouganim, MD,Carolyn Milano, Lisa Vandermeer, MSc, Susan Dent, MD, Paul Wheatley-Price, MD, Jenny Laporte, RN, Karen-Ann Oxborough, RN, Mark Clemons, MD
Abstract
Background
Even with modern antiemetic regimens, up to 20% of cancer patients suffer from moderate to severe chemotherapy-induced nausea and vomiting (CINV) (≥ grade 2). We previously developed chemotherapy cycle–based risk predictive models for ≥ grade 2 acute and delayed CINV. In this study, the prospective validation of the prediction models and associated scoring systems is described.
Objective
Our objective was to prospectively validate prediction models designed to identify patients at high risk for moderate to severe CINV.
Methods
Patients receiving chemotherapy were provided with CINV symptom diaries. Prior to each cycle of chemotherapy, the acute and delayed CINV scoring systems were used to stratify patients into low- and high-risk groups. Logistic regression was used to compare the occurrence of ≥ grade 2 CINV between patients considered by the model to be at high vs low risk. The external validity of each system was assessed via an area under the receiver operating characteristic (AUROC) curve analysis.
Results
Outcome data were collected from 97 patients following 401 cycles of chemotherapy. The incidence of ≥ grade 2 acute and delayed CINV was 13.5% and 21.4%, respectively. There was a significant correlation between the risk score and the probability of developing acute and delayed CINV following chemotherapy. Both the acute and delayed scoring systems had good predictive accuracy when applied to the validation sample (acute, AUROC = 0.70, 95% CI, 0.62–0.77; delayed, AUROC = 0.75, 95% CI, 0.69–0.80). Patients who were identified as high risk were 3.1 (P = .006) and 4.2 (P < .001) times more likely to develop ≥ grade 2 acute and delayed CINV than were those identified as low risk.
Conclusion
This study demonstrates that the scoring systems are able to accurately identify patients at high risk for acute and delayed CINV.
*For a PDF of the full article click in the link to the left of this introduction.
Prospective Validation of a Prediction Tool for Identifying Patients at High Risk for Chemotherapy-Induced Nausea and Vomiting
George Dranitsaris, BPharm, PhD,
Nathaniel Bouganim, MD,Carolyn Milano, Lisa Vandermeer, MSc, Susan Dent, MD, Paul Wheatley-Price, MD, Jenny Laporte, RN, Karen-Ann Oxborough, RN, Mark Clemons, MD
Abstract
Background
Even with modern antiemetic regimens, up to 20% of cancer patients suffer from moderate to severe chemotherapy-induced nausea and vomiting (CINV) (≥ grade 2). We previously developed chemotherapy cycle–based risk predictive models for ≥ grade 2 acute and delayed CINV. In this study, the prospective validation of the prediction models and associated scoring systems is described.
Objective
Our objective was to prospectively validate prediction models designed to identify patients at high risk for moderate to severe CINV.
Methods
Patients receiving chemotherapy were provided with CINV symptom diaries. Prior to each cycle of chemotherapy, the acute and delayed CINV scoring systems were used to stratify patients into low- and high-risk groups. Logistic regression was used to compare the occurrence of ≥ grade 2 CINV between patients considered by the model to be at high vs low risk. The external validity of each system was assessed via an area under the receiver operating characteristic (AUROC) curve analysis.
Results
Outcome data were collected from 97 patients following 401 cycles of chemotherapy. The incidence of ≥ grade 2 acute and delayed CINV was 13.5% and 21.4%, respectively. There was a significant correlation between the risk score and the probability of developing acute and delayed CINV following chemotherapy. Both the acute and delayed scoring systems had good predictive accuracy when applied to the validation sample (acute, AUROC = 0.70, 95% CI, 0.62–0.77; delayed, AUROC = 0.75, 95% CI, 0.69–0.80). Patients who were identified as high risk were 3.1 (P = .006) and 4.2 (P < .001) times more likely to develop ≥ grade 2 acute and delayed CINV than were those identified as low risk.
Conclusion
This study demonstrates that the scoring systems are able to accurately identify patients at high risk for acute and delayed CINV.
*For a PDF of the full article click in the link to the left of this introduction.
