Clinical investigation
Impact of radiation oncology practice on pain: A cross-sectional survey

https://doi.org/10.1016/j.ijrobp.2004.04.040Get rights and content

Abstract

Purpose

A cross-sectional study was performed to evaluate the prevalence of pain in our radiotherapy (RT) department. The impact of RT practice on pain and pain management were analyzed.

Methods and materials

Of 126 patients, 93 (73.8%) completed the questionnaire proposed in this survey. It was designed to assess the proportion of patients experiencing pain in the department, the impact of RT practice on pain, and patients' estimate of the quality of management of their pain by the medical staff. Pain intensity and patient satisfaction were assessed using an 11-point numeric rating scale.

Results

Of the 93 patients, 66 experienced pain during RT, 13 of whom were totally relieved by analgesic treatment. The mean pain intensity was 3.9 (SD 2.3). A total of 26 patients had a numeric rating ≥4, indicating that their pain was not sufficiently treated. The objective length of waiting time for a session, transportation, and mobilization for session positioning worsened the pain of a substantial proportion of patients. A total of 56% of patients had a favorable opinion about pain management in our department. A high percentage (72.2%) of patients found that the time spent by the medical staff for pain management was inadequate, and 54.5% believed that the psychological support they received was insufficient. Personnel in the RT department remained the primary source of information regarding pain control. However, 17.5% of patients did not report their pain or talked about it to non–health care professionals.

Conclusion

The prevalence of pain was high in the department. The specific practice of RT worsened pain and nearly one-half of patients were not satisfied with its management. The necessity for medical staff to be more available was highlighted by patients.

Introduction

Pain is a common symptom in cancer patients, affecting about 55% of patients (1). Many studies have shown that pain is often undertreated with available analgesics no matter which country is considered 2, 3, 4, 5. Numerous factors can compromise good application of national or international guidelines for treating patients with pain. Barriers can be related to the patient's reluctance to discuss the pain, a lack of physician knowledge and training, or particular practices such as outpatient treatment. In addition, national constraints on the use of opioids are often ambiguous, and differences between legitimate and illegitimate opioid use can also influence a physician's practices. Studies from France have pointed out a similar situation (6), and, until 1998, the severity of French laws concerning the use of opioids meant that France was a country with a low national consumption of morphine (7). In 1998, a triennial government plan against pain was begun to provide better comprehensive patient management. Four areas were defined: taking into account the patients' requests, developing specific structures in hospitals for fighting against pain, caregiver training and information on pain evaluation and treatment, and public information. By March 2003, the government announced a new cancer plan that reinforced these health policy orientations (8).

At the hospital level, these measures were implemented by creating committees for pain prevention (French acronym, CLUD). In addition, a memorandum was published that encouraged training for paramedical staff in pain assessment and gave them the possibility to initiate treatment when necessary. However, these actions developed for managing cancer pain remained more related to patients hospitalized in medical oncology departments. In addition to the pain due to disease itself, radiotherapy (RT) can induce or alter preexistent pain because of treatment manipulations under megavoltage units and daily transportation or waiting time. In addition, the acute toxicity of RT generates significant pain, and chronic post-RT syndromes such as plexopathy can occur. These points are generally not mentioned in studies about outpatient oncology practice, which are more concerned with medical oncology practices 4, 5, 9.

To appreciate the impact of radiation oncology practice on pain, a cross-sectional study was performed in our department. The aim was to evaluate the factors that can alter the management of pain and modify patients' quality of life and how these issues were dealt with in our department. To our knowledge, this is the first patient-centered study specifically aimed at the management of pain in a RT department.

Section snippets

Methods and materials

A 1-day cross-sectional survey was conducted in our radiotherapy-oncology department. A questionnaire was given to all patients treated on the same day, except for 2 children who were excluded from the study. RT technologists gave a questionnaire to a total of 126 treated patients with the request that it be filled out during the waiting time for the treatment session. When patients were unable to complete the questionnaire right away, the technologists were available to collect it the next

Results

A total of 126 patients were asked to participate in the study. Of these, 33 patients declined. They found the study too troublesome (n = 6), did not understand it because of language difficulties (n = 3), were not motivated (n = 14), were too ill (n = 7), or began RT the day of study (n = 3). The mean age was statistically similar between the two groups, and tumor location was significantly different (p <0.01). The characteristics of the 93 remaining patients (73.87%) are presented in Table 1.

Discussion

A significant number of cancer patients experience pain at diagnosis or when the disease is progressing. Many studies have attempted to evaluate the proportion of patients concerned but with wide discrepancies between results. However, pain is a real problem that has been recognized by the World Health Organization (12) as adversely affecting patients' quality of life. About 30% of newly diagnosed patients and 65–95% of patients during the course of the illness will be concerned with the

Acknowledgements

We acknowledge the following radiotherapy technologists and nurses who participated to the study: Martine Boureille, Céline Chambon, Emmanuelle Cosme, Valérie Frauciel, Gisèle Galaup, Marie-Christine Glin, Josette Liebens, Chantal Manceau, Raymonde Mélanie, Aurélie Millo, Emmeline Motyl, Christiane Piras, Marie-Ange Rabou, Nathalie Thauvin, Stéphanie Tosello, and Joëlle Verhoven.

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