Adequacy of Cancer-Related Pain Treatments and Factors Affecting Proper Management in Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia

Abstract

Background. Cancer-related pain (CRP) is a major problem with a potential negative impact on quality of life of the patients and their caregivers. Purpose. To assess the adequacy of cancer-related pain management in Ayder Comprehensive Specialized Hospital (ACSH). Methodology. A facility-based cross-sectional study design was conducted in ACSH from January to March 2019. A well-structured professional-assisted questionnaire using Brief Pain Inventory-Short Form (BPI-SF) was used to collect data concerning the severity of pain, functioning interference, and adequacy of pain management in cancer patients. Data were analyzed using SPSS v.21. Result. Out of 91 participants, 47 (51.6%) were male and 52 (57.1%) were between the age group of 18–45, with the mean age of 44.8 ± 13.6 years. According to the pain assessment tool (BPI), 85 (93.4%) patients experienced pain and 90 (98.9%) patients had activity interference; negative pain management index (PMI) was observed in 40 (43.95%) patients, showing that 43.95% were receiving inadequate pain management. Out of 38 patients who received no analgesics, 35.2% were found to have inadequate pain management, whereas those who took strong opioids had 100% effective pain management and the majority of the patients were in stage III. Among 38 (41.76%) only 20 (52.63%) received adequate pain management, based on patients’ self-report in which 18.7% of the participants stated that they got 30% pain relief and only 1.1% got 90% relief. The predictors of undertreatment were presence of severe pain, metastasis, comorbidity, and stage of the cancer and could also be due to the educational level and monthly income, as evidenced by significant association. Conclusion. This study suggests that cancer pain management in ACSH was sufficient for only 56%. However, large numbers of individuals are suffering from a manageable pain. Hence, remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice.

Factors associated with adherence to guidelines in cancer pain management among adult patients evaluated at oncology unit, in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

“…But this study is higher than a study in Libya, 3.87% of patients were associated with poor adherence to guidelines in cancer pain management ( 8 ). On the other hand, this study is lower than a study conducted in a similar setting (UoGCSH) 5 years before (65%) ( 16 ) and Ayder Comprehensive Specialized Hospital (43.95%) ( 18 ) in Ethiopia, in Japan (70%) ( 7 ), and in Punjab, India (77%) ( 9 ). This might be due to the difference in socioeconomic status, the patient's inability to communicate the intensity of his or her pain, and the patient's culture ( 9 ).…”

“…The sample size for this study is determined using a single population proportion formula by considering the prevalence of 43.95% from the study done in the same setting 5 years ago ( 18 ), 95% CI, 5% margin of error.…”

“…Different factors contributed to poor adherence to guidelines in cancer pain management, such as the differences in socioeconomic status, inequality of access to a doctor and medication, inappropriate use, and fear of opioids due to patients' cultural attitudes regarding pain and the use of opioid medications ( 13 – 15 ). Studies also showed that factors such as sex ( 17 ), presence of metastasis ( 16 , 18 ), comorbidity ( 18 ), stage of cancer ( 18 ), educational level ( 16 – 18 ), and monthly income ( 18 ) have a significant association with poor adherence to guidelines in cancer pain management. The WHO estimates that 80% of the world population has insufficient access to appropriate opioid analgesics such as morphine ( 19 , 20 ).…”

“…As far as our search, despite there being only two studies in the country that tried to assess the prevalence of adequate cancer pain management ( 16 , 18 ), there were small sample sizes (<100) which makes it difficult to generalize for all source populations.…”

A cross-sectional assessment of symptom burden among patients with advanced cervical cancer

“…This finding is comparable to a previous study in Ethiopia which documented that 80% of non-communicable diseases experience moderate to severe pain [ 26 ]. Other studies in Ethiopia, among patients with chronic diseases, also reported that over three-quarters of them experienced pain [ 27 , 28 ]. The prevalence of pain was very high compared to a study done amongst Portuguese cancer patients [ 19 ], which reported a prevalence of 42%; the pain prevalence was also higher than studies done in other countries: in Japan among cancer patients (66%), [ 22 ], in the UK and Germany among cancer patients (62%), [ 18 ], and in the Czech Republic among patients with chronic diseases including cancer (52%), [ 29 ].…”