Cancer pain assessment, management and effect on the quality of life of patients at a tertiary hospital in Ghana

Abstract

Background: Despite extensive technological advancements in medicine in recent years, cancer still remains poorly managed resulting in pain and affecting adversely the quality of life (QoL) of patients. Additionally, evidence suggests that effective cancer pain management is largely inadequate in low and middle income countries such as Ghana. Aim: This study seeks to assess the severity and management of cancer pain at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods: Using a structured questionnaire, the socio-demographic data, clinical characteristics, and drug history of 204 consenting ambulatory oncology patients, aged 18 years or older, attending clinic at the Oncology Directorate, KATH were obtained from medical folders and the Hospital Administration Management System (HAMS) from January – December, 2015. Structured interviews were also conducted for the patients using the Brief Pain Inventory Long Form (BPI-LF) and the World Health Organization Quality of Life-Brief version (WHOQoL- Bref) to evaluate patients‘ level of self-reported pain and how pain affects their quality of life. Data obtained was analysed using reliability and validity tests, parametric and non-parametric tests. Results: Majority of patients were females (82.8%), married (56.6%), Christians (89.3%), and employed (86.8%), with mean age and parity of 53.54 years (SD = 15.457) and 4.39 children (SD = 3.118) respectively. Most patients (81.4%) subscribed to the National Health Insurance Authority (NHIA) registration to cover medical expenses. Diagnosis for breast cancer (37.7%), stage III/ IV disease (63.3%) and metastases (32.5%) were predominantly identified. Only 9.1% of patients had positive family history of cancer while 8 in 10 (79.6%) patients had Eastern Cooperative Oncology Group performance status of 1. Hypertension was the predominant comorbid condition identified in 19.6% of the patients. Dual chemotherapeutic agents combination therapy (46.5%) and mono analgesic therapy (51.1%) were most used. Internal consistency reliability of the BPI-LF and WHOQoL-Bref were 0.876 and 0.910 respectively. More than half of the patients (63.7%) reported moderate pain while 28.4% reported severe pain. Cancer pain interfered highly with sleep (46.2%) and general activity (42.5%) of patients. Common sites of cancer pain reported by patients were abdomen (20.3%) and left breast (12.4%). A set of patients‘ factors did not predict their overall quality of life and the regression model did not adequately fit the data (R2= 0.44). Conclusion: Patients predominantly reported moderate cancer pain. Pain management was mostly inadequate in the patients and pain significantly affected the quality of life of the patients.