Attitudinal Barriers to Pain Management and Associated Factors Among Cancer Patients in Mainland China: Implications for Cancer Education

Burden of gastrointestinal cancers in China from 1990 to 2019 and projection through 2029

Although gastrointestinal (GI) cancers pose a great challenge to public health, data are scant for understanding the burden of GI cancers in China. We aimed to provide an updated estimate of the burden of major GI cancers in China over three decades. According to the GLOBOCAN 2020 database, 1,922,362 GI cancer cases were newly diagnosed and 1,497,388 deaths occurred in China in 2020, with the highest incidence in colorectal cancer (555,480 new cases; 23.90/100,000 age-standardized incidence rate [ASIR]) and the highest mortality in liver cancer (391,150 deaths; 17.20/100,000 age-standardized mortality rate [ASMR]). The age-standardized rates (ASRs) in incidence, mortality, and disability-adjusted life year (DALY) rates for esophageal, gastric, and liver cancers have declined overall (1990-2019, average annual perventage change [AAPC] < 0%, p < 0.001) but have become flattened or reversed in recent years, alarmingly. The spectrum of GI cancers in China will continue transitioning in the next decade, characterized by rapid increases in colorectal and pancreatic cancers in addition to a high burden of esophageal, gastric, and liver cancers. High body-mass index was found to be the fastest-growing risk factor for GI cancers (estimated annual perventage change [EAPC]: 2.35%-3.20%, all p < 0.001), whereas smoking and alcohol consumption remained the top contributors to GI cancer-related deaths in men. In conclusion, GI cancers in China are challenging the healthcare system with a growing burden and a transitioning pattern. Comprehensive strategies are needed to reach the Healthy China 2030 target.

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic

BACKGROUND

Pain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management.

AIM

Examine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication.

METHODS

A sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit.

RESULTS

Significant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001).

CONCLUSIONS

Patients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.

Factors Affecting Nurses' Performance of Cancer Pain Management in a Tertiary Hospital

Purpose

More than 60% of patients with advanced cancer experience pain, and uncontrolled pain reduces the quality of life. Nurses are the closest healthcare providers to the patient and are suitable for managing cancer pain using pharmacological and non-pharmacological interventions. This study aimed to identify factors affecting the performance of cancer pain management among nurses.

Methods

This study was conducted among 155 participating nurses working at a tertiary hospital who had experience with cancer pain management. Data collection was performed between October 18, 2021 and October 25, 2021. Data analysis was conducted using descriptive statistics, the independent-sample t-test, one-way analysis of variance, and hierarchical regression analysis.

Results

There were 110 subjects (71.0%) who had no experience of cancer pain management education. The results of regression analysis indicated that barriers included medical staff, patients, and the hospital system for cancer pain management (β=0.28, P<0.001). The performance of cancer pain management was also affected by experience of cancer pain management training (β=0.22, P=0.007), and cancer pain management knowledge (β=0.21, P=0.006). The explanatory power of the variable was 16.6%.

Conclusion

It is crucial to assess system-related obstacles, as well as patients and medical staff, in order to improve nurses' cancer pain management performance. A systematic approach incorporating multidisciplinary interventions from interprofessional teams is required for effective pain management. Furthermore, pain management education is required both for cancer ward nurses and nurses in other wards.

A living systematic review to assess the analgesic undertreatment in cancer patients

This living, systematic review aims to provide an updated summary of the available evidence on pain undertreatment prevalence in patients with cancer; correlations with some potential determinants and confounders were also carried out. We updated a systematic review published in 2014, including observational and experimental studies reporting the use of the pain management index (PMI) in adults with cancer and pain, from 2014 to 2020. We conducted searches in PubMed/MEDLINE, Embase, and Google Scholar. We performed univariate and multivariable regression analyses to describe the relationship between PMI and a list of potential explanatory variables. Twenty new papers were identified, yielding a total sample size of 66 studies. The proportion of patients classified as undertreated according to the year of study publication shows a higher decrease from 1994 to 2013 (-13% as relative change) than the most recent years 2014-2020 (-11%). The quality of the included studies has increased over the years (from 80% to 93%). At the multivariable analysis, a statistically significant relationship was confirmed between undertreatment and the year of the publication of the study and with a low-medium economic level of the countries where the studies were conducted. Despite the improvement when compared to the period 1994-2000,-still about 40% of the cases identified received an analgesic treatment inadequate to the intensity of pain, according to the PMI. Despite its intrinsic limitations, PMI continues to be widely used and it could allow a continuous monitoring of pain management across a different mix of studies and patients.

Evaluation of a whole process management model based on an information system for cancer patients with pain: A prospective nonrandomized controlled study

Objective

The aim of this study was to evaluate the effects of whole process management model interventions based on information system benefits reported by patients with cancer pain.