Original Research
Prospective Validation of a Prediction Tool for Identifying Patients at High Risk for Chemotherapy-Induced Nausea and Vomiting
George Dranitsaris, BPharm, PhD,
Nathaniel Bouganim, MD,Carolyn Milano, Lisa Vandermeer, MSc, Susan Dent, MD, Paul Wheatley-Price, MD, Jenny Laporte, RN, Karen-Ann Oxborough, RN, Mark Clemons, MD
Abstract
Background
Even with modern antiemetic regimens, up to 20% of cancer patients suffer from moderate to severe chemotherapy-induced nausea and vomiting (CINV) (≥ grade 2). We previously developed chemotherapy cycle–based risk predictive models for ≥ grade 2 acute and delayed CINV. In this study, the prospective validation of the prediction models and associated scoring systems is described.
Objective
Our objective was to prospectively validate prediction models designed to identify patients at high risk for moderate to severe CINV.
Methods
Patients receiving chemotherapy were provided with CINV symptom diaries. Prior to each cycle of chemotherapy, the acute and delayed CINV scoring systems were used to stratify patients into low- and high-risk groups. Logistic regression was used to compare the occurrence of ≥ grade 2 CINV between patients considered by the model to be at high vs low risk. The external validity of each system was assessed via an area under the receiver operating characteristic (AUROC) curve analysis.
Results
Outcome data were collected from 97 patients following 401 cycles of chemotherapy. The incidence of ≥ grade 2 acute and delayed CINV was 13.5% and 21.4%, respectively. There was a significant correlation between the risk score and the probability of developing acute and delayed CINV following chemotherapy. Both the acute and delayed scoring systems had good predictive accuracy when applied to the validation sample (acute, AUROC = 0.70, 95% CI, 0.62–0.77; delayed, AUROC = 0.75, 95% CI, 0.69–0.80). Patients who were identified as high risk were 3.1 (P = .006) and 4.2 (P < .001) times more likely to develop ≥ grade 2 acute and delayed CINV than were those identified as low risk.
Conclusion
This study demonstrates that the scoring systems are able to accurately identify patients at high risk for acute and delayed CINV.
*For a PDF of the full article click in the link to the left of this introduction.
Supreme Court Ruling Just the Beginning for Health Reform
Days after the landmark Supreme Court ruling declaring the Affordable Care Act to be constitutional, some uncertainties remain. While most of the law was upheld, the Court did strike down the provision withholding Medicaid funding from states who opt out of the expansion. It's unclear, yet, how many states will choose to opt out.
Meanwhile, many physician groups have voiced support for the Court's ruling. However, they continue to call for eliminating the law's Independent Payment Advisory board, implementing malpractice reform, and finding a permanent replacement to Medicare's Sustainable Growth Rate formula.
Days after the landmark Supreme Court ruling declaring the Affordable Care Act to be constitutional, some uncertainties remain. While most of the law was upheld, the Court did strike down the provision withholding Medicaid funding from states who opt out of the expansion. It's unclear, yet, how many states will choose to opt out.
Meanwhile, many physician groups have voiced support for the Court's ruling. However, they continue to call for eliminating the law's Independent Payment Advisory board, implementing malpractice reform, and finding a permanent replacement to Medicare's Sustainable Growth Rate formula.
Check out our video for more details.
Days after the landmark Supreme Court ruling declaring the Affordable Care Act to be constitutional, some uncertainties remain. While most of the law was upheld, the Court did strike down the provision withholding Medicaid funding from states who opt out of the expansion. It's unclear, yet, how many states will choose to opt out.
Meanwhile, many physician groups have voiced support for the Court's ruling. However, they continue to call for eliminating the law's Independent Payment Advisory board, implementing malpractice reform, and finding a permanent replacement to Medicare's Sustainable Growth Rate formula.
