1. Unveil the importance of pain management in cancer patients
09 : 40 – 09 : 55
Unveil the importance of pain
management in cancer patients
饒 坤 銘
Kun-Ming Rau
Moderator
陳 仁 熙
Jen-Shi Chen

2. Unveil the Importance of Pain Management in Cancer Patients at Taiwan
饒坤銘醫師
高雄長庚紀念醫院血液腫瘤科

3. Why pain control in cancer patients is so important?
Symptoms/Problems Prioritized as One of the
Five Most Important at T0 in 175 Advanced
Cancer Patients
Patients Prioritizing the Symptom Highest
(% of Respondents)
Patients Prioritizing Symptoms 1-5
(% of Respondents)
For cancer patients, pain was prioritized the most often and distressing symptoms and as the single most important symptom.
Symptom/Problem
Pain
Fatigue
Physical function
Appetite reduction
Nausea/vomiting
Dyspnea
Depression/sadness
Constipation
Role function
Inactivity
Anxiety
Dry mouth
Poor well-being
Existential/spiritual
problems
Concentration/memory
124 99 68 56 45 42 33 23 21 19 18 14 13
(71)
(57)
(39)
(32)
(26)
(24)
(19)
(13)
(12)
(11)
(10)
(8)
(7) 77 11 21 4 7 13 1 9
(44)
(6)
(12)
(2)
(4)
(7)
(1)
(5)
Symptom priority and course of symptomatology in specialized palliative care. J Pain Symptom Manage 2006;31:199–206.
When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 1995; 61: 277–284.

4. Why pain control in cancer patients is so important?
Table 4. Effects of cancer pain on patients’ quality of life (QoL, n = 1190).
*A profound impact of pain was apparent on the physical, social, and economic well-being of patients and their overall QoL.
* Chronic pain was identified as a major cause of unemployment and impacted work performance for many patients.
n (%) of respondents in agreement
Effects of cancer pain on QoL
Cancer pain affects patient’s activities
of daily living
967 (81.3)
Aspects of daily life affected (n = 967)
Pain affects sleeping patterns
Pain affects concentration and focus
831 (85.9)
841 (87.0)
Pain causes too much reliance on
642 (66.4)
other people
Overall QoL is good
328 (33.9)
Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries. Cancer Medicine 2015, 4(8):1196–1204

5. Did we make any progression
Did we make any progression? Satisfactoriness with Pain managements from 2001 to 2014 in Taiwan
63.8%
80.8%
2001
2009
84%
2014
1.Pain control in Taiwanese patients with cancer: a multicenter, patient-oriented survey.  Journal of the Formosan Medical Association 104(12):913-9 · January 2006
2. The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan. Japanese Journal of Clinical .Oncology, 2015, 45(11) 1042–1049
3. A Clinical Survey on Satisfaction of Pain Management in Patients with Cancer in Taiwan. Taiwan Society of Cancer Palliative Medicine . MASCC2015

6. Satisfactoriness with Pain managements in Europe
Nearly two-thirds said they felt “very or extremely satisfied” with the doctor who treats their pain. Satisfaction was highest in Belgium (78%) and lowest in Poland, where only 20% of people were “extremely” or “very satisfied”
Seventy percent are treated by their primary care doctor
The median length of time with their with their current doctor was 4.5 years
Satisfactoriness with Pain managements in U.S
Pain round initiative completed implemented hospital-wide
Pain round initiative implemented hospital-wide
Pain In Europe – A Report
Effective Pain Management and Improvements in Patients’ Outcomes and Satisfaction. CriticalCareNurse Vol 35, No. 3, JUNE 2015

7. Even when patients are disease free, pain may still arise from complications of adjuvant treatments, worsening the QoL
The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan. Japanese Journal of Clinical Oncology, 2015, 45(11) 1042–1049

8. 23.31% patients still suffered from pain during the previous week even they had no evidence of disease in Taiwan
A Clinical Survey on Satisfaction of Pain Management in Patients with Cancer in Taiwan. Taiwan Society of Cancer Palliative Medicine. MASCC2015

9. A meta-analysis revealed that pain was reported in 59% of patients undergoing cancer treatment, in 64% of patients with advanced disease, and in 33% of patients after curative treatment.

10. Barriers to effective pain management
lack of awareness of patients’ symptoms,
Inadequate training of clinicians concerning opioid abuse
Poor patient–doctor communication
Fear of addition/side effects
Table 3. Physicians’ perceived barriers to optimizing cancer pain management (n = 463).
n (%)
(NRS score>5)
Potential barrier
Median (IQR)
Patent’ reluctance to take opioids due to fear of addiction
Patent’ reluctance to take opioids due to fear of adverse events
Patent’ reluctance to report pain
Inadequate assessment of by physicians and/or nurses
Lack of available pain management or palliative care services
Excessive regulation of opioid drugs
Physician’s reluctance to prescribe opioids
Patient’s inability to pay for interventional analgesics/pharmacotherapy/opioid analgesics
311
301
243
230
226
222
198
173
(67.2)
(65.0)
(52.5)
(49.7)
(48.8)
(48.0)
(42.8)
(37.4)
7.0
6.0
5.0
(3.0)
(5.0)
(4.0)
An NRS scoring system from 0 to 10 was used to evaluate physicians’ responses. NRS, numeric rating scale; IQR, interquartile range.
The impact of pain control on physical and psychiatric functions of cancer patients: a nation-wide survey in Taiwan. Japanese Journal of Clinical Oncology, 2015, 45(11) 1042–1049
Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries. Cancer Medicine 2015, 4(8):1196–1204

11. The important of relieving pain and the availability of effective therapies make it imperative that health care providers be adept at the cancer pain assessment and treatment. This required familiarity with the pathogenesis of cancer pain, pain assessment techniques, and common barriers to the delivery of appropriate analgesia.
Providers should be familiar with pertinent pharmacologic, anesthetic, neurosurgical, and behavioral intervention for treating cancer pain, as well as complimentary approaches such as physical/occupational therapy.

12. From 2005 to 2014 and beyond..
For the last 10 years, patients reported satisfaction over physician and pain management improved and reached 80% in patients with cancer pain in Taiwan, while up to 40% cancer survivors still reported pain.
No matter patients who are disease free, relief from disease or disease deterioration, continuous evaluation and effective treatment of patients at every status of cancer survival are the cornerstones of satisfied control of pain.
More education and trainings for guidelines of pain control are urgently needed