Influence of Pain on Quality of Life for Cancer Patients

Influence of Pain on lumber of sustenance for crabmeat PatientsAbstractPurpose Pain is a common complaint of crabby person patients which is found to importantly affect the theatrical role of life of promontory and bang malignant neoplastic disease patients. For patients suffering from crabby person, control of symptoms and ache athletics a significant role in improving the overall role of life of nous and manage crabmeat patients. A literature search revealed that studies on the intensity of imposition and musical note of life a maneuver receiving anticancer therapy are lacking. Thus, this resume was an attempt to assess the influence of intensity of spite on quality of life of cancer patients before receiving anticancer sermonsMethods A total of snow histopathologically confirmed cases of head and sleep together cancer were interviewed. Intensity of bruise was evaluated development the sketch Pain Inventory and the quality of life of patients was evaluat ed victimisation EORTC QLQ-C30 module..Results The results showed that majority of patients suffering from literal cancer belonged to 5th and sixth decade of life. Kruskal Wallis test showed statistically significant in the quality of life and tumor exhibits. Chi square test in addition gave significant fellowship between the quality of life and inconvenience oneself sensation.Conclusions. Assessment of Quality of life in cancer patients pull up stakes site the attention of clinician to the n primaeval important symptom pain. Thus appropriate interventions can be instituted at objurgate time along with moderating sympathize with to improve the Quality of Life of cancer patients.Keywords Pain, Quality of Life, genus Cancer, lenitive careIntroductionHead and discern cancer encompasses a group of tumours involving the lip, oral cavity, nasal cavity, larynx, throat and paranasal sinuses. By incidence, it is the sixerth leading cancer worldwide and eighth by fatality. E very category 0.5 million new cases are account. It usually develops in 6th-7th decade of life and five year survival of the fittest rate in a patient suffering from HNSCC is 40-50%. somewhat 40% of these tumours occur in the oral cavity, 15% occur in the pharynx, and 25% occur in the larynx in 90% of the cases, the well-nigh common histologic type is squamous cell carcinoma. (1)Pain is the most burdensome symptom and is angiotensin converting enzyme of the most common complaints in a patients suffering from Head and Neck cancer. A systematic review evaluating the prevalence of pain in cancer patients over past 40 years reported high figures in the range of 52-77%. (2) The review also stated that as the wooden leg of cancer march on the prevalence of pain also increase. They reported a prevalence of 62%86% in patients with advanced cancer. (2) These figures are in contrast to rapidly increasing research work in the field of pain second-stringer.Pain is whizz of the most significant symptoms of cancer patients that affects multiple domains of life ranging from its impact on physical surgery to frantic functioning. It is a usual symptom of cancer patients, accounting for 30% to 40% of their chief complaints, and is of multifactorial aetiology. Approximately 58% of cancer patients suffer from unbearable pain, and this prevalence increases to 85% in patients with cancer in advanced stages. (3. A metanalysis which was carried out in the year of 52 studies for evaluating the prevalence of pain in cancer patients, reported that head and neck cancer patients had the highest prevalence of pain exceeding gastrointestinal gynaecological, breast and lung tumours. (2) In Head and Neck cancer patients, pain distresses the oral functions and is chief complaint in about 58% of the patients awaiting word and in 30% of the treated patients (4,5).The term Quality of Life has been used in literature in various ways both as a concept and an instrument of measurement . Very rarely has it been defined clearly. It may be considered as a subjective term which conveys the perception of a patient close to his life which may either be positive or negative. It includes an assessment of general health, satisfaction, fulfilment, ability to cope, happiness, being in control and degree of independence. (6)Not only does pain affect the life of quality of patients before seeking antineoplastic discourse, also it has devastating effect in patients undergoing treatment. Thus there has been a exploitation interest in the inclusion of measures for improving life quality of patients before, during and after undergoing quality of life treatments. belles-lettres search revealed that studies on the intensity of pain and quality of life before receiving anticancer therapy are lacking. Thus, this understand was undertaken to assess the insensibility of pain and its impact on the quality of life (QoL) in untreated patients with head and neck carcinoma using ques tionnaire. Also the association of pain severity with clinical stage of the tumour and lymph thickening involvement was assessed.Materials and MethodsThe study was carried out in the patients reporting to the outpatient department of K.L.E.V.K.I.D.S and Belgaum Cancer Institute. Ethical clearance was obtained from the institution. A total of 100 confirmed head and neck cancer patients were interviewed. Untreated histopathologically confirmed head and neck cancer patients were included in the study while patients who were receiving, or had completed their course of treatment for cancer, with r horizontalant malignant disease and with compromised physical and affable state which prevented them from answering questions were excluded from the study.Patients were divided into four groups depending on their stage of tumour as follows-Group I = leg I=23 patientsGroup II = Stage II=25 patientsGroup III = Stage III=25 patientsGroup IV = stage IV=27 patientsPain was evaluated using Brief Pain Inventory (BPI) (7) which was validated in the northernmost Indian Population.