Sunil Shrestha

Comprehensive assessment of pain characteristics, quality of life, and pain management in cancer patients: a multi-center cross-sectional study

Abstract Introduction 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. Objectives 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%. Conclusion 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.

Determinants of cervical cancer screening utilisation among women in the least developed countries: A systematic review and meta-analysis

Background and aims Globally, cervical cancer is the fourth most common cancer among women, and more than 90% of all cervical cancer-related deaths worldwide are recorded in resource-limited countries. The present review investigated the uptake rate of cervical cancer screening and identified the factors associated with screening service utilisation in the female populations of least developed countries (LDCs). Methods Five electronic databases (EMBASE, Ovid MEDLINE, CINAHL, Cochrane Library, and PubMed) and grey literature were searched for relevant literature using the keywords of the included studies. Both qualitative and quantitative studies were included. Three reviewers performed critical appraisals using the Mixed Methods Appraisal Tool. Meta-analysis was performed to pool the quantitative results from comparable studies. Results A total of twenty-five studies were included in the review. The cervical cancer screening uptake rate in LDCs ranged from 4% to 21%. Multiple factors were associated with screening service utilisation among women in the LDCs, namely socio-demographic characteristics, including employment status (odds ratio (OR): 2.72; 95% CI: 1.97–3.76; p < 0.001); knowledge of cervical cancer and its screening (OR: 3.39; 95% CI: 2.00–5.75; p < 0.001); sexual and reproductive health-related factors such as parity status (OR: 2.73; 95% CI: 1.61–4.64; p = 0.002); healthcare providers’ recommendations (OR: 5.32; 95% CI: 2.44–11.58; p < 0.001); perceived risk of developing cervical cancer (OR: 3.76; 95% CI: 2.62–5.38; p < 0.001); use of media for cervical cancer screening promotion, including radio; cultural factors; and myths and misconceptions about cervical cancer and its screening. Conclusions The uptake of cervical cancer screening among eligible women in the LDCs was notably low. The governments of these countries are advised to invest and allocate additional resources to advance policies and develop cervical cancer prevention programmes that are accessible, affordable, and acceptable.