Pain control in head and neck cancer

Abstract

Objective: To describe the treatment of head and neck cancer pain in KHMC and to evaluate the predictive factors for inadequate management between April 2007 and March 2010. Subjects: Twenty-five patients with head and neck cancer. Main measures: Patients rated prevalence and severity of pain and functional impairment related to pain. Doctors reported patients' cancer characteristic, performance status, pain severity, and analgesic drugs ordered. Results: 57% (14/25) of patients with cancer reported pain due to their disease, and, of those with pain, 69% (9/13) rated their worst pain at a level that impaired their ability to function. 30% (5/12) were reported as receiving no drugs for their pain. Of the 18 patients in pain for whom information on treatment was available 51% (41/18) were not receiving adequate pain reliefs, according to an index based on the World Health Organization's guidelines. Doctors were found to underestimate the severity of their patients' pain. Younger patients, patients without metastasis disease, patients with a better performance status, and patients who rated their pain as more severe than their doctors did were at greater risk for under treatment of their pain. Conclusion: In the light of the high prevalence and the severity of pain among patients with head and neck cancer, the assessment and treatment of cancer pain was inadequate, emphasizing the need for changes in patient care.