Adequacy of pharmacologic pain therapy in advanced gynecologic cancer at Moi Teaching and Referral Hospital- Eldoret, Kenya

Abstract

Background: Pain is an unpleasant sensory and emotional experience associated with actual or potential damage and is common with advanced cancer. Prevalence is 40- 100% in those with uterine, cervical or ovarian cancers. Under treatment of pain is well acknowledged internationally. Using self- reported pain and validated Pain Management Index (PMI), we assessed adequacy of pain management in gynecological cancer patients at Moi Teaching and Referral Hospital (MTRH). Methods: This was a descriptive cross-sectional study at MTRH, Eldoret, Kenya, where 112 women with advanced gynecologic cancer were recruited to the study. A questionnaire-based interview using Brief Pain Inventory Tool and a structured questionnaire were used to collect data. PMI was calculated to determine the adequacy of analgesics. Interference of activities of daily living was quantified using a score derived as average of the seven domains of activities of living (range 0- 10).Mean and standard deviation were used to summarize interference of activities of daily living .Association between pain medication and some predictive clinical characteristics were evaluated using Fisher's exact test. Comparison between median level of functional interference with analgesics, pain rating and cancer type was evaluated using Kruskal-Wallis test. Results: Mean age of the participants was 47 years (SD: ± 11.54), majority were over 35 years of age .Cervical cancer was predominant at 60.7% followed by ovarian cancer at 24.1%. The median duration of illness was 12 months (IQR: 8-24).Majority of the participants were on analgesics 85.0% (96), with 78.6 %( 88) utilizing opioids. Moderate to severe pain was reported by 72.7% of participants. According to the PMI, 82.1% (92) of the participants received adequate pain management. There was statistically significant association between level of pain and choice of analgesic administered (p-value=0.026), no association between the level of pain and the cancer type (p-value=0.988).Participants reported mild interference with activities of daily living (mean less than 5). Conclusion: Opioids were utilized by majority of participants, though more than 50% of patients received more potent analgesic than required for their level of pain. Pain management was adequate among majority of the participants. Participants reported mild interference with activities of daily living (mean less than 5). Recommendations: Continued assessment and evaluation of cancer pain management at the division thus further improving care. Further study to explore patients perspective on the adequacy of advanced cancer pain management