Prevalence and management of cancer pain in Srinagarind Hospital, Khon Kaen, Thailand.

OBJECTIVE: Cancer pain remains an invisible problem in cancer care and our study aimed to document its prevalence, characteristics, and patterns of management at a tertiary care teaching hospital. STUDY DESIGN: Descriptive, prospective, cohort study. MATERIAL AND METHOD: We recruited 335 consecutive adult patients diagnosed with cancers, admitted to Srinagarind Hospital, between February and April 2004. All of the participants were interviewed, and their pain evaluated by direct assessment using a numeric rating scale. RESULTS: The overall prevalence of cancer pain prior to admission was 56.5%, and within the first 24 hours of admission 41.5%. Three-quarters (74%) of patients with pain reported improvement; however one-third of those with pain never received any pain control intervention. Moreover; about half of those with persistent pain only received treatment by requesting it and then only received simple analgesics. CONCLUSION: Cancer pain remains under-detected and under-treated in many patients. Pain monitoring on a regular basis as well as a training program on pain management should be considered as first-line tools for improving pain control among cancer patients.

Pain and quality of life of cancer patients: a multi-center study in Thailand.

OBJECTIVE: To identify the association between Quality Of Life (QOL) and pain intensity, and the magnitude of change of pain scores that have a clinically significant impact on patients' QOL. DESIGNS: Multi-center; prospective cohort study. MATERIAL AND METHOD: Patients suffering from cancer pain were recruited from seven university hospitals and three tertiary care centers in Thailand. The FACT-G and the Brief Pain Inventory were used to assess QOL and cancer pain severity, respectively, at study entry and at two-week follow-up. RESULTS: Five-hundred-and-twenty patients were recruited with a mean age of 52. The majority (76%) reported two sites of pain with 80% being treated at either step 2 or 3 (WHO guidelines of pain management). After two weeks, the average level of maximum pain was reduced from 6.6 to 4.8 (mean difference = -1.8, p < 0.001) and the QOL was improved from 58.6 to 61.0 (mean difference = 2.4, p < 0.001). There was a high correlation between the average change of pain intensity and QOL scores (rs = -0.42, p < 0.001). The results show that changes of pain scores of at least three points (3 out of 10) were required for a minimal important difference of FACT-G scores, indicating a significant change on patients' QOL. Pain deterioration had slightly more impact on QOL than pain improvement. A 3-point pain deterioration impaired QOL 10.3 points while 3-point reduction increased QOL only 7.6 points. CONCLUSION: The present findings suggest the importance of pain management. The change of pain scores of at least three points (out of 10 points) had statistical and clinical significance to patients' QOL.

Health related quality of life instruments for glaucoma: a comprehensive review.

Health related quality of life (HRQOL) outcome is becoming important and of interest for clinicians and patients alike. HRQOL can be affected immediately after the initial diagnosis of the disease through anxiety of blindness. Further impairment in various aspects of HRQOL is expected over time as the disease progresses, reducing daily activities. Without a gold standard for HRQOL construct in this population, a number of instruments have become available with different characteristics and foci. This article reviews published HRQOL instruments and their psychometric properties in glaucoma patients. Of the 10 instruments reviewed, 2 were generic, 4 were vision-specific and 4 were glaucoma-specific instruments. Overall, vision- and glaucoma-specific instruments appear to be more sensitive than generic instruments in detecting potential changes of HRQOL in the patients. The shortcoming of existing instruments, however, arises from being predominantly focused on physical functions while omitting other aspects relevant to patients HRQOL such as psychological and social well-being. In addition, many vision-specific instruments have inadequate coverage of important issues, such as peripheral and color vision, which are affected by glaucoma disease. Validation of the instruments using various magnitudes of visual field is warranted and further investigation of their responsiveness is required for them to be more useful for outcome evaluation in the clinical setting. Refinement of an instrument to enhance the incorporation of HRQOL in routine management of patients with glaucoma is briefly described.