More time in a community setting: A service evaluation of the impact of intrathecal drug delivery systems on place of care of patients with cancer pain

Mitchell, A., Somerville, L., Williams, N., McGhie, J., McConnachie, A. , McGinn, G. and Lee, J. (2023) More time in a community setting: A service evaluation of the impact of intrathecal drug delivery systems on place of care of patients with cancer pain. Palliative Medicine, (doi: 10.1177/02692163231191548) (PMID:37632373) (Early Online Publication)

Abstract

Background: Intrathecal Drug Delivery Systems are underutilised in the management of refractory cancer pain despite evidence of their efficacy. Not all patients who are offered this treatment modality accept it. There is no current evidence that indicates if the use of intrathecal drug delivery systems impacts on place of care for patients with cancer related pain. Aims: This service evaluation compared place of care, place of death and morphine equivalent daily dose at end of life for patients in whom Intrathecal Drug Delivery was successfully established versus those who chose comprehensive medical management. Setting/participants: A retrospective longitudinal cohort study of 45 patients with cancer pain comparing those who had ongoing analgesia successfully delivered via an implanted Intrathecal Drug Delivery System (n = 28) with those who continued to receive comprehensive medical management (n = 17). Results: There was a markedly greater time spent in the community in the intrathecal group than the medical management group (median 126.5vs 25.5 days; p = 0.002) and a lower morphine equivalent daily dose at end of life (median 127.5vs 440.0 p = 0.022). Conclusion: In patients with advanced cancer, the successful establishment of intrathecal analgesia is associated with more time in the community and a lower morphine equivalent daily dose at end of life. The study has low numbers, and the sample was retrospectively selected. Nevertheless, these findings suggest the initial investment of time in an inpatient setting may be beneficial. Further research is required, using larger, prospective studies of patient outcomes in this setting.

• Item Type: Articles
• Additional Information: Funding. The author(s) disclosed receipt of the following financial sup-port for the research, authorship, and/or publication of this article: Statistical analysis was funded by NHSGGC Endowment Fund.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McConnachie, Professor Alex and Lee, Miss Jiyoung
• Authors: Mitchell, A., Somerville, L., Williams, N., McGhie, J., McConnachie, A., McGinn, G., and Lee, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Palliative Medicine
• Publisher: SAGE Publications
• ISSN: 0269-2163
• ISSN (Online): 1477-030X
• Published Online: 26 August 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Palliative Medicine, 2023
• Publisher Policy: Reproduced in accordance with the publisher policy