B103
The role of cordotomy in the management of mesothelioma-related pain in the UK (The INPIC Pilot Study) (Invasive Procedures In Cancer Pain)
Matthew Makin1, John Ellershaw2, Austin Leach3, Marlise Poolman4
1North Wales NHS Trust, UK, 2Marie Curie Palliative Care Institute Liverpool, UK, 3National Refractory Angina Centre, Liverpool, UK, 4Cardiff University, UK, 5Glyndwr University, Wrexham, UK, 6Liverpool University, UK
We report on an NCRI-funded UK-wide pilot study on the use of cordotomy in cancer pain and the potential of using the proposed research methodology to study wider topics in palliative care.
Background
There are around 1800 new cases of mesothelioma annually in the UK and the incidence is rising. Symptom control is central to the management of patients with mesothelioma as the disease is often associated with difficult pain syndromes resistant to pharmacological approaches. The National Mesothelioma Framework (UK 2007) indicated that patients should have access to cordotomy as a palliative intervention.
There is great inequity in service provision offering cordotomy in the UK and the level of evidence to support provision is poor. The procedure may yield significant analgesic benefit, but has an unquantified risk of associated morbidity.
Aim
We received a NCRI Lung Cancer SuPaC Research Award to
(1) systematically review the literature examining the evidence-base of cordotomy use
(2) to use Consensus methodology to clarify the role of cordotomy, provide a benchmark for the availability and produce national guidelines for use of this procedure
(3) in partnership with Industry to set up a National Register (UK) for Cordotomy.
We anticipate that the study will produce a more reasoned and robust governance framework to guide clinicians and commissioners on the use of cordotomy in mesothelioma-related pain management. The benefit will be a more equitable and effective service provision for patients. The registry and subsequent registry reports will inform clinicians more fully on the outcomes of the intervention, and hence aid the users in making informed choices.
If the methodology is successful, we plan to apply it to other interventional procedures in the cancer pain management. The methodology also lends itself to study wider palliative care interventions on a national, and even international basis.
