Prevalence of pain and treatment outcomes among cancer patients in a Malaysian palliative care unit

Keywords: Pain, Pain Management, Pain Measurement, Prevalence, Palliative Care, Terminal Care, Treatment Outcome, Analgesics, Opioid, Analgesics, Non-Narcotic, Patient Reported Outcome Measures, Malaysia

Abstract

Background: Pain remains one of the most common and debilitating symptoms of advanced cancer. To date, there is a lack of studies on pain and its treatment among Malaysian palliative care patients.

Objective: This study aimed to explore the prevalence of pain and its treatment outcomes among adult cancer patients admitted to a palliative care unit in Sabah, Malaysia.

Methods: Of 327 patients screened (01/09/15-31/12/17), 151 patients with assessed self-reported pain scores based on the numerical rating scale of 0-10 (current, worst and least pain within the past 24 hours) upon admission (baseline), 24, 48 and 72 hours post-admission and discharge were included. Pain severity and pain score reductions were analysed among those who experienced pain upon admission or in the past 24 hours. Treatment adequacy was measured by the Pain Management Index (PMI) among discharged patients. The PMI was constructed upon worst scores categorised as 0 (no pain), 1 (1-4, mild pain), 2 (5-6, moderate pain), or 3 (7-10, severe pain) which is then subtracted from the most potent level of prescribed analgesic drug scored as 0 (no analgesia), 1 (non-opioid), 2 (weak opioid) or 3 (strong opioid). PMI≥0 indicated adequate treatment.

Results: Upon admission, 61.1% [95%CI 0.54:0.69] of 151 patients presented with pain. Of 123 patients who experienced pain upon admission or in the past 24 hours, 82.1% had moderate to severe worst pain. Throughout patients’ ward stay until discharge, there was an increased prescribing of analgesics and adjuvants compared to baseline, excluding weak opioids, with strong opioids as the mainstay treatment. For all pain score types (current, worst and least pain within the past 24 hours), means decreased at each time point (24, 48 and 72 hours post-admission and discharge) from baseline, with a significant decrease at 24 hours post-admission (p<0.001). Upon discharge (n=100), treatment adequacy significantly improved (PMI≥0 100% versus 68% upon admission, p<0.001).

Conclusions: Accounting for pain’s dynamic nature, there was a high prevalence of pain among cancer patients in the palliative care unit. Continuous efforts incorporating comprehensive pain assessments, evidence-based treatments and patient education are necessary to provide adequate pain relief and end-of-life comfort care.

Downloads

Download data is not yet available.

References

van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016;51(6):1070-1090. https://dx.doi.org/10.1016/j.jpainsymman.2015.12.340

Daut RL, Cleeland CS. The prevalence and severity of pain in cancer. Cancer. 1982;50(9):1913-1918.

Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto, Apolone G. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol. 2014;32(36):4149-4154. https://dx.doi.org/10.1200/JCO.2014.56.0383

Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994;330(9):592-596. https://dx.doi.org/10.1056/NEJM199403033300902

World Health Organization. Cancer Pain Relief: With a Guide to Opioid Availability. Geneva: WHO; 1996.

NCCN Clinical Practice in Oncology (NCCN Guidelines®) Palliative Care. Version 1. 2019. Available on https://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf (accessed Dec 18, 2018).

Lim R. Improving cancer pain management in Malaysia. Oncology. 2008;74(Suppl 1):24-34. https://dx.doi.org/10.1159/000143215

Oommen R. A palliative care programme in Malaysia. Indian J Palliat Care 2005;11:49-52. https://dx.doi.org/10.4103/0973-1075.16646

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-655.

Bates BP, Bates BR, Northway DI. PQRST: A mnemonic to communicate a change in condition. J Am Med Dir Assoc. 2002;3(1):23-25.

PQRST Pain Assessment Method. http://www.crozerkeystone.org/healthcare-professionals/nursing/pqrst-pain-assessment-method/ (accessed Jun 5, 2018).

Clinical Practice Guidelines: Management of Cancer Pain Guideline Development Group, Ministry of Health Malaysia; July 2010.

Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995;61(2):277-284.

Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23(2):129-138.

NCCN Clinical Practice in Oncology (NCCN Guidelines®) Adult Cancer Pain. Version 2. 2017. Available on https://www.nccn.org/professionals/physician_gls/pdf/pain.pdf (accessed Jun 5, 2018).

Robert Twycross AW, Paul Howard PCF5+ Palliative Care Formulary. palliativedrugs.com Ltd; 2015.

