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Cognition and Sociodemographic Determinants for Effective Pain Control in Patients with Cancer Pain: a Cross-sectional Survey in China

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This cross-sectional study aimed to investigate cancer patients’ cognitive level of pain control and to evaluate the patient-related factors or barriers to effective cancer pain management in China. In seven tertiary hospitals across China, 372 patients experiencing cancer pain were surveyed through a self-designed questionnaire to assess the factors associated with effective pain control. Patients’ demographic data and pain control-related factors were recorded. Cluster sampling and binary logistic regression models were used to investigate the association between predictive factors and effective pain control. The survey showed that the majority of the patients were more than 45 years old (76.3%), and 64.4% had an average annual income of more than 20 000 RMB. One-third of the patients suffered from cancer pain for more than 3 months, and 75.1% received professional guidance during medication. The barriers to pain control for patients included preference to enduring pain and refusing analgesics (62.9%), negligence towards drug usage (28.5%), concerns about the addiction (48.2%) and adverse reaction (56.4%). The average annual family income, professional guidance, knowledge of pain medication, adherence to analgesics, and concerns about addiction to analgesics were significantly correlated to the effect of patients’ pain control. The study presents major barriers to optimal pain control among patients with cancer in China. Our findings suggest that educational programs and medical insurance reimbursement support from the government are urgently needed to overcome the cognitive barriers toward effective pain management and to relieve the economic burden among patients with cancer pain in China.

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References

  1. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, et al. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol, 2007,18(9):1437–1449

    Google Scholar 

  2. van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, et al. Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. J Pain Symptom Manage, 2016,51(6):1070–1090

    Google Scholar 

  3. Inoue S, Kobayashi F, Nishihara M, et al. Chronic pain in the Japanese community-prevalence, characteristics and impact on quality of life. PLoS One, 2015,10(6):e0129262

    PubMed  PubMed Central  Google Scholar 

  4. Rau KM, Chen JS, Wu HB, et al. The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan. Jpn J Clin Oncol, 2015,45(11):1042–1049

    PubMed  PubMed Central  Google Scholar 

  5. Knaul FM, Farmer PE, Krakauer EL, et al. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet, 2018,391(10128):1391–1454

    PubMed  Google Scholar 

  6. Cancer pain relief. Geneva: World Health Organization; 1986.

  7. Gao W, Gulliford M, Bennett MI, et al. Managing cancer pain at the end of life with multiple strong opioids: a population-based retrospective cohort study in primary care. PLoS One, 2014,9(1):e79266

    PubMed  PubMed Central  Google Scholar 

  8. Caraceni A, Hanks G, Kaasa S, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol, 2012,13(2):58–68

    Google Scholar 

  9. Jara C, Del Barco S, Grávalos C, et al. SEOM clinical guideline for treatment of cancer pain (2017). Clin Transl Oncol, 2018,20(1):97–107

    CAS  PubMed  Google Scholar 

  10. Lara-Solares A, Ahumada Olea M, Basantes Pinos ALÁ, et al. Latin-American guidelines for cancer pain management. Pain Manag, 2017,7(4):287–298

    PubMed  Google Scholar 

  11. Swarm RA, Paice JA, Anghelescu DL, et al. Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2019,17(8):977–1007

    CAS  PubMed  Google Scholar 

  12. Shute C. The challenges of cancer pain assessment and management. Ulster Med J, 2013,82(1):40–42

    PubMed  PubMed Central  Google Scholar 

  13. Mack KA, Jones CM, Ballesteros MF. Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas-United States. Am J Transplant, 2017,17(12):3241–3252

    CAS  PubMed  Google Scholar 

  14. Hamieh NM, Akel R, Anouti B, et al. Cancer-Related Pain: Prevalence, Severity and Management in a Tertiary Care Center in the Middle East. Asian Pac J Cancer Prev, 2018,19(3):769–775

    PubMed  PubMed Central  Google Scholar 

  15. Vuong S, Pulenzas N, DeAngelis C, et al. Inadequate pain management in cancer patients attending an outpatient palliative radiotherapy clinic. Support Care Cancer, 2016,24(2):887–892

    PubMed  Google Scholar 

  16. Shen WC, Chen JS, Shao YY, et al. Impact of Undertreatment of Cancer Pain with Analgesic Drugs on Patient Outcomes: A Nationwide Survey of Outpatient Cancer Patient Care in Taiwan. J Pain Symptom Manage, 2017,54(1):55–65

    PubMed  Google Scholar 

  17. Greco MT, Roberto A, Corli O, et al. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol, 2014,32(36):4149–4154

    PubMed  Google Scholar 

  18. Sharkey L, Loring B, Cowan M, et al. National palliative care capacities around the world: results from the World Health Organization Noncom-municable Disease Country Capacity Survey. Palliat Med, 2018,32:106–113

    PubMed  Google Scholar 

  19. Ministry of Health of the People’s Republic of China. Norms for cancer pain treatment, 2011. http://www.moh.gov.cn/mohyzs/s3585/201112/53838.