Methods

We performed a quantitative, prospective nonrandomized controlled design from June to October 2020. A total of 124 cancer patients with pain were enrolled. Patients in the experimental group received a whole process management model intervention based on an information system compared to the control group who received routine cancer pain management. Data were collected at baseline and after a four-week follow-up, acting as a test-retest control. The primary outcome was pain management quality, which was measured using the American Pain Society Patient Outcome Questionnaire-Chinese version (APS-POQ-C). Secondary outcomes were patient-related attitudinal barriers and analgesic adherence. The Barrier Questionnaire (BQ) and a single-item questionnaire were used. Chi-square tests were used to compare the pain intensity and analgesic adherence, independent sample t-test and Mann-Whitney U test were performed to test the differences in the pain management quality and patient-related attitudinal barriers between control and experimental groups.

Results

Baseline characteristics and outcomes of the participants did not differ significantly (P ​> ​0.05). Primary outcomes were changes in four aspect of the quality of pain management (APS-POQ-C) between the two groups (P ​< ​0.05). Patients in the whole process management group reported significantly better pain control and perception of care than the control group. With respect to secondary endpoints, a significant difference in favor of the experimental group was found for barriers (P ​< ​0.05) and medication adherence (60.0% vs. 40.0%; P ​< ​0.05) after the interventions.

Conclusions

The whole process management of patients with cancer pain effectively improves patient-reported quality of pain management, reduces patient-perceived barriers, enhances patient adherence to analgesic drugs and is worthy of clinical application.

Gender Difference in Pain Management Among Adult Cancer Patients in Saudi Arabia: A Cross-Sectional Assessment

Objective

To compare gender differences in pain management among adult cancer patients in Saudi Arabia and to explore the predictors associated with attitudinal barriers of cancer patients to pain management.

Methods

A descriptive cross-sectional study was conducted among 325 cancer patients from tertiary hospitals in Saudi Arabia.

Result

Of the total participants, 67.4% were women (N = 219) and 32.6% were men (N = 106). The overall mean scores of the attitudinal barriers questionnaire were 49.51 ± 13.73 in men and 54.80 ± 22.53 in women. The analysis shows significant differences in scores in subscales of tolerance (men = 7.48 ± 2.37), (women = 8.41 ± 3.01) (p = 0.003) and fear of distraction in the course of treatment (men = 6.55 ± 1.34), and (women = 7.15 ± 2.63) (p = 0.008). Female patients reported a more moderate to severe level of pain than men (worst pain in last week of 7.07 ± 1.50, worst pain in last week of 5.84 ± 2.65, respectively). Splitting by gender, the significant predictor for physiology effect domains in male cancer patients includes age, marital status, employment status, monthly income, cancer type, and presence of comorbid disease (p < 0.050). Age was a significant predictor of the domains of fatalism, communication, and harmful effects (p < 0.050) among female cancer patients.

Conclusion

The present study revealed significant differences between men and women with attitudinal barriers to cancer pain management. Managing pain requires the involvement of all methods in a comprehensive manner, thus unalleviated pain influences the patient's psychological or cognitive aspect.

Relationships between patient-related attitudinal barriers, analgesic adherence and pain relief in Chinese cancer inpatients

PURPOSE

The purpose of this study was to evaluate patient-related attitudinal barriers and identify associated factors in Chinese cancer inpatients receiving opioids and to explore relationships between patient-related attitudinal barriers, analgesic adherence and pain relief.

METHODS

A cross-sectional study was conducted. A total of 146 participants completed face-to-face surveys, including information about demographics, the Barriers Questionnaire-Chinese (BQ-C), analgesic adherence, average pain and breakthrough pain in the past 24 h. The Mann-Whitney U test and Kruskal-Wallis test were performed to test the differences in the attitudinal barrier scores between the adherence and nonadherence groups, the complete and incomplete pain relief groups and the groups based on demographics.

RESULTS

The majority of participants in this study were men (67.8%), over half of all participants were less than 60 years old, gastrointestinal cancer (47.3%) was the most common diagnosis and 59 (40.4%) acquired comprehensive pain education from the last discharge guidance procedure. The total BQ-C mean (SD) score was 1.61 ± 0.94. A total of 87 (59.6%) patients with cancer pain were completely relieved. Most of the patients (73.3%) completely took analgesics by orders. There was no significant difference in the total BQ-C score between the adherence group and the nonadherence group (P > 0.05), but the difference was significant between the complete pain relief group and the incomplete pain relief group (P < 0.05).

CONCLUSION

The findings of this study support unsatisfactory pain management and moderate analgesic adherence for Chinese inpatients. It is suggested that patient-related attitudinal barriers do not play an undermining role in pain management by negatively affecting patients' analgesic adherence. Conversely, patients' beliefs are more likely to be shaped by under treatment rather than as a cause.