A 43-year-old woman who was BRCA1 and -2 negative presented initially in 2002, when she was 35 years old, with inflammatory breast carcinoma on the right side. She was 9 months post partum. A biopsy revealed that the tumor was estrogen-receptor (ER)/progesterone- receptor (PR) negative and HER2 (human epidermal growth factor receptor–2) positive. She received neoadjuvant chemotherapy with adriamycin plus docetaxel for 6 cycles, followed by right mastectomy and prophylactic left mastectomy. There was no residual disease in the breast. After mastectomy, the patient underwent CMF (cyclophosphamide, methotrexate, and fluorouracil) chemotherapy for 3 months, as well as radiation therapy to the chest wall. Adjuvant trastuzumab was started concurrently with the CMF chemotherapy, and was continued for 1 year.
*For a PDF of the full article, click on the link to the left of this introduction.
A 43-year-old woman who was BRCA1 and -2 negative presented initially in 2002, when she was 35 years old, with inflammatory breast carcinoma on the right side. She was 9 months post partum. A biopsy revealed that the tumor was estrogen-receptor (ER)/progesterone- receptor (PR) negative and HER2 (human epidermal growth factor receptor–2) positive. She received neoadjuvant chemotherapy with adriamycin plus docetaxel for 6 cycles, followed by right mastectomy and prophylactic left mastectomy. There was no residual disease in the breast. After mastectomy, the patient underwent CMF (cyclophosphamide, methotrexate, and fluorouracil) chemotherapy for 3 months, as well as radiation therapy to the chest wall. Adjuvant trastuzumab was started concurrently with the CMF chemotherapy, and was continued for 1 year.
*For a PDF of the full article, click on the link to the left of this introduction.
A 43-year-old woman who was BRCA1 and -2 negative presented initially in 2002, when she was 35 years old, with inflammatory breast carcinoma on the right side. She was 9 months post partum. A biopsy revealed that the tumor was estrogen-receptor (ER)/progesterone- receptor (PR) negative and HER2 (human epidermal growth factor receptor–2) positive. She received neoadjuvant chemotherapy with adriamycin plus docetaxel for 6 cycles, followed by right mastectomy and prophylactic left mastectomy. There was no residual disease in the breast. After mastectomy, the patient underwent CMF (cyclophosphamide, methotrexate, and fluorouracil) chemotherapy for 3 months, as well as radiation therapy to the chest wall. Adjuvant trastuzumab was started concurrently with the CMF chemotherapy, and was continued for 1 year.
*For a PDF of the full article, click on the link to the left of this introduction.
As a community oncologist, I fully embrace the opportunity to cure cancer, but I find the greatest services I provide are to palliate and enhance survivorship. We live in a tremendously fortunate time of scientific discovery. The weapons we have in our armamentarium of cancer killers grow in magnitude and specificity daily. Learning then to continue to balance each patient’s battle with their quality of life is practicing the art of medicine. Although most patients hope that their cancer will be cured, the daily reality of a community oncologist lies in the subtle art of helping patients to manage life with cancer and to strike the right balance between cancer control and quality of life. This management challenge really lies in the individual variability of each patient and in being able to choose the agent that fits the patient, not just the disease.
*For a PDF of the full article, click on the link to the left of this introduction.
As a community oncologist, I fully embrace the opportunity to cure cancer, but I find the greatest services I provide are to palliate and enhance survivorship. We live in a tremendously fortunate time of scientific discovery. The weapons we have in our armamentarium of cancer killers grow in magnitude and specificity daily. Learning then to continue to balance each patient’s battle with their quality of life is practicing the art of medicine. Although most patients hope that their cancer will be cured, the daily reality of a community oncologist lies in the subtle art of helping patients to manage life with cancer and to strike the right balance between cancer control and quality of life. This management challenge really lies in the individual variability of each patient and in being able to choose the agent that fits the patient, not just the disease.
*For a PDF of the full article, click on the link to the left of this introduction.
As a community oncologist, I fully embrace the opportunity to cure cancer, but I find the greatest services I provide are to palliate and enhance survivorship. We live in a tremendously fortunate time of scientific discovery. The weapons we have in our armamentarium of cancer killers grow in magnitude and specificity daily. Learning then to continue to balance each patient’s battle with their quality of life is practicing the art of medicine. Although most patients hope that their cancer will be cured, the daily reality of a community oncologist lies in the subtle art of helping patients to manage life with cancer and to strike the right balance between cancer control and quality of life. This management challenge really lies in the individual variability of each patient and in being able to choose the agent that fits the patient, not just the disease.
