Is percutaneous cervical cordotomy underused for cancer pain in the UK?

  • Poolman M & al.
  • BMJ Support Palliat Care
  • 27 Mar 2020

  • curated by Dawn O'Shea
  • UK Medical News
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Percutaneous cervical cordotomy (PCC) is a safe and effective treatment for cancer pain, but UK patients receive the treatment quite late, concludes a study published in BMJ Supportive and Palliative Care.

The analysis looked at data for 159 PCCs performed from 1 January 2012 to 6 June 2017 in three UK centres. Median age was 66 years, and 47 PCCs (30%) were performed in females. Mesothelioma was the most common primary malignancy (57%).

The median time from cancer diagnosis to PCC assessment was 13.3 months. The median time from PCC to follow-up was nine days. Median survival after PCC was 1.3 months.

The findings suggest patients are receiving the procedure late in their disease trajectory, averaging just over a month before their death.

The mean for ‘average pain’ using a numerical rating scale was 6 before PCC and 2 at follow-up, and for ‘worst pain’, it was 9 and 3, respectively. The median reduction in strong opioid dose at follow-up was 50 per cent.

With the exception of ‘activity’, all health-related quality of life scores (five-level version of EuroQol-5 Dimension) either improved or were stable after PCC.

Six patients (4%) had PCC-related adverse events.

The authors say the results support the role of PCC as an effective and safe treatment for cancer-related pain. They recommended referring suitable patients early, rather than progressing through multiple types of analgesia.