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Percutaneous cervical cordotomy for cancer-related pain: prospective multimodal outcomes evaluation
  1. Aimee Doyle1,2,
  2. Manohar Lal Sharma2,
  3. Manish Gupta2,
  4. Andreas Goebel3,4 and
  5. Kate Marley1,2
  1. 1Palliative Medicine, University Hospital Aintree, Liverpool, UK
  2. 2Pain Medicine and Neuromodulation, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
  3. 3The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
  4. 4Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
  1. Correspondence to Dr Manohar Lal Sharma, Pain Medicine and Neuromodulation, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; manohar.sharma{at}thewaltoncentre.nhs.uk

Abstract

Background Percutaneous cervical cordotomy (PCC) offers pain relief to patients with unilateral treatment-refractory cancer-related pain. There is insufficient evidence about any effects of this intervention on patients’ quality of life.

Method Comprehensive multimodal assessment to determine how PCC affects pain, analgesic intake and quality of life of patients with medically refractory, unilateral cancer-related pain.This study was set in a multidisciplinary, tertiary cancer pain service. Patient outcomes immediately following PCC were prospectively recorded. Patients were also followed up at 4 weeks.

Results Outcome variables collected included: background and breakthrough pain numerical rating scores before PCC, at discharge and 4 weeks postprocedure; oral morphine equivalent opioid dose changes, Patient’s Global Impression of Change, Eastern Cooperative oncology group performance status and health related quality of life score, that is, EuroQol-5 dimension-5 level (EQ-5D).

Conclusions Despite significant improvement in pain and other standard outcomes sustained at 4 weeks, there was little evidence of improvement in EQ-5D scores. In patients with terminal cancer, improved pain levels following cordotomy for cancer-related pain does not appear to translate into improvements in overall quality of life as assessed with the generic EQ-5D measure.

  • cancer
  • pain
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Footnotes

  • Contributors Category 1: conception and design of study: MLS, KM and MG. Acquisition of data: MLS, MG. Analysis and/or interpretation of data: MLS, KM, MG, AG and AD. Category 2: drafting the manuscript: MLS, KM, MG, AG and AD. Revising the manuscript critically for important intellectual content: MLS, MG, KM, AG and AD. Category 3: approval of the manuscript to be published: MLS, MG, KM, AG and AD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project was approved by the Walton Centre NHS Foundation Trust for service evaluation and anonymised data are submitted to national UK cordotomy registry.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.

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