    Google Scholar 

  20. Xia Z. Cancer pain management in China: current status and practice implications based on the ACHEON survey. J Pain Res, 2017,10:1943–1952

    PubMed  PubMed Central  Google Scholar 

  21. Jamison RN, Sheehan KA, Scanlan E, et al. Beliefs and attitudes about opioid prescribing and chronic pain management: survey of primary care providers. J Opioid Manag, 2014,10(6):375–382

    PubMed  Google Scholar 

  22. Alnajar MK, Darawad MW, Alshahwan SS, et al. Knowledge and Attitudes Toward Cancer Pain Management Among Nurses at Oncology Units. J Cancer Educ, 2019,34(1):186–193

    PubMed  Google Scholar 

  23. Gunnarsdottir S, Donovan HS, Serlin RC, et al. Patient-related barriers to pain management: the Barriers Questionnaire II (BQ-II). Pain, 2002,99(3):385–396

    PubMed  Google Scholar 

  24. Potter VT, Wiseman CE, Dunn SM, et al. Patient barriers to optimal cancer pain control. Psychooncology, 2003,12(2):153–160

    PubMed  Google Scholar 

  25. Konstantis A, Exiara T. Family caregiver beliefs and barriers to effective pain management of cancer patients in home care settings. J BUON, 2018,23(7):144–152

    PubMed  Google Scholar 

  26. Lee BO, Liu Y, Wang YH, et al. Mediating effect of family caregivers’ hesitancy to use analgesics on homecare cancer patients’ analgesic adherence. J Pain Symptom Manag, 2015,50(6):814–821

    Google Scholar 

  27. Wang NY, Liu YM, Zhao HJ, et al. The treatment effect analysis of related factors effecting chronic pain patients with moderately sever pain. Chin J Clin Oncol, 2014,41(10):655–658

    Google Scholar 

  28. Yanjun S, Changli W, Ling W, et al. A survey on physician knowledge and attitudes towards clinical use of morphine for cancer pain treatment in China. Support Care Cancer, 2010,18(11):1455–1460

    PubMed  Google Scholar 

  29. Liu W, Xie S, Yue L, et al. Investigation and analysis of oncologists’ knowledge of morphine usage in cancer pain treatment. Onco Targets Ther, 2014,7:729–737

    PubMed  PubMed Central  Google Scholar 

  30. Zhang Q, Yu C, Feng S, et al. Physicians’ Practice, Attitudes Toward, and Knowledge of Cancer Pain Management in China. Pain Med, 2015,16(11):2195–203

    PubMed  Google Scholar 

  31. Robinson JP, Dansie EJ, Wilson HD, et al. Attitudes and Beliefs of Working and WorkDisabled People with Chronic Pain Prescribed Long-Term Opioids. Pain Med, 2015,16(7):1311–1324

    PubMed  Google Scholar 

  32. Cleary J, Powell RA, Munene G, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol, 2013,24(Suppl 11):xi14–xi23

    PubMed  Google Scholar 

  33. Liang SY, Chen KP, Tsay SL, et al. Relationship between belief about analgesics, analgesic adherence and pain experience in taiwanese cancer outpatients. Asian Pac J Cancer Prev, 2013,14(2):713–716

    PubMed  Google Scholar 

  34. Al-Atiyyat NMH, Vallerand AH. Patient-related attitudinal barriers to cancer pain management among adult Jordanian patients. Eur J Oncol Nurs, 2018,33:56–61

    PubMed  Google Scholar 

  35. Oldenmenger WH, Smitt PAS, van Dooren S, et al. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer, 2009,45(8):1370–1380

    PubMed  Google Scholar 

  36. Meghani SH, Thompson AM, Chittams J, et al. Adherence to analgesics for cancer pain: a comparative study of African Americans and Whites using an electronic monitoring device. J Pain, 2015,16(9):825–835

    PubMed  PubMed Central  Google Scholar 

  37. Wang Z, Chang R, Luo Y B, et al. Evaluation of Need and Distribution of National Essential Medicines List in Village Clinics: A Cross-sectional Study Based on the Perspective of Village Doctors in China. Curr Med Sci, 2019,39(4):663–669

    PubMed  Google Scholar 

  38. Gunnarsdottir S, Serlin RC, Ward S. Patient-related barriers to pain management: the icelandic barriers questionnaire II. J Pain Symptom Manag, 2005,29(3):273–285

    Google Scholar 

  39. Gunnarsdottir S, Sigurdardottir V, Kloke M, et al. A multicenter study of attitudinal barriers to cancer pain management. Support Care Cancer, 2017,25(11):3595–3602

