Abstract
Purpose
The purpose of this study was to examine attitudinal barriers to cancer pain management and their relationship to pain, analgesic use, clinical, and demographic variables, as well as QOL, in a large sample of patients receiving strong opioids for pain in three European countries.
Methods
Participants in the present study were 555 patients with cancer, 18 years and older recruited from six centers in Germany, Iceland, and Norway. All had received strong opioids for at least 72 h. Data was collected with the Barriers Questionnaire-II, the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer QLQ-C30.
Results
The mean (SD) age of patients was 61.68 (12.35) years and 53% were men. Most common diagnoses were gastrointestinal, lung, prostate, and breast cancer. The mean (SD) time from diagnosis was 32.24 (44.55) and 4.97 (9.64) months from start of opioid therapy. Mean (SD) pain severity was 3.19 (1.93) on a 0 to 10 scale, and 46.5% reported worst pain of 7 or higher. Attitudinal barriers had a mean (SD) of 1.95 (0.82) on a 0–5 scale, with fear of addiction as the strongest barrier across countries 2.85 (1.49). Barrier scores increased with age, and were higher among men than women. Higher barrier scores were associated with higher pain severity and interference, and lower performance status, but not with global health-QOL. Patients who had been on opioids for a shorter time reported higher barriers.
Conclusions
Attitudinal barriers are frequent in cancer pain patients on opioids and are associated with less effective pain control.
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References
Bagcivan G, Tosun N, Komurcu S, Akbayrak N, Ozet A (2009) Analysis of patient-related barriers in cancer pain management in Turkish patients. J Pain Symptom Manag 38:727–737
Bennett MI, Bagnall AM, Jose Closs S (2009) How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain 143:192–199
Breitbart W, Passik S, McDonald MV, Rosenfeld B, Smith M, Kaim M, Funesti-Eesch J (1998) Patient-related barriers to pain management in ambulatory AIDS patients. Pain 76:9–16
Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB (2003) What decline in pain intensity is meaningful to patients with acute pain? Pain 105:151–157
Chang MC, Chang YC, Chiou JF, Tsou TS, Lin CC (2002) Overcoming patient-related barriers to cancer pain management for home care patients. A pilot study. Cancer Nurs 25:470–476
Chen CH, Tang ST, Chen CH (2012) Meta-analysis of cultural differences in Western and Asian patient-perceived barriers to managing cancer pain. Palliat Med 26:206–221
Chung TK, French P, Chan S (1999) Patient-related barriers to cancer pain management in a palliative care setting in Hong Kong. Cancer Nurs 22:196–203
Daut RL, Cleeland CS, Flanery RC (1983) Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 17:197–210
Edrington J, Sun A, Wong C, Dodd M, Padilla G, Paul S, Miaskowski C (2009) Barriers to pain management in a community sample of Chinese American patients with cancer. J Pain Symptom Manag 37:665–675
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee MC, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw KCA, Sullivan M, Takeda F (1993) The European organisation for research and treatment of cancer QLQ-C30: A quality-of-lifeinstrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376
Gunnarsdottir S, Donovan HS, Serlin RC, Voge C, Ward S (2002) Patient-related barriers to pain management: the Barriers Questionnaire II (BQ-II). Pain 99:385–396
Gunnarsdottir S, Serlin RC, Ward S (2005) Patient-related barriers to pain management: the Icelandic Barriers Questionnaire II. J Pain Symptom Manag 29:273–285
Gunnarsdottir S, Ward S, Serlin RC (2008) Attitudinal barriers to cancer pain management in the Icelandic population. Cancer Nurs 31:95–102
Jacobsen R, Samsanaviciene J, Liubarskiene Z, Sjogren P, Moldrup C, Christrup L, Sciupokas A, Hansen OB (2014) Barriers to cancer pain management in Danish and Lithuanian patients treated in pain and palliative care units. Pain Manag Nurs Off J Am Soc Pain Manag Nurs 15:51–58
Jahn P, Kuss O, Schmidt H, Bauer A, Kitzmantel M, Jordan K, Krasemann S, Landenberger M (2014) Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial. Pain 155:746–754
Klepstad P, Fladvad T, Skorpen F, Bjordal K, Caraceni A, Dale O, Davies A, Kloke M, Lundstrom S, Maltoni M, Radbruch L, Sabatowski R, Sigurdardottir V, Strasser F, Fayers PM, Kaasa S, European Palliative Care Research C, European Association for Palliative Care Research N (2011) Influence from genetic variability on opioid use for cancer pain: a European genetic association study of 2294 cancer pain patients. Pain 152:1139–1145
Klepstad P, Loge JH, Borchgrevink PC, Mendoza TR, Cleeland CS, Kaasa S (2002) The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manag 24:517–525
Kwon JH, Oh SY, Chisholm G, Lee JA, Lee JJ, Park KW, Nam SH, Song HH, Lee K, Zang DY, Kim HY, Choi DR, Kim HJ, Kim JH, Jung JY, Jang G, Kim HS, Won JY, Bruera E (2013) Predictors of high score patient-reported barriers to controlling cancer pain: a preliminary report. Support Care Cancer 21:1175–1183
Lai YH, Dalton JA, Belyea M, Chen ML, Tsai LY, Chen SC (2003) Development and testing of the pain opioid analgesics beliefs scale in Taiwanese cancer patients. J Pain Symptom Manag 25:376–385
Lin CC (2000) Barriers to the analgesic management of cancer pain: a comparison of attitudes of Taiwanese patients and their family caregivers. Pain 88:7–14
Lin CC, Lai YL, Ward SE (2003) Effect of cancer pain on performance status, mood states, and level of hope among Taiwanese cancer patients. J Pain Symptom Manag 25:29–37
