Implementing practice change in chronic cancer pain management: clinician response to a phase III study of ketamine

Area of Science:

• Palliative Care
• Pain Management
• Clinical Pharmacology

Background:

• A large randomized controlled trial demonstrated no net clinical benefit of subcutaneous ketamine compared to placebo for cancer pain refractory to standard treatments.
• Trial results were disseminated internationally, prompting an investigation into its impact on clinical practice.

Purpose of the Study:

• To assess the influence of a major randomized controlled trial on the clinical practice of pain management in Australasia.
• To understand how clinicians perceived and responded to evidence regarding ketamine use in refractory cancer pain.

Main Methods:

• An online survey was distributed to members of the Australia and New Zealand Society of Palliative Medicine.
• The survey collected data on ketamine prescribing habits and awareness of a key clinical trial.

Main Results:

• A 31% response rate (123/392 clinicians) was achieved, with most respondents having over 10 years of experience.
• 91% of clinicians had prescribed ketamine, and 92% were aware of the trial. Consequently, 65% reported practice changes, primarily reducing or becoming more selective in its use.
• Reasons for practice change included trial findings, toxicity concerns, and availability of alternative treatments. Thirty-five percent of clinicians did not alter their practice.

Conclusions:

• Two-thirds of surveyed clinicians modified their practice following the trial, indicating significant impact.
• A minority of clinicians remain unconvinced of the trial's findings, preferring to rely on personal observations and seeking further evidence for ketamine's efficacy.