Deandrea S, Montanari M, Moja L, Apolone G. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol. 2008;19(12):1985-1991. https://dx.doi.org/10.1093/annonc/mdn419

Black B, Herr K, Fine P, Sanders S, Tang X, Bergen-Jackson K, Titler M, Forcucci C. The relationships among pain, nonpain symptoms, and quality of life measures in older adults with cancer receiving hospice care. Pain Med. 2011;12(6):880-889. https://dx.doi.org/10.1111/j.1526-4637.2011.01113.x

Kang JH, Kwon JH, Hui D, Yennurajalingam S, Bruera E. Changes in symptom intensity among cancer patients receiving outpatient palliative care. J Pain Symptom Manage. 2013;46(5):652-660. https://dx.doi.org/10.1016/j.jpainsymman.2012.11.009

Shin DW, Choi JE, Miyashita M, Choi JY, Kang J, Baik YJ, Mo HN, Park J, Kim HJ, Park EC. Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care. J Pain Symptom Manage. 2011;41(2):478-484. https://dx.doi.org/10.1016/j.jpainsymman.2010.05.009

Bradley N, Davis L, Chow E. Symptom distress in patients attending an outpatient palliative radiotherapy clinic. J Pain Symptom Manage. 2005;30(2):123-131. https://dx.doi.org/10.1016/j.jpainsymman.2005.02.015

Caraceni A, Portenoy RK. An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain. Pain. 1999;82(3):263-274.

Portenoy RK, Ahmed E. Cancer Pain Syndromes. Hematol Oncol Clin North Am. 2018;32(3):371-386. https://dx.doi.org/10.1016/j.hoc.2018.01.002

Toshiyuki N, Kimura T, Suzumura T, Yoshimoto N, Oka T, Yamamoto N, Matsuura K, Mitsuoka S, Asai K, Tochino Y, Yoshimura N, Kawaguchi T, Kudoh S, Matsuoka T , Ohsawa M, Hirata K. The macroscopic appearance of computed tomography-guided needle biopsy specimens correlates with tumor metastasis in non-small cell lung cancer. Osaka City Med J. 2015;61(2):105-112.

Reis-Pina P, Acharya A, Lawlor PG. Cancer pain with a neuropathic component: a cross-sectional study of its clinical characteristics, associated psychological distress, treatments, and predictors at referral to a cancer pain clinic. J Pain Symptom Manage. 2018;55(2):297-306. https://dx.doi.org/10.1016/j.jpainsymman.2017.08.028

Stjernsward J. WHO cancer pain relief programme. Cancer Surv. 1988;7(1):195-208.

Stjernsward J, Colleau SM, Ventafridda V. The World Health Organization Cancer Pain and Palliative Care Program. Past, present, and future. J Pain Symptom Manage. 1996;12(2):65-72.

Khan MI, Walsh D, Brito-Dellan N. Opioid and adjuvant analgesics: compared and contrasted. Am J Hosp Palliat Care. 2011;28(5):378-383. https://dx.doi.org/10.1177/1049909111410298

Mercadante S, Bruera E. Opioid switching in cancer pain: From the beginning to nowadays. Crit Rev Oncol Hematol. 2016;99:241-248. https://dx.doi.org/10.1016/j.critrevonc.2015.12.011

Lee DZF, Kiu DKF, Voon PJ. Pain control among cancer patients receiving strong opioids and their perspective towards opioids in a developing coiuntry with a diverse multicultural background. Ann Oncol. 2018;29(suppl 9):439P. https://dx.doi.org/10.1093/annonc/mdy444.019

Flemming K. The use of morphine to treat cancer-related pain: a synthesis of quantitative and qualitative research. J Pain Symptom Manage. 2010;39(1):139-154. https://dx.doi.org/10.1016/j.jpainsymman.2009.05.014

Koh SJ, Keam B, Hyun MK, Ju Seo J, Uk Park K, Oh SY, Ahn J, Lee JY, Kim J. Cancer pain management education rectifies patients' misconceptions of cancer pain, reduces pain, and improves quality of life. Pain Med. 2018;19(12):2546-2555. https://dx.doi.org/10.1093/pm/pny039

Fink RM, Brant JM. Complex Cancer Pain Assessment. Hematol Oncol Clin North Am. 2018;32(3):353-369. https://dx.doi.org/10.1016/j.hoc.2018.01.001

Published
2019-03-18
How to Cite
1.
Mejin M, Keowmani T, Abdul Rahman S, Liew J, Lai J, Chua M, Che Wan I. Prevalence of pain and treatment outcomes among cancer patients in a Malaysian palliative care unit. Pharm Pract (Granada) [Internet]. 2019Mar.18 [cited 2019Aug.19];17(1):1397. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/1397
Section
Original Research