Hopkins Kimmel Cancer Center

Rome, MD, United States

Hopkins Kimmel Cancer Center

Rome, MD, United States

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Dy S.M.,Johns Hopkins University | Dy S.M.,Hopkins Kimmel Cancer Center
Cancer Journal | Year: 2010

Pain is a source of suffering in most advanced cancer patients, but many effective treatments exist. We updated previous systematic reviews on cancer pain treatment with targeted literature searches. Addressing pain involves comprehensive assessment, including other symptoms and sources of distress and barriers to pain management, and investigating potential etiologies and oncological emergencies when potential benefits exceed burdens. Initial treatment may involve acetaminophen or nonsteroidal anti-inflammatory agents, although opioids should be considered quickly if not effective or for severe pain. The initial approach also includes education and psychosocial interventions as appropriate. Neuropathic pain and bony pain may require specific interventions if initial treatment is not effective; the best evidence supports the use of gabapentin and single-fraction radiation, respectively. Potential spinal cord compression requires urgent evaluation and treatment. Most cancer pain can be effectively addressed with an evidence-based approach of medications, nonpharmacological approaches, and interventions when appropriate. Copyright © 2010 by Lippincott Williams & Wilkins.


Dy S.M.,Hopkins Kimmel Cancer Center
Journal of Supportive Oncology | Year: 2013

Oncology quality measurement programs should include measures in key domains of palliative care and supportive oncology. This article describes an approach to quality measurement in these areas including the key steps of defining the quality measurement goal; identifying stakeholders and audiences; defining the population and setting (including potential characteristics of interest, such as specific conditions or disparities); and choosing the domain, target, and steps in the process of care, such as assessment and treatment. Other key steps include choosing or adapting measures that have been evaluated in other settings or are in widespread use; identifying data sources or collection needs; and considering issues of scientific acceptability, such as evidence to support process-outcome relationships. Other quality measurement considerations include the challenges of measurement, particularly in important domains such as communication and spiritual care, variation in patient preferences, or inconsistent documentation. In addition, potential unintended consequences, such as measurement burden and overemphasis of checklist care, may reduce patient-centeredness and attention to important patient concerns not addressed by quality measures. © 2013 Frontline Medical Communications.

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