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ElMokhallalati Y, Alaloul E, Shatat M, Shneewra T, El Massri S, Shaer O, Relton S, Abu-Odah H, Allsop MJ. The Symptom Burden and Quality of Life in Cancer Patients in the Gaza Strip, Palestine: A Cross-Sectional Study. PLoS One 2022; 17:e0262512. [PMID: 35025966 PMCID: PMC8758072 DOI: 10.1371/journal.pone.0262512] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Cancer is the second leading cause of death in the Gaza Strip, Palestine, but there is an absence of evidence systematically assessing symptom burden and quality of life (QoL) using validated tools. Our objective was to assess associations between socio-demographic and disease-related characteristics, symptom burden and QoL in a sample of cancer patients accessing outpatient services in the Gaza Strip. DESIGN A cross-sectional, descriptive survey using interviews and medical record review involving patients with cancer accessing oncology outpatient services at Al Rantisi Hospital and European Gaza Hospital (EGH) in the Gaza Strip was employed. Socio-demographic and disease-related data, the Lebanese version of the Memorial Symptom Assessment Scale (MSAS-Leb), and the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) were collected. Multiple linear regression was used to judge the relative influence of determinants of QoL. RESULTS Of 414 cancer patients approached, 385 patients consented to participation. The majority were women (64.7%) with a mean age of 52 years (SD = 16.7). Common cancer diagnoses were breast (32.2%), haematological (17.9%) and colorectal (9.1%). The median number of symptoms was 10 (IQR 1.5-18.5). Mean overall QoL was 70.5 (SD 19.9) with common physical and psychological symptoms identified. A higher burden of symptoms was associated with marital status, education and income. Limited access to both opioids and psychological support were reported. CONCLUSIONS A high symptom burden was identified in outpatients with cancer. Increasing provision and access to supportive care for physical and psychological symptoms should be prioritised alongside exploring routine assessment of symptom burden and QoL.
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Affiliation(s)
- Yousuf ElMokhallalati
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Enas Alaloul
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | | | | | - Saad El Massri
- Faculty of Medicine, Islamic University, Gaza, occupied Palestinian territory
| | - Omar Shaer
- Faculty of Medicine, Islamic University, Gaza, occupied Palestinian territory
| | - Samuel Relton
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Matthew J. Allsop
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
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LeBaron V, Adhikari A, Bennett R, Chapagain Acharya S, Dhakal M, Elmore CE, Fitzgibbon K, Gongal R, Kattel R, Koirala G, Maurer M, Munday D, Neupane B, Sagar Sharma K, Shilpakar R, Shrestha S, Thapa U, Zhang H, Dillingham R, Dutta Paudel B. A survey of cancer care institutions in Nepal to inform design of a pain management mobile application. BMC Palliat Care 2021; 20:171. [PMID: 34740339 PMCID: PMC8570036 DOI: 10.1186/s12904-021-00824-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs. OBJECTIVES This research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application ('app') to scale-up implementation of existing locally developed PMG. METHODS We conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app. FINDINGS Surveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39). CONCLUSIONS Smart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | | | - Rachel Bennett
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | | | - Manita Dhakal
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | - Catherine E. Elmore
- University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA 22908 USA
| | - Kara Fitzgibbon
- University of Virginia Center for Survey Research, Charlottesville, VA USA
| | | | - Regina Kattel
- Nepal Cancer Hospital & Research Center, Kathmandu, Nepal
| | | | - Martha Maurer
- University of Wisconsin School of Pharmacy, Sonderegger Research Center, Madison, WI USA
| | - Daniel Munday
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bijay Neupane
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | | | - Ramila Shilpakar
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Sudip Shrestha
- Nepal Cancer Hospital & Research Center, Kathmandu, Nepal
| | - Usha Thapa
- B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal
| | - Hexuan Zhang
- University of Virginia Center for Survey Research, Charlottesville, VA USA
| | - Rebecca Dillingham
- University of Virginia Center for Global Health Equity, Charlottesville, VA USA
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Li Z, Aninditha T, Griene B, Francis J, Renato P, Serrie A, Umareddy I, Boisseau S, Hadjiat Y. Burden of cancer pain in developing countries: a narrative literature review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:675-691. [PMID: 30464561 PMCID: PMC6219110 DOI: 10.2147/ceor.s181192] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cancer pain is one of the most common, feared, debilitating, and often undertreated symptoms among cancer patients. It needs attention since it has a significant impact on the quality of life (QoL) of the patients. Also, since cancer has emerged as a major health problem in developing countries, there is a need to strengthen preventive strategies for effective cancer pain management and provide comfort to cancer patients. Nonetheless, various barriers limit developing countries toward optimal cancer pain management. To bridge the gap between adequate pain management and burden of cancer pain in developing countries, a comprehensive understanding of the limitations faced and the prevalence of cancer pain should be addressed. The aim of this literature review is to provide a deeper understanding on the factors associated with cancer pain as well as barriers toward optimal cancer pain management in developing countries. Some of the barriers addressed were administrative, judicial, economic, and professional barriers. Also, estimates on the prevalence of cancer pain and detrimental effects of pain on the QoL of cancer patients have been addressed. In summary, pain, which is one of the most debilitating symptoms of cancer, remains uncontrolled and undertreated in developing countries. It has a profound impact on the patient’s QoL and can have physical, psychological, and social consequences; therefore, it needs to be managed urgently and appropriately. Most importantly, optimal treatment of cancer pain should be highlighted as a priority in developing countries and concerted efforts should be made to eliminate different barriers discussed in this review for effective and humane care.
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Affiliation(s)
- Zhang Li
- Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | | | | | | | - Paulo Renato
- Anesthesiology Service and Clinical Oncological IOC Group Pain, Brazil
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Odonkor CA, Kim G, Erdek M. Global cancer pain management: a systematic review comparing trials in Africa, Europe and North America. Pain Manag 2017; 7:299-310. [PMID: 28699421 DOI: 10.2217/pmt-2016-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM Despite the rise in cancer survivorship, few reviews have examined the quality of studies of cancer pain management and practices around the globe. With a void in trials spanning multiple geographical settings, this review evaluates the quality of cancer trials across three continents. MATERIALS & METHODS A literature review and search of established databases was conducted to identify eligible studies. The Cochrane method, the Jadad Score and a cancer pain-specific ad hoc tool were used to evaluate quality of studies. RESULTS Eighteen studies representing a total of 4693 individuals were included in the review. Study quality correlated positively with study sample size and palliative care index. Trials in all three continents were prone to use opioids for pain management, whereas trials in Europe and North America utilized other adjuvant therapies such as antidepressants and steroids. CONCLUSION This review underscores the need for better multidimensional quality assessment tools for cancer pain trials.
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Affiliation(s)
- Charles A Odonkor
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Gabriel Kim
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC 20059, USA
| | - Michael Erdek
- Division of Pain Medicine, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Are M, McIntyre A, Reddy S. Global disparities in cancer pain management and palliative care. J Surg Oncol 2017; 115:637-641. [PMID: 28230243 DOI: 10.1002/jso.24585] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 02/06/2023]
Abstract
Palliative care and pain management constitute an integral part of the multi-disciplinary approach to treating patients with cancer. There are major disparities in the global presence of sustainable palliative care models and universal availability of effective pain medications, especially in low and middle income countries with the highest predicted future burden of cancer. Active intervention is needed to improve the availability of palliative care and effective pain control worldwide.
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Affiliation(s)
- Madhuri Are
- Divison of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Amanda McIntyre
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Suresh Reddy
- Division of Cancer Medicine, Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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