Assessment of pain control among patients with cancer in hospitals of the Gaza Strip: a cross-sectional study

BackgroundPoor control of cancer pain is a major public health problem worldwide. Many potential barriers can lead to suboptimal treatment of cancer pain. One such barrier is inadequate measurement and assessment of cancer-related pain control. This study aimed to assess current pain control and management for hospitalized adult patients with cancer in the Gaza Strip.MethodsA cross-sectional study was conducted from Dec 10, 2017, to April 25, 2018, in the Gaza Strip. The validated Brief Pain Inventory (BPI) questionnaire was translated into Arabic for data collection. The first section of the questionnaire described the patients’ sociodemographic characteristics, the second evaluated the severity of cancer, and the third assessed the interference of pain with daily activities. A ten-point Likert scale was used to evaluate the magnitude of cancer pain and its impact on the patients’ lifestyle. Participants were 12 years of age and older, and were patients with cancer who had been admitted to Al-Rantisi Hospital or European Gaza Hospital (the two cancer institutes available in the Gaza Strip), and who had no mental illness or disorder affecting pain perception. Convenience sampling was used to recruit eligible patients for face-to-face interviews to complete the questionnaire. The primary outcome was the median score of cancer pain control. Ethical approval was obtained from the Palestinian Ministry of Health and informed verbal consent was obtained from patients. Data were analysed with SPSS version 22.Findings97 patients were assessed, of whom 75% (73 of 97) were eligible and were recruited. The sample size was decided based on the available cases in the included centres during study period. The median age was 49 years (IQR 37–60), 56% (41 of 73) were females, and 86% (63 of 73) were married. Most (81%; 59 of 73) had an educational level of high school or below, and 52% (38 of 73) were unemployed. 90% of patients (66 of 73) had cancer pain as a presenting symptom at diagnosis. 93% (68 of 73) had received painkillers (analgesics) within the past week, 74% (54 of 73) were using analgesics daily, and 43% (31 of 73) reported that they needed potent analgesics. 15% (11 of 73) reported concerns about analgesic addiction. The level of functional impairment owing to pain, as reported using the ten-point Likert scale, was highest for daily activities and routines (median 9·0, IQR 7·0–10·0) and least for social relationships (5·0, 0·0–9·0). There was no statistically significantly association between cancer-related pain and gender, educational level, or occupation.InterpretationMost patients were taking analgesics but a large proportion reported the need for more potent or frequent doses of painkillers. In addition, pain had a significant effect on the patients’ lifestyle. These findings indicate poor control of cancer pain. There is an urgent need to address the reasons for this, to alleviate pain and to improve quality of life.FundingNone.