Cancer is the second leading cause of death worldwide, with approximately 18.1 million new cases and 9.6 million deaths reported in 2018. Cancer-related pain is experienced by 50-70% of patients, with a higher prevalence at advanced disease stages (66.4%). Since the development of WHO's cancer pain guidelines, several studies have reported good relief of symptoms and suffering for a majority of patients. Recent reports suggest that up to 50% of patients still report insufficient pain control. Patients with cancer often present with multiple symptoms and functional decline. Evidence supports multidisciplinary approaches to address symptoms and suffering, including early palliative care referral From review literatures we found that the telemedicine group had significantly higher quality of life than the usual care group. In addition, the telemedicine group had lower anxiety and depression scores than the usual care group. Therefore, we will conduct the non-randomized controlled study of using telemedicine comparing to conventional in-person at OPD in hospitalized cancer pain patients. The purpose of this study is to assess the pain interference by using the Brief Pain Inventory (BPI) and to compare between the in-person group and the telemedicine group. To assess the cost-effectiveness of telemedicine for reducing symptoms associated with cancer and its treatment.
The pain interference will be assessed and compared using Brief Pain Inventory from 0-70 between In-person group and telemedicine group at 1 month.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
QUADRUPLE
Enrollment
193
Telemedicine
In-person
Faculty of medicine Siriraj Hospital Mahidol University
Bangkoknoi, Bangkok, Thailand
Pain interference
The pain interference will be assessed and compared using Brief Pain Inventory from 0-70 between In-person group and telemedicine group.
Time frame: at 1 month
Pain intensity
The pain intensity from BPI (Brief Pain Inventory), including worst, least, average, and current pain reduction, will be assessed and compared using the numerical rating (NRS) from 0-10; 0 designating "no pain" and 10 designating " worst possible pain" scale between the in-person group and the telemedicine group.
Time frame: at 1 month, 2 months and 3 months
Quality of life (QoL)
The quality of life will be assessed and compared using EuroQoL 5D5L between In-person group and telemedicine group.
Time frame: at 1 month
Functional status
Functional status evaluated using Palliative Performance Status Score
Time frame: At baseline, 1 month, 2 month, 3 month
Opioid consumption
Opioid consumption is recorded using the Morphine Equivalent Daily Dosage
Time frame: At baseline, 1 month, 2 month and 3 month
Economic study
We conducted an economic study evaluation from the patient and caregiver perspective. Costs analyzed included direct medical costs, direct non-medical costs (such as transportation and food), and indirect costs (total productivity loss). We calculated the Incremental Cost-Effectiveness Ratio (ICER) to determine the economic value of telemedicine relative to in-person care. The ICER was defined as the incremental difference in total direct costs divided by the incremental difference in clinical effectiveness across multiple outcomes, including EQ-5D-5L utility, EQ-VAS, PPS, total BPI reduction, and avoided increases in MEDD. The results were further visualized on a cost-effectiveness plane.
Time frame: At Baseline, 1 month, 2 month and 3 month
Medication adverse effects
Medication adverse effects such as sedation, constipation and nausea and vomiting were evaluated using the sedation score, Rome IV, and 4 point scale of nausea and vomiting.
Time frame: At baseline, 1-month, 2-month and 3-month
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