Pain assessment and management in cancer patients

Background: Pain is one of the most common associated symptoms in cancer patients. It develops a number of devastating physical and psychological symptoms. Aim: The purpose of this study is to evaluate the current pain assessment and management plans in cancer patients. Settings and Design: This prospective multicenter observational study was carried out in 3 university hospitals in Lebanon over 6 months from October 2014 to April 2015. Materials and Methods: Men and women aged 18 years and above were observed if they have had any type of cancer, more than 1 day of hospitalization, cancer-related pain, and receiving analgesics. A total of 508 patients were screened over 1 year, where 100 patients have met the eligibility criteria and were observed. The primary outcome measure was an evaluation of pain assessment adherence to the National Comprehensive Cancer Network (NCCN) guidelines. Secondary outcomes included evaluation of adherence of pain management approaches. Statistical Analysis Used: Data were analyzed with SPSS version 21.0. Adherence to the guideline recommendations for assessment was compared using t-test, whereas, adherence to guideline recommendations for treatment was compared using linear regression. Results and Conclusions: Most patients were not adhered to the pain assessment guidelines (82% vs. 18%, P = 0.002), where although patients were assessed by a health-care provider during initial hospitalization, yet, no tool was used for assessment, and there was no documentation of measured pain intensity. For the pain management adherence, 76% were adhered versus 24% were not adhered, P = 0.006. The mis-adherence was in the choice of opioid agent (61.8% vs. 38.2%, P = 0.003), and dosing of these agents (75.5% vs. 24.5%, P< 0.001). Well adherence was observed in terms of nonopioid analgesics use (72.5% were adhered vs. 27.5% were not, P = 0.01). Poor overall adherence to NCCN guidelines was found, and the gaps were related to pain assessment and management recommendations.