*For a PDF of the full article, click on the link to the left of this introduction.
Ixabepilone has been studied in the neoadjuvant setting, as first-line treatment of metastatic disease and in combination with other agents. The efficacy of ixabepilone in triple-negative breast cancer has been the focus of much research. Dose reduction is an effective strategy to manage adverse events associated with ixabepilone and does not result in diminished clinical outcomes. In addition, weekly administration of ixabepilone may decrease toxicity; however, this may come at the expense of lower progression-free survival but not overall survival. The optimal schedule and dosing of this agent will be clarified with the results of upcoming trials...
*For a PDF of the full article, click on the link to the left of this introduction.
Ixabepilone has been studied in the neoadjuvant setting, as first-line treatment of metastatic disease and in combination with other agents. The efficacy of ixabepilone in triple-negative breast cancer has been the focus of much research. Dose reduction is an effective strategy to manage adverse events associated with ixabepilone and does not result in diminished clinical outcomes. In addition, weekly administration of ixabepilone may decrease toxicity; however, this may come at the expense of lower progression-free survival but not overall survival. The optimal schedule and dosing of this agent will be clarified with the results of upcoming trials...
*For a PDF of the full article, click on the link to the left of this introduction.
Ixabepilone has been studied in the neoadjuvant setting, as first-line treatment of metastatic disease and in combination with other agents. The efficacy of ixabepilone in triple-negative breast cancer has been the focus of much research. Dose reduction is an effective strategy to manage adverse events associated with ixabepilone and does not result in diminished clinical outcomes. In addition, weekly administration of ixabepilone may decrease toxicity; however, this may come at the expense of lower progression-free survival but not overall survival. The optimal schedule and dosing of this agent will be clarified with the results of upcoming trials...
*For a PDF of the full article, click on the link to the left of this introduction.
Background The prevalence of concomitant depression among cancer survivors is not well established, although half of those diagnosed with cancer are reported to experience depression at some stage during the cancer experience.
Objectives To establish rates of diagnosed depression in a cohort of nonelderly adult cancer survivors by cancer site, to characterize those with diagnosed depression, and to assess the impact of diagnosed depression on patterns of health care utilization and costs.
Methods Medical and pharmacy claims data on military health care beneficiaries were used to develop a cohort of survivors across all cancer sites. Selected cases were diagnosed with and treated for cancer in fiscal years 2006-2007, and had at least 1 health care claim each subsequent year through fiscal year 2010 to ensure survival of at least 2 years. All cancer sites were included except those for nonmelanoma skin cancer. Fiscal year 2009 was used as the index year for determining annual health care utilization and costs. Bivariate and regression analyses were used.
Results Across the cohort of 11,014 cancer survivors, 12.6% had a comorbid diagnosis of depression at the time of or after a cancer diagnosis. The highest rates of diagnosed depression occurred in those with cancers of the esophagus, pancreas, ovary, or bronchus, lung, or other respiratory organ; and were associated with female sex, single marital status, and enlisted sponsor rank. Survivors who were diagnosed with depression had significantly higher health care utilization for inpatient and outpatient services, more medication prescriptions, and higher annual costs.
Limitations Due to the nature of claims data, we were unable to ascertain cancer stage or phase of illness. In this analysis, we did not include the presence of comorbidities, history of preexisting depression, or health system factors, all of which may impact the rate of depression among cancer survivors.
Conclusions The findings suggest the importance for the Military Health System, as well as other health care systems, to address the mental health needs of cancer survivors and the fiscal efficiencies of cancer care.
*For a PDF of the full article, click on the link to the left of this introduction.
Background The prevalence of concomitant depression among cancer survivors is not well established, although half of those diagnosed with cancer are reported to experience depression at some stage during the cancer experience.
Objectives To establish rates of diagnosed depression in a cohort of nonelderly adult cancer survivors by cancer site, to characterize those with diagnosed depression, and to assess the impact of diagnosed depression on patterns of health care utilization and costs.
