The Current Condition Of Cancer Pain Treatment In The Cancer Center Of Tongji Hospital And Physicians' And Patients' Knowledge Of Cancer Pain Management

ObjectTo investigate the the current condition of cancer pain treatment in the cancer center of Tongji Hospital and physicians' and patients' knowledge of cancer pain management,to explore the associated factors of PMI,and to promote a better pain management.MethodsThe patients who are qualified at the cancer center of Tongji Hospital during2015.10.1-11.30 are investigated.Patients' basic information,medical information,and all the medical records during hospitalization are collected.Using a self-design questionnaire to investigate the patients' knowledge about cancer pain treatment.Patients who are more than18 years-old,have pathological or histological evidences of cancer,have pain during the past24 hours,haven't received anti-cancer treatment before,and patients who are opioid-naive(not having opioid tolerant) are qualified.According to the FDA,”patients considered opioid tolerant are those who are taking at least:60mg oral morphine/day,25 mcg transdermal fentanyl/hour,30 mg oral oxycodone/day,8mg oral hydromorphone/day,25 mg oral oxymorphone/day,or an equianalgesic dose of another opioid for one week or longer”[5].On the other hand,the physicians at the cancer center of Tongji Hospital during 2015.10.1-11.30 are investigated using a self-design questionnaire about the current condition of cancer pain treatment,physician's knowledge about cancer pain treatment,and the potential barriers of cancer pain management.Statistical methods are using the software of SPSS version 19.0.Results168 patients are included in this research after excluding 22 patients who are not qualified,among whom 86 are male,82 are female.The mean ages of the patients are54.69±12.20 years-old.The incidence of cancer pain of all the newly diagnosed patients is31.5%,the proportions of mild,moderate,severe pain and bone pain are 27.4%,33.3%,39.3%,40.5%,respectively.The most common cancer type of pain is lung cancer(40.5%[n=68]). Among all the bone pain patients,88.9% patients received bisphosphonates treatment(n=64).The mean score of the worst pain is 5.4(SD 1.983).Among all the cancer pain patients,90.5% received analgesics.The medications used most often in mild,moderate,severe pain are diclofenac sodium(30.4%), oxycodone-acetaminophen(50%),oxycodone(57.6%),respectively.The incidence of breakthrough pain is 51.2%(n=86),among which 87.6% used morphine to rescue,10.1% morphine and bucinperazine,2.3% used bucinperazine.The negative PMI percentage of all the cancer pain patients is 22.6%,with mild,moderate,severe,bone pain be 30.4%,10.7%, 27.3%,30.6%,respectively.Multivariate Logistic analysis showed,the associated factors of PMI include:?60 years-old(OR=3.93),low economical status(OR=3.96),and having a past history of analgesics(OR=15.33).43 physicians participated in the investigation,among whom 16 are male and 27 are female.The mean ages of the physicians are 30.7±4.32 years-old,the mean time of work is4.86±4.07 years.The results showed,more than 60% physicians overestimated the actual incidence of cancer pain,30% underestimated the incidence of severe pain.55.8% of the physicians don't know much about PMI.The top three analgesics they recommend in persistent moderate-severe pain are oral morphine controlled release tablets(76.7%),NSAIDs(14%), codeine and its compound preparation(4.7%),and morphine(83.7%),bucinperazine(14%),pethidine(2.3%) in breakthrough pain. About the application of opioids in cancer pain treatment,the top three problems they worry most are patients' and their families' fear about the narcotic drugs(72.1%),the safety of medication in cancer patients(58.1%),severe side effects are difficult to handle(53.5%). Physicians' report about the top three side effects of opioids are constipation(81.4%), nausea/vomiting(16.3%),respiratory depression(2.3%).And the top three side effects which are most difficult to handle are constipation(33.3%),respiratory depression(20%), addiction or dependence(15.6%).The results of the investigation about physicians' knowledge of cancer pain treatment showed,the mean correct rate of all the participated physicians is81.93±16.3%.The highest error rates of True Or False are:1.Mild-moderate cancer pain should do morphine titration before medication(error rate 25.6%);2.Cancer pain treatment should be a priority in comprehensive anti-cancer treatment(18.6%);3.NSAIDs can't be used to handle mild-moderate bone pain(16.3%);4.For patients who take morphine for the first time,the initial dose should be 5-15mg(16.3%);5.The analgesic effect of NSAIDs has a minimum effective dose,but not a ceiling dose(11.6%).The highest error rate of Choice Questions is “the most common cause of cancer pain”(32.6%).About the potential barriers of cancer pain management,the top five factors the physicians reported are:the acceptance andcompliance of the patients and their families to analgesics is very poor(76.7%),physicians' assessments of cancer pain are inadequate(46.5%),physicians' lack of knowledge about pain management(41.9%),patients' and their families' reluctance to report pain(37.2%),patients are not satisfied with the pain relief after medication(37.2%).ConclusionsWith the number of cancer survivors increasing,the survival of the cancer survivors prolonging,how to improve the QOL has become the main issue of the oncology physicians.Pain is a common symptom cancer patients have to face,which can significantly influence the patients' QOL.The results of this research showed,the incidence of cancer pain is still high,and the proportion of mild-moderate cancer pain weighs much.However,there still exist a considerable part of patients who haven't got adequate analgesic treatment in clinical practice.This research has investigated the current condition of cancer pain treatment in the cancer center of Tongji Hospital and physicians' and patients' knowledge of cancer pain management,and proposed some practical advice to cancer pain management to stress the importance of good pain management to cancer pain patients.Further work should be done to ensure a better pain management,and to improve the QOL of the cancer survivors.