Prevalence And Management Of Cancer Pain In Ambulatory Patients At Kenyatta National Hospital.

Abstract

Background: Cancer is a leading cause of death worldwide and an important cause of morbidity and mortality in Kenya. Pain is one of the most common and distressing symptoms in cancer patients. Pain is an important determinant of a cancer patient's quality oflife. Adequate management of cancer pain is required to improve the quality oflife in cancer patients. The current prevalence of cancer pain and its management in Kenya is unknown. This study aimed to determine the prevalence and management of cancer pain in patients and correlate this with patient characteristics. Objective: To determine the prevalence and management of cancer pain in ambulatory cancer patients attending the Kenyatta National Hospital oncology clinics. Methods: The study was carried out in the hemato-oncology and radio-oncology clinics of Kenyatta National Hospital. Ambulatory cancer patients were consecutively recruited in this cross sectional survey to a sample size of 520 patients. We recruited patients who had a pathological diagnosis of cancer, were aware of their diagnosis, were 18 years and older and. gave written consent. We excluded patients with severe cognitive or mental illness or in remission for cancer. Each patient was interviewed using the BPI questionnaire for assessing presence of cancer pain, cancer pain severity and management. Information on cancer type, treatment information and currently prescribed analgesics was obtained. The adequacy of pain management was calculated using the PMI, which compares the potency of analgesic used with the severity of pain experienced by the patient. Results: The population was middle aged (mean age 50 years). Majority (74%) of the sample population was female. The commonest cancers were breast (31.2%) and cervix (24.2%). Prevalence of cancer pain was found to be 38.5%. Metastatic cancer was associated with increased likelihood of having cancer pain (P=0.044, OR, 1.9). A poorer functional status (P<O.OOl,OR, 4.4) and a longer duration since diagnosis (P=O.Oll, OR, 0.986) were associated with more likelihood of presence of cancer pain. Pain was sub optimally managed in 65% of cancer patients. Forty seven percent of t,he cancer patients with pain were on non opioid drugs, while 13% were on no analgesics. Only 10% were on a strong opioid. Presence of metastatic disease was associated with less likelihood of inadequate pain management (OR 0.5, P=0.045). Conclusions: Cancer pain is common in patients at Kenyatta National Hospital and its management is insufficient. Action should be taken to include cancer pain screening in management of cancer patients. Cancer symptom management guidelines tailored around the WHO cancer pain relief guidelines should be developed. Increasing awareness among clinicians on pain management should be undertaken.