Overcoming Barriers in Cancer Pain Management

Pain is a devastating symptom of cancer that affects the quality of life of patients, families, and caregivers. It is a multidimensional symptom that includes physical, psychosocial, emotional, and spiritual components. Despite the development of novel analgesics and updated pain guidelines, cancer pain remains undermanaged, and some patients with moderate to severe pain do not receive adequate pain treatment. Inadequate pain management can be attributed to barriers related to health care professionals, patients, and the health care system. Common professional-related barriers include poor pain assessment, lack of knowledge and skill, and the reluctance of physicians to prescribe opioids. Patient-related barriers include cognitive factors, affective factors, and adherence to analgesic regimens. System-related barriers such as limits on access to opioids and the availability of pain and palliative care specialists present additional challenges, particularly in resource-poor regions. Given the multidimensional nature of cancer pain and the multifaceted barriers involved, effective pain control mandates multidisciplinary interventions from interprofessional teams. Educational interventions for patients and health care professionals may improve the success of pain management.

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Cancer pain management

Orvosi Hetilap ◽

10.1556/oh.2014.29808 ◽

2014 ◽

Vol 155 (3) ◽

pp. 93-99

Author(s):

Péter Heigl

Keyword(s):

Quality Of Life ◽

Pain Management ◽

Pain Relief ◽

Life Expectancy ◽

Cancer Pain ◽

Cancer Pain Management ◽

Medical Activity ◽

Short Summary ◽

Adequate Quality

Pain is a significant and alarming symptom of cancer seriously affecting the activity and quality of life of patients. Recent research proved that inadequate analgesia shortens life expectancy. Therefore, pain relief is not only a possibility but a professional, ethical and moral commitment to relieve patients from suffering, as well as ensure their adequate quality of life and human dignity. Proper pain relief can be achieved with medical therapy in most of the cases and the pharmacological alternatives are available in Hungary. Yet medical activity regarding pain relief is far from the desired. This paper gives a short summary of the guidelines on medical pain management focusing particularly on the use of opioids. Orv. Hetil., 2014, 155(3), 93–99.

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LONGTERM EPIDURAL ANALGESIA FOR PANCREATIC CANCER PAIN MANAGEMENT AS ALTERNATIVE TECHNIQUE TO IMPROVE QUALITY OF LIFE – A SERIAL CASE REPORT

10.26226/morressier.598b05d9d462b80290b53a73 ◽

2017 ◽

Author(s):

Bambang Pujo Semedi

Keyword(s):

Quality Of Life ◽

Pancreatic Cancer ◽

Case Report ◽

Pain Management ◽

Epidural Analgesia ◽

Cancer Pain ◽

Alternative Technique ◽

Improve Quality ◽

Cancer Pain Management

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Implementing Guidelines for Cancer Pain Management: Results of a Randomized Controlled Clinical Trial

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.1.361 ◽

1999 ◽

Vol 17 (1) ◽

pp. 361-361 ◽

Cited By ~ 188

Author(s):

Stuart L. Du Pen ◽

Anna R. Du Pen ◽

Nayak Polissar ◽

Jennifer Hansberry ◽

Beth Miller Kraybill ◽

...

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Pain Management ◽

Cancer Pain ◽

Symptom Management ◽

Controlled Study ◽

Cancer Pain Management ◽

Randomized Controlled ◽

Prospective Longitudinal

PURPOSE: Pain and symptom management is an integral part of the clinical practice of oncology. A number of guidelines have been developed to assist the clinician in optimizing comfort care. We implemented clinical guidelines for cancer pain management in the community setting and evaluated whether these guidelines improved care. PATIENTS AND METHODS: Eighty-one cancer patients, aged 37 to 76 years, were enrolled onto a prospective, longitudinal, randomized controlled study from the outpatient clinic settings of 26 western Washington–area medical oncologists. A multilevel treatment algorithm based on the Agency for Health Care Policy and Research Guidelines for Cancer Pain Management was compared with standard-practice (control) pain and symptom management therapies used by community oncologists. The primary outcome of interest was pain (Brief Pain Inventory); secondary outcomes of interest were all other symptoms (Memorial Symptom Assessment Scale) and quality of life (Functional Assessment of Cancer Therapy Scale). RESULTS: Patients randomized to the pain algorithm group achieved a statistically significant reduction in usual pain intensity, measured as slope scores, when compared with standard community practice (P < .02). Concurrent chemotherapy and patient adherence to treatment were significant mediators of worst pain. There were no significant differences in other symptoms or quality of life between the two treatment groups. CONCLUSION: This guideline implementation study supports the use of algorithmic decision making in the management of cancer pain. These findings suggest that comprehensive pain assessment and evidence-based analgesic decision-making processes do enhance usual pain outcomes.

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Health-Care Professionals Perceived Barriers to Effective Cancer Pain Management in the Home Hospice Setting: Is Dying at Home Really Best?

OMEGA - Journal of Death and Dying ◽

10.1177/0030222819857871 ◽

2019 ◽

pp. 003022281985787

Author(s):

Lee A. Johnson ◽

Cynthia J. Bell ◽

Sheila Ridner ◽

Barbara Murphy

Keyword(s):

Health Care ◽

Pain Management ◽

Cancer Pain ◽

Health Care Professionals ◽

Cultural Beliefs ◽

Comparative Approach ◽

Unexpected Finding ◽

Convenience Sample ◽

Alternative Placement ◽

Patients At Risk

Hospice health-care professionals (HCP) evaluate and manage cancer pain in patient homes. This study explores HCP’s perceptions of barriers that affect pain management for home hospice cancer patients. A convenience sample of 20 experienced hospice HCP were recruited from a regional hospice agency. Data were collected through two focus groups using semistructured interviews and analyzed using a constant comparative approach to generate themes. An unexpected finding revealed patient’s religious and cultural beliefs about suffering and family caregiver’s beliefs that patients deserve to suffer due to past actions are barriers to pain management in home hospice. Hospice HCP can identify patients at risk for suffering at the end of life. Interventions targeting spiritual suffering and needs are needed. Home hospice HCP have an ethical obligation to address undue suffering through family’s withholding of necessary pain medications and should consider alternative placement when home is not suitable for a peaceful death.

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