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Submitted: 16 August 2011 Modified: 16 August 2011
HERDIN Record #: PCHRD08161101081513

The practice of cancer pain management among physicians in the Philippines.

Adriano V. Laudico

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A 17-page, 49-item questionnaire was distributed to specialists practicing in tertiary hopsitals where majority of cancer patients in the locality were treated. The questionnaire was modified from that used by Cleeland and the Pain Research Group within the Eastern Comparative Oncology Group in the United States. There were a total of 264 respondents with a median age of 32.5 years (range = 24.81 years), with surgeons comprising 48.1%. Only 26% and 32% felt their training in cancer pain management as excellent or good in medical school and residency training, respectively. Regarding the treatment of prolonged moderate to severe cancer pain, 43% reported NSAIDs to be their first choice, and 14% picked meperidine. Respondents felt that only 51% of physicians they worked with made somewhat more good analgesic choices than poor choices. Only 48% disagreed that parenteral administration was better than the oral route, even when the patient was not vomiting . Regarding the prognosis at which they would use the maximum tolerated analgesic therapy, 26% would wait until the prognosis was less than 6 months, and only 29% would do so when prognosis was less than 24 months. Logistic regression analysis of 34 candidate predictors identified through univariate analysis showed 2 characteristics of persons who would treat pain aggresively earlier in the disease: 1) those who tended to insist on complete pain relief as the goal of treatment rather than pain not becoming distressing until shortly before the next dose, and 2) saw higher proportions of patients who had pain that lasted more than one month. Only 36.8% felt that pain control in their own practice setting was well or very well. Physicians were asked to rank a list of potential barriers to optimal cancer pain management in their setting. The proportions of respondents who ranked the top 4 items were: 1) inadequate staff knowledge about pain management (61.3%): 2) inadequate pain assessment (53.2%): 3) excessive state regulation in prescribing analgesics (38.5%): and, 4) medical staff reluctance to prescribe aspirates (35.9%).

Objectives

To determine the attitudes toward cancer pain control and the practice of cancer pain treatment among Philippine physicians.