Cancer pain management – opportunities beyond the WHO ladder

Knowledge, attitudes, and practices toward cancer pain management amongst healthcare workers (physicians, pharmacists, and nurses): a cross-sectional study from first-tier cities in China

PURPOSE

China is currently one of the countries with the largest increased number of new cancer cases in the world, but cancer pain management (CPM) is still inadequate. This study uses a questionnaire to demonstrate the status and differences in knowledge, attitude and practice (KAP) of CPM among healthcare workers (HCWs) in developed regions of China, to find deficiencies and priorities for improvement, from which areas and advantages of the role of pharmacists and mobile devices can be explored.

METHODS

This study used data from a questionnaire on CPM from March to June 2019. The study population consisted of a total of 515 HCWs in four first-tier developed cities in China. The questionnaire has four major components, analysis of differences in KAP of different occupations through one-way analysis of variance (ANOVA).

RESULTS

Among the respondents, the physicians had the highest knowledge scores toward CPM, pharmacists had the lowest practice scores. Around half of the respondents indicated that their hospital or department have a pharmacist participating in CPM. Physicians and nurses were more likely to expect pharmacists to provide drug counseling. The HCWs interviewed most expect that the mobile-based pain management system can automatically screen and mark patients with pain.

CONCLUSION

From this study, it can be suggested that pharmacists and nurses in the CPM team should actively promote relevant knowledge. Besides, pharmacists should focus on improving practical ability such as increasing the frequency of pain assessment. Multidisciplinary collaboration and the introduction of mobile devices can improve and refine the CPM.

[Management of lung cancer-related pain]

Pain occurs in seventy-four percent of patients suffering from advanced lung cancer, and eighty-two percent of patients feels that the applied treatment of pain was inefficient. The management of cancer-related pain is based on the WHO analgesic ladder. The ladder has three steps. Step one involves the use of nonsteroidal anti-inflammatory drugs for mild pain, step two mild opioids for moderate pain and step three strong opioids for the treatment of heavy pain. This management - in case of emergency - is supplemented by interventional procedures (nerve blockades, surgery). The most effective pain-killing intervention is the all-round oncological and surgical therapy. The different treatments (oncological, radiological, surgical, drug and interventional) are applied in combination with each other. The paper is dealt with the possibility offered by the drug and interventional treatments.