Pruritus as an unmet palliative care need in cancer patients: A retrospective cohort study of a Duke patient-reported outcomes database.
97 Background: For cancer patients, the impact of pruritus is not well known, and may be increasing in incidence and severity for those receiving targeted agents. We aimed to describe pruritus in patients with solid tumors, assessing the incidence, pattern, treatments, and associations with cancer types and therapies. Methods: From 2009-2011, patients seen in the Duke Cancer Institute solid tumor clinics directly reported their symptoms on electronic tablets as part of routine care, using Patient Care Monitor 2.0. Of the resulting 17,338 encounters, >1,000 patients reported moderate-severe itching (score of >3 out of 10). The analysis cohort included 215 patients who reported severe itching (>6 out of 10) on at least one visit (total visits = 536). We reviewed charts to abstract demographics, diagnosis, stage, cancer therapy, comorbidities, anti-pruritus therapy, and provider response, and applied descriptive statistics and chi-square analyses. Results: Most patients had advanced disease (56% stage IV), and had breast (36%), lung (23%), kidney (8%), colorectal (6%), or prostate cancer (5%). Thirty percent were not on active therapy, 27% were receiving a targeted therapy, 29% were receiving cytotoxic chemotherapy, and 14% were receiving both. Pruritus persisted in 56% of patients, and resolved but recurred in 10%. Patients receiving chemotherapy were more likely to have severe rather than moderate pruritus (p 0.01), while those receiving targeted drugs were more likely to have persistent pruritus (p 0.03). Potentially high-risk targeted therapies including EGFR inhibitors, multi-kinase inhibitors, and mTOR inhibitors were not associated with severity or persistence of pruritus. Only 20% of patients were receiving an anti-pruritus treatment. Clinicians documented discussing pruritus in just 28% of cases, and addressed it directly only 10% of the time. Only 5% of patients were started on a new anti-pruritus treatment. Conclusions: Pruritus is common among patients with advanced cancer, and occurs across a range of cancer types and treatments. Pruritus is frequently not recognized or addressed by clinicians, and appears to be an unmet palliative care need in oncology.
Hudson, KE; Wolf, SP; Pupa, MR; King, DG; Locke, SC; Abernethy, AP; LeBlanc, TW
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