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