Methods Medical and pharmacy claims data on military health care beneficiaries were used to develop a cohort of survivors across all cancer sites. Selected cases were diagnosed with and treated for cancer in fiscal years 2006-2007, and had at least 1 health care claim each subsequent year through fiscal year 2010 to ensure survival of at least 2 years. All cancer sites were included except those for nonmelanoma skin cancer. Fiscal year 2009 was used as the index year for determining annual health care utilization and costs. Bivariate and regression analyses were used.
Results Across the cohort of 11,014 cancer survivors, 12.6% had a comorbid diagnosis of depression at the time of or after a cancer diagnosis. The highest rates of diagnosed depression occurred in those with cancers of the esophagus, pancreas, ovary, or bronchus, lung, or other respiratory organ; and were associated with female sex, single marital status, and enlisted sponsor rank. Survivors who were diagnosed with depression had significantly higher health care utilization for inpatient and outpatient services, more medication prescriptions, and higher annual costs.
Limitations Due to the nature of claims data, we were unable to ascertain cancer stage or phase of illness. In this analysis, we did not include the presence of comorbidities, history of preexisting depression, or health system factors, all of which may impact the rate of depression among cancer survivors.
Conclusions The findings suggest the importance for the Military Health System, as well as other health care systems, to address the mental health needs of cancer survivors and the fiscal efficiencies of cancer care.
*For a PDF of the full article, click on the link to the left of this introduction.
Background The prevalence of concomitant depression among cancer survivors is not well established, although half of those diagnosed with cancer are reported to experience depression at some stage during the cancer experience.
Objectives To establish rates of diagnosed depression in a cohort of nonelderly adult cancer survivors by cancer site, to characterize those with diagnosed depression, and to assess the impact of diagnosed depression on patterns of health care utilization and costs.
Methods Medical and pharmacy claims data on military health care beneficiaries were used to develop a cohort of survivors across all cancer sites. Selected cases were diagnosed with and treated for cancer in fiscal years 2006-2007, and had at least 1 health care claim each subsequent year through fiscal year 2010 to ensure survival of at least 2 years. All cancer sites were included except those for nonmelanoma skin cancer. Fiscal year 2009 was used as the index year for determining annual health care utilization and costs. Bivariate and regression analyses were used.
Results Across the cohort of 11,014 cancer survivors, 12.6% had a comorbid diagnosis of depression at the time of or after a cancer diagnosis. The highest rates of diagnosed depression occurred in those with cancers of the esophagus, pancreas, ovary, or bronchus, lung, or other respiratory organ; and were associated with female sex, single marital status, and enlisted sponsor rank. Survivors who were diagnosed with depression had significantly higher health care utilization for inpatient and outpatient services, more medication prescriptions, and higher annual costs.
Limitations Due to the nature of claims data, we were unable to ascertain cancer stage or phase of illness. In this analysis, we did not include the presence of comorbidities, history of preexisting depression, or health system factors, all of which may impact the rate of depression among cancer survivors.
Conclusions The findings suggest the importance for the Military Health System, as well as other health care systems, to address the mental health needs of cancer survivors and the fiscal efficiencies of cancer care.
*For a PDF of the full article, click on the link to the left of this introduction.
Axitinib is a second-generation inhibitor of vascular endothelial growth factor receptors (VEGFR) 1, 2, and 3 that exhibits increased potency in VEGFR inhibition and reduced off-target effects compared with first-generation inhibitors. The phase 3 AXIS trial recently compared axitinib with the VEGFR inhibitor sorafenib in the second-line treatment of advanced renal cell carcinoma (RCC). The trial is the first phase 3 trial to directly compare antiangiogenesis agents in this setting.1
*For a PDF of the full article and an accompanying Commentary, click on the links to the left of this introduction.
Axitinib is a second-generation inhibitor of vascular endothelial growth factor receptors (VEGFR) 1, 2, and 3 that exhibits increased potency in VEGFR inhibition and reduced off-target effects compared with first-generation inhibitors. The phase 3 AXIS trial recently compared axitinib with the VEGFR inhibitor sorafenib in the second-line treatment of advanced renal cell carcinoma (RCC). The trial is the first phase 3 trial to directly compare antiangiogenesis agents in this setting.1
*For a PDF of the full article and an accompanying Commentary, click on the links to the left of this introduction.
