The Characteristics and the Pharmacological Management of Cancer Pain and Its Effect on the Patients’ Daily Activities and their Quality of Life: A Cross – Sectional study from Malaysia

Abstract

Context: Pain is a major health care problem for the patients with cancer and one of the most frequent and disturbing cancer related symptoms. Aim:To study the characteristics of pain in cancer patients and its pharmacological management by using a subjective selfassessment questionnaire and the World Health Organization (WHO)analgesic ladder for pain management. Settings and Designs:This study was conducted in the Oncology Wards of Penang Hospital, Penang, Malaysia. A questionnaire was developed to assess the pain characteristics and their effect on the patients' daily life activities and the information on the pharmacological management of the cancer pain. The cancer pain intensity was noted from the patients' medical database. Material and Methods:By using the validated questionnaire, an observational, cross sectional study was conducted on the cancer patientswho were admitted in the oncology wards of Penang Hospital, Malaysia, for a period of 1 month.Statistical Analysis: Descriptive statistics like mean, frequency and percentages were used for this study. Results and Conclusion:A total of 42 patients out of 143, who fulfilled the criteria, were interviewed. The results showed mild pain in 66.7% (28) of the patients, moderate pain in 7.1% (3) and severe painin 26.2% (11). The normal daily life activities were affected by the pain in almost all the patients. Among the interviewed patients, sleep was affected in 88% (37) of the patients and the normal physical activity was affected in 92.9% (39) of the patients. Similarly, the pain decreased the appetite in 78.6% (33) of the patients, it affected the personal relation ship in 35.7% (15), it affected the emotion in 71.5% (30) and it affected the visual activity in 33.6% (13) of the patients. Mild pain with distressing symptoms was not treated with any analgesic or adjuvant medications in 40.5% (17) of the patients. In contrast, all the patients with moderate and severe pain were treated with medications. Among them, 66.7% (2) of the patients with moderate pain and 90.9% (10) of the patients with severe pain were treated with analgesics as per the WHO analgesic ladder.The WHO analgesic ladder guide for pain management was followed in a majority of the cases, when analgesics were prescribed. However, there was inadequate treatment of the cancer pain in many patients with mild pain and, consequently, their quality of life was largely affected.

Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an integrative review

“…With moderate or greater pain, there are often marked negative changes in physical or emotional functioning that interferes with the patient’s quality of life. 15 , 62 , 63 Therefore, the delineation of adequate pain relief should be within the mild or no pain categories.…”

“…Several recent studies indicate inadequate cancer pain relief still exists, but these studies also fail to indicate if the WHO guidelines were being implemented during treatment. 15 A review of studies by Deandrea et al, 71 that used the PMI, demonstrated that ∼43% of patients with cancer pain are undertreated. The PMI compares the intensity/strength of the analgesic treatment according to the WHO Analgesic Ladder with the patients’ reported pain.…”

“…Patients being treated by oncology subspecialists, however, have also been inadequately medicated for pain according to the WHO guidelines. 15 , 45 Therefore, the use of the WHO guidelines in oncology specialty areas and by the oncologists themselves cannot be assumed. In future studies, the use of the WHO guidelines to treat patients with cancer with pain should be clearly stated, consistently applied, and then evaluated with the PMI.…”

Consistency and Accuracy of Multiple Pain Scales Measured in Cancer Patients From Multiple Ethnic Groups

“…25 Previous researchers examined cancer pain targeting metastatic cancer patients, thus they may have reported a higher proportion of severe pain than the present study. 24 Others assessed cancer pain targeting all cancer patients admitted to the hospital, thus they might have more severe pain compared to cancer patients dwelling in the community in our study.…”

“…24 Others assessed cancer pain targeting all cancer patients admitted to the hospital, thus they might have more severe pain compared to cancer patients dwelling in the community in our study. 25 …”