Sebastiano Mercadante1, Claudio Adile2, Federica Aielli3, Lanzetta Gaetano4,5, Kyriaki Mistakidou6, Marco Maltoni7, Andrea Cortegiani8, Luiz Guilherme Soares9, Stefano De Santis10, Patrizia Ferrera2, Marta Rosati7, Romina Rossi7, Alessandra Casuccio11. 1. Main Regional Center for Pain Relief & Supportive Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90145, Palermo, Italy. terapiadeldolore@lamaddalenanet.it. 2. Pain Relief & Supportive Care, La Maddalena Cancer Center, Palermo, Italy. 3. Department of Oncology, Hospital of Teramo, Teramo, Italy. 4. Medical Oncology Unit, IRCCS Neuromed, Pozzilli, Italy. 5. Medical Oncology Unit, Italian Neuro-Traumatology Institute, Grottaferrata, Italy. 6. Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece. 7. Palliative Care Unit - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 8. Department of Anesthesioloogy, University of Palermo, Palermo, PA, Italy. 9. Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil. 10. Palliative Care and Oncologic Pain Service - S. Camillo-Forlanini Hospital, Rome, Italy. 11. Università di Palermo, Palermo, Italy.
Abstract
AIM: The aim of this study was to assess the Personalized Insomnia Intensity Goal (PIIG), the achievement of Personalized Goal Response (PGR), and Patient Global Impression (PGI) after a comprehensive symptom management. PATIENTS AND METHODS: Advanced cancer patients admitted to palliative care units rated pain and symptoms intensity and their PIIG by using the Edmonton Symptom Assessment Score (ESAS) (T0). In patients with significant levels of insomnia, the achievement of target expected (PIIG) was measured (patient goal response, PIGR), as well the patient global impression (PGI), by the minimal clinically important difference (MCID), after a comprehensive symptom management (T7). RESULTS: Three hundred ninety-seven patients with a level of insomnia of ≥ 3 on ESAS were analyzed in this study. The mean values of PIIG at T0 and T7 were 1.2 (SD 1.5) and 0.9 (SD 1.4), respectively. Most patients (n = 406, 89.8%) indicated a PIIG of ≤ 3 as a target at T0. Such target was significantly lower at T7 (p = < 0.0005). PGI, expressed as MCID, was perceived with a mean decrease in insomnia intensity of - 2.3. In a minority of patients (n = 26; 5.8%) insomnia worsened, with a MCID of 0.50 (SD 2.8). Higher insomnia intensity at T0 and lower insomnia intensity at T7 were independently related to PGI. PIGR was achieved in 87.9% of patients. PIGR was associated with PIIG at T0, and inversely associated to insomnia intensity at T0 and T7, and PIIG at T7. CONCLUSION: PGIR and PGI seem to be relevant for evaluating the effects of a comprehensive management of insomnia, suggesting therapeutic decisions according to PIIG. Some factors influencing the individual target and clinical response have been detected.
AIM: The aim of this study was to assess the Personalized Insomnia Intensity Goal (PIIG), the achievement of Personalized Goal Response (PGR), and Patient Global Impression (PGI) after a comprehensive symptom management. PATIENTS AND METHODS: Advanced cancerpatients admitted to palliative care units rated pain and symptoms intensity and their PIIG by using the Edmonton Symptom Assessment Score (ESAS) (T0). In patients with significant levels of insomnia, the achievement of target expected (PIIG) was measured (patient goal response, PIGR), as well the patient global impression (PGI), by the minimal clinically important difference (MCID), after a comprehensive symptom management (T7). RESULTS: Three hundred ninety-seven patients with a level of insomnia of ≥ 3 on ESAS were analyzed in this study. The mean values of PIIG at T0 and T7 were 1.2 (SD 1.5) and 0.9 (SD 1.4), respectively. Most patients (n = 406, 89.8%) indicated a PIIG of ≤ 3 as a target at T0. Such target was significantly lower at T7 (p = < 0.0005). PGI, expressed as MCID, was perceived with a mean decrease in insomnia intensity of - 2.3. In a minority of patients (n = 26; 5.8%) insomnia worsened, with a MCID of 0.50 (SD 2.8). Higher insomnia intensity at T0 and lower insomnia intensity at T7 were independently related to PGI. PIGR was achieved in 87.9% of patients. PIGR was associated with PIIG at T0, and inversely associated to insomnia intensity at T0 and T7, and PIIG at T7. CONCLUSION: PGIR and PGI seem to be relevant for evaluating the effects of a comprehensive management of insomnia, suggesting therapeutic decisions according to PIIG. Some factors influencing the individual target and clinical response have been detected.
Entities:
Keywords:
Advanced cancer; Global impression of change; Insomnia; Palliative care; Personalized symptom goal; Symptom assessment
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