Axitinib is a second-generation inhibitor of vascular endothelial growth factor receptors (VEGFR) 1, 2, and 3 that exhibits increased potency in VEGFR inhibition and reduced off-target effects compared with first-generation inhibitors. The phase 3 AXIS trial recently compared axitinib with the VEGFR inhibitor sorafenib in the second-line treatment of advanced renal cell carcinoma (RCC). The trial is the first phase 3 trial to directly compare antiangiogenesis agents in this setting.1
*For a PDF of the full article and an accompanying Commentary, click on the links to the left of this introduction.
Community Oncology Podcast - Ruxolitinib for myelofibrosi
Dr. David Henry takes you on an audio tour of the June issue, including reviews of ruxolitinib for myelofibrosis, advances in the treatment of medullary thyroid cancer, and biosimilars. Also, original research on recurrence and survival in early-stage triple-negative breast cancer.
Dr. David Henry takes you on an audio tour of the June issue, including reviews of ruxolitinib for myelofibrosis, advances in the treatment of medullary thyroid cancer, and biosimilars. Also, original research on recurrence and survival in early-stage triple-negative breast cancer.
Dr. David Henry takes you on an audio tour of the June issue, including reviews of ruxolitinib for myelofibrosis, advances in the treatment of medullary thyroid cancer, and biosimilars. Also, original research on recurrence and survival in early-stage triple-negative breast cancer.
The U.S. Supreme Court, in a 5-4 ruling, upheld the constitutionality of most provisions of the Affordable Care Act on June 28. Democrats claimed victory while Republicans resolved to repeal the law in Congress and use the justice's comments as ammunition against President Obama in the coming election. See our video for more details.
The U.S. Supreme Court, in a 5-4 ruling, upheld the constitutionality of most provisions of the Affordable Care Act on June 28. Democrats claimed victory while Republicans resolved to repeal the law in Congress and use the justice's comments as ammunition against President Obama in the coming election. See our video for more details.
The U.S. Supreme Court, in a 5-4 ruling, upheld the constitutionality of most provisions of the Affordable Care Act on June 28. Democrats claimed victory while Republicans resolved to repeal the law in Congress and use the justice's comments as ammunition against President Obama in the coming election. See our video for more details.
Perceived Levels of Pain Associated with Bone Marrow Aspirates and Biopsies
Original research
Perceived Levels of Pain Associated with Bone Marrow Aspirates and Biopsies
Giampaolo Talamo, MD; Jason Liao, PhD; Jamal Joudeh, MD; Nicholas E. Lamparella, DO; Hoang Dinh, PA; Jozef Malysz, MD; W. Christopher Ehmann, MD
Abstract
Background
Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB).
Objective
To evaluate the effectiveness of several strategies aimed at reducing the pain score.
Methods
We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner.
Results
On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels.
Conclusions
Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores.
*For a PDF of the full article click in the link to the left of this introduction.
Perceived Levels of Pain Associated with Bone Marrow Aspirates and Biopsies
Giampaolo Talamo, MD; Jason Liao, PhD; Jamal Joudeh, MD; Nicholas E. Lamparella, DO; Hoang Dinh, PA; Jozef Malysz, MD; W. Christopher Ehmann, MD
Abstract
Background
Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB).
Objective
To evaluate the effectiveness of several strategies aimed at reducing the pain score.
Methods
We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner.
Results
On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels.
Conclusions
Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores.
*For a PDF of the full article click in the link to the left of this introduction.
Original research
Perceived Levels of Pain Associated with Bone Marrow Aspirates and Biopsies
Giampaolo Talamo, MD; Jason Liao, PhD; Jamal Joudeh, MD; Nicholas E. Lamparella, DO; Hoang Dinh, PA; Jozef Malysz, MD; W. Christopher Ehmann, MD
Abstract
Background
Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB).
Objective
To evaluate the effectiveness of several strategies aimed at reducing the pain score.
Methods
We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner.
Results
On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels.
Conclusions
Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores.
*For a PDF of the full article click in the link to the left of this introduction.
