Tumori Journal Abstract Book - October 2020 - 175

S - Management of Cancer Pain	

175

S15

S16

High utility of early supportive
care: prevention of complications
and improvement of the quality
of life in cancer patients in Covid
19 Era

Have we changed our work
during Covid19 pandemic?

Parascandolo I.1, Russo P.2, Simioli R.3, Franzese E.3, Nuzzolillo L.4,
Facciuti P.5
1

2

3

Asl Napoli, Napoli; Asl Napoli 2 Nord IOC Oncologia, Napoli; Asl Napoli 2
Nord, Napoli; 4Asl Caserta, Napoli; 5Asl Napoli 3 Sud, Napoli

Background: Early palliative care management in
advanced cancer patients have been evaluated in numerous studies worldwide. We have monitored 127 cancer
patients followed at home and we have collected information on the importance of the early management of supportive / palliative care together with anticancer therapy
to prevent complications such as cachexia, hyperalgesia,
constipation, insomnia.
Methods: On their first visit, patients were subjected to
evaluation with ESAS Pall Score for a quantification of
QOL and KarnofskyPS. At the end of January 2020, due
to the Pandemic disease from Sars Cov 2, patients were
monitored in a protected path in order to avoid hospitalizations from Covid19 (interstitial pneumonia and multiorgan syndrome).
Results: 127 patients we followed in 6 months with fortnightly visits, 19 of whom died from disease progression.
The 108 patients on therapy were divided into two groups in
relation to the Karnofsky PS: the first group with patients
with a KPS> 50 and the second group with patients with a
KPS <50. Early supportive therapies were activated in both
groups: nutritional support has been applied with ONS in 43
patients. 11 patients used the gastric nasal tube for feeding.
32 had no nutritional support needs. The others received
parenteral nutrition through a central venous catheter, with
lipid bags. We measured oncological pain with NRS in all
visits, in order to manage it, and we administered analgesic
therapy to patients, using different therapeutic strategies.
Dysphagic patients used transdermal fentanyl patch and
nasal fentanyl spray to relief BTCP. Non-dysphagic patients
used oxycodone / naloxone or tapentadol titrated in oral
morphine, to control neuropathic / nociceptive / mixed pain
in basic therapy and ROOs to relief the BTCP, measured
with the algorithm. In a subset of 21 patients, pregabalin
was added in the evening with a single dose, in order to
improve sleep quality. Control of opioid constipation was
achieved by using oral tablet naloxegol.
Conclusions: The parameters measured through validated
assessments (ESAS) to evaluate QOL and KPS have
shown that early management of supportive / palliative
care improves pain, nutrition, depression, sleep / wake
rhythm and QOL independently of the basic Karnofsky
Performance Status.

Bagassi A.1, Antoniazzi F.2, Ghelfi S.1, Geronimi C.1, De Carlo A.1,
Pedrotti C.2, Maiolani M.3, Cubeddu A.3, Caponigro G.3, Deligiannis
P.3, Fusco O.3, Pastorini A.3, Fregoni V.4, Cantini S.3, Menatti E.3,
Bertolini A.3
1
ASST della Valtellina e Alto Lario-Cure Palliative, Morbegno; 2ASST della
Valtellina e Alto Lario-Cure Palliative, Sondalo; 3ASST della Valtellina e Alto
Lario-Oncologia Medica, Sondrio; 4ASST della Valtellina e Alto Lario-Breast
Unit, Sondalo

Background: Pain is one of the most debilitating symptoms in oncological diagnosis, and is present in most cancer patient (in the literature range 20 to 95%).
Cancer pain is a chronic pain with multifactorial pathogenesis with which intense episodic transient acute pain can
coexist (Btcp).
Hence the need to assess / correctly measure pain to set an
appropriate drug therapy (treatment based on the "three
steps of pain" -OMS 1986-) and it is possible to have a
more objective evaluation of the results of the established
analgesic therapy.
During the emergency period, outpatient visits were
reduced both in terms of organization and frequency and
the reduction in the number of doctors available and the
limitations of patient access to hospital clinics for their
protection led to a new approach to taking load.
Material (patients) and methods: Experience of our
center, from 1 March 2020 to 31 May 2020, during the
covid 19 emergency compared with the pre-covid period
from 1 November 2019 to 31 January 2020 regarding the
evaluation of pain, the need to set specific analgesic therapy, the need to modify this therapy in the course of time
(switching between opioids or association between opioids
of two different classes) and the need to add adjuvant drugs.
Results: During this time we followed 15 patients versus 17
patients in pre-covid period. Pain was measured in all the first
evaluation (using one-dimensional measurement scales numerical scale -), in 90% of cases this was done by telephone
(versus 0% pre covid). Furthermore, the cargiver's telephone
involvement was necessary, especially in monitoring over
time to evaluate pain control, Btcp episodes and side effects
(in the pre-covid period it was the patient who exposed these
data during the visit). On the other hand, as regards the specific analgesic therapy set, the need to rotate the opioids or to
associate two opioids of different classes, the prescription of
the rescue dose and the adjuvant drugs, there were no differences compared to the pre-emergency period.
Conclusions: During the emergency period, in consideration of the high frequency of pain and the impact on the
patient's quality of life, it was necessary to modify our
approach to manage the patient with cancer, make a correct assessment (repeated over time) and set up an effective analgesic therapy.



Tumori Journal Abstract Book - October 2020

Table of Contents for the Digital Edition of Tumori Journal Abstract Book - October 2020

Contents
Tumori Journal Abstract Book - October 2020 - Cover1
Tumori Journal Abstract Book - October 2020 - Cover2
Tumori Journal Abstract Book - October 2020 - I
Tumori Journal Abstract Book - October 2020 - II
Tumori Journal Abstract Book - October 2020 - Contents
Tumori Journal Abstract Book - October 2020 - IV
Tumori Journal Abstract Book - October 2020 - V
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Tumori Journal Abstract Book - October 2020 - Cover3
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