RESUMO
Background: Pain remains common in people living with advanced cancer and is often inadequately managed. This study was designed to assess knowledge, perceptions and barriers to morphine use in cancer pain management among doctors in Malaysia. Methods: Doctors from multiple disciplines in a general hospital were invited to complete a 39-item self-reported questionnaire between November 2020 and December 2020. Each question was based on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree). 'Agree' and 'strongly agree' were considered correct or positive responses, except for nine questions worded in the opposite direction. Associations between variables were confirmed using Pearson's chi-squared and Fisher's exact tests. Results: Most respondents were house officers (206/321; 64.2%) with less than two years of service, followed by medical officers (68/321; 21.2%) and specialists (47/321; 14.6%). Only 7.2% of the respondents had received formal palliative care training before the study. Of the respondents, 73.5% were aware of the World Health Organization (WHO) analgaesic ladder, 60.7% were correct on oral morphine as the first line for moderate to severe cancer pain treatment and 91.9% knew the need to add rescue morphine for breakthrough pain. Additionally, 34.0% (P < 0.001) perceived morphine use caused addiction, 57.9% (n = 186) expressed fear of respiratory depression and 18.3% of medical officers and specialists perceived limited access and a maximum dose to prescribe. There was a significant difference in knowledge and perception between junior doctors and senior clinicians. The majority strongly agreed and agreed that there were inadequate training opportunities in cancer pain management. Conclusion: Inconsistent knowledge and negative perceptions of cancer pain management among doctors were demonstrated in this study.
RESUMO
INTRODUCTION: The prognosis of patients with chronic myeloid leukaemia (CML) has improved since the introduction of imatinib. However, patients who do not achieve complete cytogenetic response (CCyR) and major molecular response (MMR) have poorer prognosis. Recent clinical trials have demonstrated that early and deeper cytogenetic and molecular responses predict a better long-term outcome. This study aimed to analyse the relationship between early molecular response and clinical outcome in a real-life setting. METHODS: This retrospective study included all patients with CML, in chronic or accelerated phase, who were treated with imatinib at University of Malaya Medical Centre, Malaysia. RESULTS: A total of 70 patients were analysed. The median follow-up duration was 74 months, and the cumulative percentages of patients with CCyR and MMR were 80.0% and 65.7%, respectively. Overall survival (OS) and event-free survival (EFS) at ten years were 94.3% and 92.9%, respectively. Patients who achieved CCyR and MMR had significantly better OS and EFS than those who did not. At six months, patients who had a BCR-ABL level ≤ 10% had significantly better OS and EFS than those who had a BCR-ABL level > 10%. The target milestone of CCyR at 12 months and MMR at 18 months showed no survival advantage in our patients. CONCLUSION: Our data showed that imatinib is still useful as first-line therapy. However, vigilant monitoring of patients who have a BCR-ABL level > 10% at six months of treatment should be implemented so that prompt action can be taken to provide the best outcome for these patients.