    PubMed  Google Scholar 

  40. Tzeng JI, Chang CC, Chang HJ, et al. Assessing analgesic regimen adherence with the Morisky Medication Adherence Measure for Taiwanese patients with cancer pain. J Pain Symptom Manag, 2008,36(2):157–166

    Google Scholar 

  41. Chou WC, Chen JS, Hung CY, et al. A nationwide survey of adherence to analgesic drugs among cancer patients in Taiwan: prevalence, determinants, and impact on quality of life. Support Care Cancer, 2019,27(8):2857–2867

    PubMed  Google Scholar 

  42. Im EO, Liu Y, Kim YH, et al. Asian American cancer patients’ pain experience. Cancer Nurs, 2008,31(3):E17–E23

    Google Scholar 

  43. Kim YC, Ahn JS, Calimag MMP, et al. Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries. Cancer Med, 2015,4(8):1196–1204

    PubMed  PubMed Central  Google Scholar 

  44. Green CR, Hart- Johnson T. The adequacy of chronic pain management prior to presenting at a tertiary care pain center: the role of patient socio-demographic characteristics. J Pain, 2010,11(8):746–754

    PubMed  Google Scholar 

  45. Lou F, Shang S. Attitudes towards pain management in hospitalized cancer patients and their influencing factors. Chin J Cancer Res, 2017,29(1):75–85

    PubMed  PubMed Central  Google Scholar 

  46. Xu X, Ou M, Xie C, et al. Pain Acceptance and Its Associated Factors among Cancer Patients in Mainland China: A Cross-Sectional Study. Pain Res Manag, 2019,2019:9458683

    PubMed  PubMed Central  Google Scholar 

  47. Jacobsen R, Moldrup C, Christrup C, et al. Patient-related barriers to cancer pain management: a systematic exploratory review. Scand J Caring Sci, 2009,23:190–208

    PubMed  Google Scholar 

  48. Zeng D, Li K, Lin X, et al. Attitudinal Barriers to Pain Management and Associated Factors Among Cancer Patients in Mainland China: Implications for Cancer Education. J Cancer Educ, 2020,35(2):284–291

    PubMed  Google Scholar 

  49. Rustoen T, Valeberg BT, Kolstad E, et al. The PRO-SELF((c)) Pain Control Program improves patients’ knowledge of cancer pain management. J Pain Symptom Manage, 2012,44(3):321–330

    PubMed  Google Scholar 

  50. Adam R, Bond C, Murchie P. Educational interventions for cancer pain. A systematic review of systematic reviews with nested narrative review of randomized controlled trials. Patient Educ Couns, 2015,98(3):269–282

    PubMed  Google Scholar 

  51. Padrnos L, Bennett R, Kosiorek H, et al. Living with Cancer: an Educational Intervention in Cancer Patients Can Improve Patient-Reported Knowledge Deficit. J Cancer Educ, 2018,33(3):653–659

    PubMed  Google Scholar 

  52. Holtzman AL, Williams JP, Hutchinson DF, et al. Improving Patient-reported Pain During Radiotherapy Through Nurse Involvement and Patient Education. Am J Clin Oncol. 2018,41(10):1028–1030

    PubMed  Google Scholar 

  53. Prevost V, Heutte N, Leconte A, et al. Effectiveness of a therapeutic patient education program in improving cancer pain management: EFFADOL, a stepped-wedge randomised controlled trial. BMC Cancer, 2019,19(1):673

    PubMed  PubMed Central  Google Scholar 

  54. Zhou L, Liu XL, Tan JY, et al. Nurse-led educational interventions on cancer pain outcomes for oncology outpatients: a systematic review. International Nursing Review. Int Nurs Rev, 2015,62(2):218–230

    CAS  PubMed  Google Scholar 

  55. Wang Y, Huang H, Zeng Y, et al. Pharmacist-led medication education in cancer pain control: A multicentre randomized controlled study in Guangzhou, China. J Int Med Res, 2013,41(5):1462–1472

    PubMed  Google Scholar 

  56. Edwards Z, Ziegler L, Craigs C, et al. Pharmacist educational interventions for cancer pain management: a systematic review and meta-analysis. Int J Pharm Pract, 2019,27(4):336–345

    PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge the seven hospitals for their support to the project. We also thank all cancer patients who devoted their time to participate in this study.

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Correspondence to Rui Huang or Cheng-Liang Zhang.

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The authors declare that they have no conflict of interest.

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This work was financially supported by Hubei Provincial Natural Science Foundation of China (No. 2016CFB678).

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Shangguan, Xf., Yu, Zq., Ji, L. et al. Cognition and Sociodemographic Determinants for Effective Pain Control in Patients with Cancer Pain: a Cross-sectional Survey in China. CURR MED SCI 40, 249–256 (2020). https://doi.org/10.1007/s11596-020-2167-3

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  • DOI: https://doi.org/10.1007/s11596-020-2167-3

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