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Turkish Journal of Cancer
2004, Volume 34, Number 3, Page(s) 114-117
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The opinions of the cancer patients about pain management: A questionnaire study
BÜLENT YALÇIN, FİLİZ ÇAY ŞENLER, ABDULLAH BÜYÜKÇELİK, GÜNGÖR UTKAN, İBRAHİM TEK, HATİCE DORUK, HAKAN AKBULUT, FİKRİ İÇLİ
Ankara University School of Medicine, Department of Medical Oncology, Ankara-Turkey
Keywords: Advanced cancer, pain, questionnaire study
Summary
The aim of this study is to evaluate the opinions of patients with cancer related pain about analgesics, by using a questionnaire. All patients with chronic cancer pain were given questionnaires by the primary physicians who have been treating them. One hundred eleven cancer patients with median age of 52 years (range: 21-75) were entered the study. The pain was relieved completely by analgesics in only 50 patients (45%). Thirty-one (27,9%) patients took the prescribed analgesics regularly. Forty (36%) patients believed frequent uses will lead to addiction to analgesics. Significant positive correlation was observed between using narcotic analgesics and regular use of them (p=0.024) plus patients belief of improvement and good communication with physician (p=0.03) [Turk J Cancer 2004;34(3):114-117]
  • Top
  • Summary
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Introduction
    It is now known that the pain especially, cancer-pain is a multifactorial phenomenon that results in complexity interactions between physiological, psychological, cognitive, social and other factors. Up to 50% of patients with any stage of the cancer experience significant pain. The underlying causes of cancer pain should be treated whenever possible [1]. Despite advances in cancer-pain management, there is evidence that cancer pain remains inadequately treated [2-5]. Several factors, including inadequate communication between patients and doctors have been blamed for this inadequacy.

    The aim of this study is to learn the judgment of patients with cancer related pain about using analgesics by using a questionnaire.

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  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Material and Methods
    Patients with chronic cancer pain who were treated at outpatient clinic of Ankara University School of Medicine, Department of Medical Oncology from October 2002 to June 2003, were given questionnaires about pain management (Figure 1). The questions were asked to the patient by the physician if the patient was illiterate.

    Fig 1: The questionnaire

    Statistical analysis
    All answers in questionnaire were tested with univariate- Spearman rho and multivariate-logistic regression tests for comparison of the pain control and other answers.

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  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Results
    The characteristics of 111 patients included in the study are shown on table 1. Also, further interviews were done with 15 patients in this group who were illiterate. The results of these questionnaire are depicted on table 2.

    Table 1: The characteristics of patients

    Table 2: Results of questionnaire

    Thirteen patients (11,8%) indicated that they could not inform the doctor about pain clearly because of either short interview or their shyness. Twenty-three patients (19,8%) thought the doctor might not understand them adequately. They thought that the main causes of physician’s misunderstanding about pain were short interview and less communication with physician (Table 3). Although 48 patients (43,3%) didn’t know the cause of the pain, others (56,7%) were aware that it was related to cancer.

    Table 3: The causes of physician’s misunderstanding of pain according to patients

    Eighty patients (72.1%) have been taking analgesics irregularly. Twenty (32,7%) of 61 patients who didn’t have improvement of the pain completely, have lost their hope on relief of pain. Only 13 (21,3%) of these patients have been taking analgesics regularly.

    Thirty-one (27,9%) of the patients said analgesics had some side effects on gastrointestinal system and sleeping. Interestingly, 28 of 31 patients (90,3%) who had side effects of analgesic have been taking them regularly.

    While 40 patients (36%) believed that the analgesic addiction would occur, other 40 patients (36%) didn’t believe it would and the rest of them (28%) had no any idea about it.

    Twenty-nine patients (26.1%) used narcotic analgesics and pain was not controlled completely in 13 of them (44,8%). Fourteen of these 29 patients (48,2%) didn’t know whether their medicine was narcotic or not. Also pain was not controlled completely in 37 of 68 patients (54,4%) who didn’t take narcotic analgesics.

    There was a significant positive correlation between using narcotic analgesics and regular use of them (p=0.024). Also, we observed a significant positive correlation between the patients confidence of improvement and communication with the physician (p=0.03).