Lin CC, Ward SE (1995) Patient-related barriers to cancer pain management in Taiwan. Cancer Nurs 18:16–22
Martinez KA, Aslakson RA, Wilson RF, Apostol CC, Fawole OA, Lau BD, Vollenweider D, Bass EB, Dy SM (2014) A systematic review of health care interventions for pain in patients with advanced cancer. Am J Hosp Palliat Care 31:79–86
Oldenmenger WH, Sillevis Smitt PA, van Dooren S, Stoter G, van der Rijt CC (2009) A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer 45:1370–1380
Pasternak GW (2001) The pharmacology of mu analgesics: from patients to genes. Neuroscientist Rev J Bringing Neurobiol Neurol Psychiatry 7:220–231
Radbruch L, Loick G, Kiencke P, Lindena G, Sabatowski R, Grond S, Lehmann KA, Cleeland CS (1999) Validation of the German version of the Brief Pain Inventory. J Pain Symptom Manag 18:180–187
Ravindranathan A, Joslyn G, Robertson M, Schuckit MA, Whistler JL, White RL (2009) Functional characterization of human variants of the mu-opioid receptor gene. Proc Natl Acad Sci U S A 106:10811–10816
Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37:1345–1351
Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS (1995) When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61:277–284
Tavoli A, Montazeri A, Roshan R, Tavoli Z, Melyani M (2008) Depression and quality of life in cancer patients with and without pain: the role of pain beliefs. BMC Cancer 8:177
Valeberg BT, Hanestad BR, Klepstad P, Miaskowski C, Moum T, Rustoen T (2009) Cancer patients’ barriers to pain management and psychometric properties of the Norwegian version of the Barriers Questionnaire II. Scand J Caring Sci 23:518–528
Valeberg BT, Miaskowski C, Paul SM, Rustoen T (2016) Comparison of oncology patients’ and their family caregivers’ attitudes and concerns toward pain and pain management. Cancer Nurs 39:328–334
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol Off J Eur Soc Med Oncol/ESMO 18:1437–1449
Ward SE, Berry PE, Misiewicz H (1996) Concerns about analgesics among patients and family caregivers in a hospice setting. Res Nurs Health 19:205–211
Ward SE, Carlson-Dakes K, Hughes SH, Kwekkeboom KL, Donovan HS (1998) The impact on quality of life of patient-related barriers to pain management. Res Nurs Health 21:405–413
Ward SE, Goldberg N, Miller-McCauley V, Mueller C, Nolan A, Pawlik-Plank D, Robbins A, Stormoen D, Weissman DE (1993) Patient-related barriers to management of cancer pain. Pain 52:319–324
Ward SE, Hernandez L (1994) Patient-related barriers to management of cancer pain in Puerto Rico. Pain 58:233–238
Ward SE, Wang KK, Serlin RC, Peterson SL, Murray ME (2009) A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain. Pain 144:49–56
Wolfert MZ, Gilson AM, Dahl JL, Cleary JF (2010) Opioid analgesics for pain control: Wisconsin physicians’ knowledge, beliefs, attitudes, and prescribing practices. Pain Med 11:425–434
Yates PM, Edwards HE, Nash RE, Walsh AM, Fentiman BJ, Skerman HM, Najman JM (2002) Barriers to effective cancer pain management: a survey of hospitalized cancer patients in Australia. J Pain Symptom Manag 23:393–405
Zoega S, Gunnarsdottir S, Wilson ME, Gordon DB (2016) Quality pain management in adult hospitalized patients: a concept evaluation. Nurs Forum 51:3–12
Acknowledgements
We would like to acknowledge Gudbjorg J Gudlaugsdottir and Gunnhild Jakobsen for their contribution to data collection and management and Dr. Sandra Ward for her helpful insight and expertise when preparing this manuscript.
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Authors and Affiliations
Contributions
PK was the principal investigator on the large parent study and responsible for the study protocol. All authors were responsible for data collection at their centers. SG was responsible for data analysis and writing the manuscript, SG and VS prepared the original manuscript, and all authors discussed the results and commented on the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participant received information about study participation and their rights and provided informed consent.
Conflict of interest
PK has received lecture honorarium from Mundipharma. The authors have full control of all primary data and agree to allow the journal to review the data if requested.
Funding
This study was funded by the European Palliative Care Research Collaborative, 6th EU program, Landspitali—the National University Hospital of Iceland Research Fund, University of Iceland Research Fund, the Icelandic Nurses Association Research Fund, the Icelandic Cancer Society Research Fund, the Memorial fund of the Palliative Care at Landspitali—the National University Hospital of Iceland, the Scientific fund of the Oncology Department at Landspitali—the National University Hospital of Iceland, and Bergthora Magnusdottir and Jakob J Bjarnason Memorial Fund.
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Relevance
1. This is the first large international multicenter study published on the effects of patient’s attitudinal barriers on cancer pain management.
2. Attitudinal barriers in cancer patients on opioids are associated with less effective pain control.
3. Even in patients with advanced cancer on opioids, attitudinal barriers need to be attend to.
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Gunnarsdottir, S., Sigurdardottir, V., Kloke, M. et al. A multicenter study of attitudinal barriers to cancer pain management. Support Care Cancer 25, 3595–3602 (2017). https://doi.org/10.1007/s00520-017-3791-8
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DOI: https://doi.org/10.1007/s00520-017-3791-8