The effectiveness of a pain management programme on pain control and quality of life in patients with metastatic cancer

Abstract

Background: Pain is one of the most frequent symptoms in cancer patients and has a negative impact on their physical, emotional and functional status, as well as their quality of life (QOL). This study evaluated the effectiveness of a pain management programme on pain control and QOL among patients with metastatic cancer receiving systemic chemotherapy. The authors investigated whether a pain management programme contributes to a better pain control and improvement in QOL in the outpatient setting. Methods: The authors conducted a randomised, single-blinded, controlled, single-centre study of metastatic cancer patients experiencing cancer pain and requiring opioid therapy. Patients were enrolled from the Medical Oncology Outpatient Clinic, Songklanagarind Hospital, Prince of Songkla University, Thailand. Participants were randomly assigned to two strategies: pain assessment and management based on the programme developed by the researchers (‘pain management programme’ arm), and pain management by individual medical oncologists per the routine procedure (‘standard of care’ arm). Demographics questionnaires, a pain intensity assessment using the Numeric Rating Scale (NRS) and the Functional Assessment of Cancer Therapy—General (FACT-G, version 4) were used to assess the QOL and cancer pain severity at baseline and at two follow-up visits. Results: Between November 2016 and July 2017, 64 consecutive patients were randomly assigned to the two treatment groups. Most were male (79.7%), with a mean age of 55.1 (±13.8) years. The majority of patients (23; 35.9%) had squamous cell carcinoma of the head and neck, with other prevalent types being lung cancer (9.4%), esophageal cancer (9.4%) and colorectal cancer (9.4%). The most frequent metastatic sites were the lungs (28.1%), liver (26.6%), and bone (20.3%). Findings: Compared with standard care, pain intensity was significantly lower among the patients receiving the pain management programme: 4.0 ±2.2 versus 5.1 ±1.8 (P = 0.033) and 3.3 ±1.7 versus 4.7 ±2.1 (P = 0.025) at visit 1 and 2, respectively. Likewise, QOL measures scored higher in the pain management programme group: 71.2 ±15.4 versus 58.6 ±14.5 (P = 0.002) and 71.8 ±15.5 versus 55.4 ±16.3 (P = 0.002) at visit 1 and 2, respectively. Furthermore, there was a statistically significant positive correlation between pain control and QOL improvement (P = 0.011). Conclusion: The investigated pain management programme significantly improved both pain control and QOL in metastatic cancer patients receiving systemic chemotherapy in the outpatient setting.