    Although 12 patients (10,8%) refused taking narcotic analgesics in future, others accepted it, after they were convinced by their doctor that it was necessary (Table 2). The rejection rate of narcotic analgesics in future was significantly higher in patients who had completely relieved pain at the present time than unrelieved group (49% vs. 91.6%, respectively) (p=0.001). Also, another significant finding was that rate of narcotic consent was higher in unrelieved pain group (p=0,001). The rate of belief on developing analgesic addiction was higher in patients taking narcotics than others (51.7% vs. 30.8%, p=0.04). Multivariate regression analyses showed that there was a significant relation between regularly taking analgesic and control of pain (p=0.026).

    During individual interviews with 15 patients who were illiterate, we observed wrong perceptions about pain in patients with advanced cancer such as, pain is fatalistic and the analgesic addiction will occur in future which will lead to more suffering. Most of the patients were not taking analgesics, because of such fears and wrong beliefs.

  • Top
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Discussion
    It was found that approximately 70% of the patients in this study have not taken analgesics regularly. Interestingly, we also observed that most of the patients who had analgesic side effects have been taking them regularly. Although we could not exactly explain why most of the patients did not take analgesics regularly, possible causes may be side effects and psychosocial distresses including wrong perceptions, such as ‘pain is fatalistic’ and ‘the analgesic tolerance will occur at the end’. In our study, the rate of taking analgesics regularly was approximately 30%, which was similar to the results in the literature [6].

    Spiegel et al. [7], found a significant association between pain intensity and psychological distress. Chronic unrelieved pain has caused psychological variations in cancer patients. But in the same study, they did not find significant association between pain intensity and depression. In our study, most of the patients indicated that they had informed the physician about their suffering from pain. The patients who could not inform the doctor about their suffering from pain clearly related it to short interview with the doctor or their shyness which may be secondary to psychological depression. Interestingly, approximately 10% of all the patients refused to use narcotic analgesics forever, in this study.

    Some studies have shown that unrelieved pain have negative effects on quality of life and survival in cancer patients [8-11]. Although the pain management in cancer patients is improved, some studies related to this subject still report that the treatment of cancer pain remains inadequate. It has been indicated that causes of undertreating cancer pain were usually the low rate of using narcotics and the inadequate communication between the patient and physician [2-5]. We found there was a significant correlation between the improvement in patients’ belief and the communication of patients with their physician, compatible with the knowledge of literature.

    There are some clinical recommendations about the management of cancer pain to address the problem of inadequate cancer pain management. It was recommended that physicians must inquire about pain and measure pain intensity, and should also evaluate and monitor factors associated with pain [1,6,11].

    In conclusion, despite the small number of study population, present study showed that the majority of cancer patients have inadequate information about analgesic use in the control of cancer pain. They also have fears and wrong beliefs in this area. We suggest that physicians should spend time to understand the suffering of cancer patients from pain and analgesics, and especially narcotics should be given adequately to control pain in patient with advanced cancer. The effective management of pain is best accomplished by multidisciplinary approach in patients with advanced cancer.

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  • Introduction
  • Methods
  • Results
  • Discussion
  • References
  • References

    1) Lesage P, Portenoy RK. Trends in cancer pain management. Cancer Control 1999;6:126-45.

    2) Kelsen DP, Portenoy RK, Thaler HT, et al. Pain and depression in patients with newly diagnosed pancreas cancer. J Clin Oncol 1995;13:748-55.

    3) Portenoy RK. Cancer pain: epidemiology and syndromes. Cancer 1989;63:2298-307.

    4) Warncke T, Breivik H, Vainio A. Treatment of cancer pain in Norway: a questionnaire study. Pain 1994;57:109-16.

    5) Sapir R, Catane R, Strauss-Liviatan N, et al. Cancer pain: knowledge and attitudes of physicians in Israel. J Pain Symptom Manage 1999;17: 266-76.

    6) Peteet J, Tay V, Cohen G et al. Characteristics and treatment in outpatient cancer population. Cancer 1986;57:1259-65.

    7) Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer 1994;74:2570-8.

    8) Ferrell BR, Grant MM, Funk BM, et al. Quality of life in breast cancer survivors: implications for developing support services. Oncol Nurs Forum 1998;25:887-95.

    9) Herndon JE, Fleishman S, Kornblith AB, et al. Is quality of life predictive of the survival of patients with advanced nonsmall cell lung carcinoma? Cancer 1999;85:333-40.

    10) Page GG, Ben-Eliyahu S. The immune-suppressive nature of pain. Semin Oncol Nurs 1997;13:10-5.

    11) Zaza C, Baine N. Cancer Pain and Psychosocial Factors: A Critical Review of the Literature. J Pain Symptom Manage 2002;24:526-42.

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