背景:疼痛是癌症患者中最常见的主诉,显着损害他们的健康相关生活质量(HRQOL)。关于尼泊尔低资源环境癌症患者疼痛特征的证据有限。
目的:本研究的主要目的是评估疼痛的临床特征,影响疼痛强度的因素,以及癌症患者疼痛严重程度与生活质量(QoL)的关系。次要目标包括调查这些患者对疼痛管理和药物依从性的感知障碍。
方法:这种多中心,横断面研究纳入了成年患者(18岁以上),这些患者报告有癌症诊断经历疼痛.社会人口统计特征(例如,年龄,性别,教育状况),临床特征(例如癌症诊断,分期),和疼痛特征(例如,持续时间,type,location,用于疼痛管理的药物,等。)被记录下来。使用数字评定量表(NRS)评估结果,疼痛管理指数,欧洲癌症研究和治疗组织生活质量问卷,障碍问卷II,药物依从性评定量表,医院焦虑和抑郁量表。
结果:四百八位患者参与了这项研究。平均±SD年龄为54.87±15.65,其中226例(55.4%)为女性。最常见的癌症诊断是宫颈癌(17.6%),肺(11.8%),和结肠/直肠(12.0%)癌症。最常见的疼痛部位是头部和颈部(27.0%);大多数(55.6%)报告疼痛持续时间超过3个月。42.4%的患者报告了伤害性疼痛;NRS的平均值±SD为4.31±2.69,其中32.4%的患者经历中度疼痛。混合疼痛类型(B=1.458,p<0.001)或多部位疼痛(B=1.175,p<0.001)的患者,较低的Karnofsky绩效状态(KPS)(B=-1.308,p<0.001),和特定的癌症诊断,如前列腺(B=-2.045,p=0.002),胰腺(B=1.852,p=0.004),食道(B=1.674,p=0.012),和卵巢癌(B=1.967,p=0.047),经历了不同程度的NRS评分增加。联合化疗和放疗治疗方式与较低的NRS评分相关(B=-0.583,p=0.017)。观察到疼痛严重程度与总体健康状况/QoL之间存在显着负相关关系(B=-37.36,p<0.001。疼痛管理的主要障碍包括对生理效应的适度感知,医生和病人之间的沟通问题,以及对止痛药有害影响的担忧。不坚持使用止痛药的患病率为13.97%。
结论:结论:本研究强调了尼泊尔低资源环境癌症患者疼痛管理和生活质量的多面性.这些发现强调了癌症患者疼痛感知的多因素性质,混合疼痛类型,多个部位疼痛,较低的KPS,和特定的癌症诊断,所有这些都对疼痛的严重程度有显著影响。此外,疼痛严重程度与QoL下降相关.这些发现为癌症疼痛的复杂方面及其对患者福祉的更广泛影响提供了有价值的见解。在低资源环境下的癌症护理背景下,为有针对性的干预措施和改善疼痛管理策略奠定基础。
BACKGROUND: Pain is the most common complaint among cancer patients, significantly impairing their health-related quality of life (HRQOL). There is limited evidence on the characteristics of pain among cancer patients in Nepal with low-resource settings.
OBJECTIVE: The primary objective of this study was to evaluate the clinical characteristics of pain, factors influencing pain intensity, and the association of pain severity with quality of life (QoL) among cancer patients. Secondary objectives included investigating perceived barriers to pain management and medication adherence among these patients.
METHODS: This multi-center, cross-sectional study enrolled adult patients (over 18 years old) with reported cancer diagnoses experiencing pain. Socio-demographic characteristics (e.g., age, gender, educational status), clinical characteristics (e.g. cancer diagnosis, staging), and pain characteristics (e.g., duration, type, location, medicines used for pain management, etc.) were recorded. Outcomes were assessed using the Numeric rating scale (NRS), Pain management Index, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire, Barriers Questionnaire II, Medication Adherence Rating Scale, and Hospital Anxiety and Depression Scale.
RESULTS: Four hundred and eight patients participated in the study. The mean ± SD age was 54.87 ± 15.65, with 226 patients (55.4%) being female. The most common cancer diagnoses were cervical (17.6%), lung (11.8%), and colon/rectum (12.0%) cancers. The most common pain locations were the head and neck (27.0%); a majority (55.6%) reported pain duration of more than 3 months. Nociceptive pain was reported by 42.4% of patients; the mean ± SD of NRS was 4.31 ± 2.69, with 32.4% of patients experiencing moderate pain. Patients with mixed pain type (B = 1.458, p < 0.001) or pain in multiple sites (B = 1.175, p < 0.001), lower Karnofsky Performance Status (KPS) (B = -1.308, p < 0.001), and specific cancer diagnoses such as prostate (B = -2.045, p = 0.002), pancreatic (B = 1.852, p = 0.004), oesophageal (B = 1.674, p = 0.012), and ovarian cancer (B = 1.967, p = 0.047), experienced varying degrees of increased NRS score. The combined chemotherapy and radiotherapy treatment modality was associated with a lower NRS score (B = -0.583, p = 0.017). A significant inverse relationship was observed between pain severity and global health status/QoL (B = -37.36, p < 0.001. Key barriers to pain management included moderate perceptions of physiological effects, communication issues between doctors and patients, and concerns about the harmful effects of pain medicine. The prevalence of non-adherence to pain medications was 13.97%.
CONCLUSIONS: In conclusion, this study highlights the multi-faceted nature of pain management and QoL for cancer patients in Nepal with low-resource settings. These findings underscore the multifactorial nature of pain perception in cancer patients, with mixed pain types, pain in multiple sites, lower KPS, and specific cancer diagnoses, all contributing significantly to pain severity. Additionally, pain severity was associated with declining QoL. These findings contribute valuable insights into the complex aspects of cancer pain and its broader implications for the well-being of patients, offering a foundation for targeted interventions and improved pain management strategies in the context of cancer care in low-resource settings.