(8) The BPI is a 11 point scale which is presented horizontally from numbers ranging from 0-10. The Questions were translated in the local anesthetic language of the patient. Patients were asked to rate their pain in the last 24 hours at its Worst, Least and on Average. Patients were also asked to encircle the number indicating the amount of pain they were having at present. The pain was then categorized into four groups No pain (0), Mild pain (1-4), Moderate pain (5-6) and Severe pain (7-8)The Quality of Life of patients was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) version 3.0 (9) which was validated in Indian Population (10).EORCTC QLQ-C30 is a 30 item questionnaire which consists of five functional scale, three symptom scale, six single items and Global Quality of life question.(8) The functional scale compr ises a set of questions to evaluate the functioning of a cancer patient which includes Physical, Role, Cognitive, Social and Emotional Functioning. Symptom Scale includes three items to evaluate the fatigue, pain and nausea in patients. A number of single items such as Dyspnoea, Insomnia, Insomnia, Constipation, appetite loss, Diarrhoea and pecuniary difficulties were also included. The Symptom scale evaluated Fatigue, Pain and Nausea.Patients were asked to answer each question on a 4 point scale ranging from 1-4 corresponding to pain as Not at all (1), A comminuted bit (2), Quite a Bit (3, Very Much (4). Patients were asked to rate the last two items (Global Quality of Life ) on a horizontal scale ranging from 1-7. All the scores thus obtained were linearly alter to be expressed on a scale from 0-100.All the data was tabulated and non-parametric tests were applied. The data was subjected to Descriptive statistics, Mann-Whitney and Kruskal Wallis test.Results100 histopathologica lly confirmed cases were enrolled in the study. The results showed that head and neck cancer was common in patients in 5th and 6th decade of life (35% and 32% respectively) with a mean age of 54.8 years (age range-24-86 years). Strong predominance of manful population (79%) was seen. Out of a total 100 patients, 67% patients had the site of primary tumour in unwritten cavity followed by Oropharynx (22 %), Larynx (6%)and Hypopharynx (5%). Lymph node involvement was present in 66% patients.The basal scores for all the items on the scale was obtained using the EORTC QLQ-C30 Scoring Manual. Patients in the early stages of tumour scored significantly higher on function scale indicating higher functionality and ease in their daily activities. On opponent patients with advanced cancer scored higher on symptom scale indicating hampered quality of life and greater obstruction in doing their day to day work.Kruskal wallis test showed significant difference in the quality of life and the tumour stages, which was statistically significant .(p valueOn applying Mann Whitney test significant differences in the quality of life of patients with lymph node involvement and without lymph node involvement. (p value Chi square test also gave significant association between the quality of life and pain. (p valueDiscussionThis study was carried out to assess the influence of pain severity on quality of life of head and neck cancer patients before receiving any antineoplastic treatment. With approximately one million of new cancer cases being added every year in India and 80% of them presenting in advanced stages ( stage III and stage IV)(11)the need for pain relief and palliative therapy is imperative.Cancer pain still being one of the most dreaded and burdensome aspects of cancer patients draws attention to the vigilance of pain in head and neck cancer patients. Inspite of introduction of WHOs step ladder pattern for the management of pain control in cancer patients (12) it h as been reported that less than 3% patients in India have an seemly access to pain relief. (13) . The present study also showed signification association between the cancer pain and stage of tumour. Patients with advanced stage of tumour experienced more difficulty in talking, swallowing etc. and measlyer quality of life thus indicating a greater need for the institution of pain relief measures. The findings were consistent with the study done by Oliveira KG et al (14) who concluded that patients in advanced stages showed higher impairment in their functional status. Similar findings were noned by Connely et al (4) who reported that patients with squamous cell carcinoma experienced significantly increased function-related intensity of pain rather than spontaneous.The reasons for under treatment and inadequate pain relief could be attributed to poor resources, inaccessibility to morphine, misconception about the drugs for pain relief e.g. addiction, opiophobia of patients and comm unication problems. (15) Also the nature of Cancer pain is not fixed. It has multiple complex aetiologies and is recurring in nature. One of the very important reasons for the inadequate pain relief in cancer patients is that currently no such medication exists for chronic cancer pain that will provide more than 30% relief to the cancer patients.(16) This makes the institution of palliative and support care even more essential.The World Health Organization has defined palliative care as An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. (17) WHO emphasizes on meeting the psychological, social and mental needs of the patients so as to improve their quality of life. However, it has been reported that approximately 85% of patients who are admitted to palliative care centres have inadequate relief of pain. (18).Despite the fact that HNC has the highest pain prevalence of all the cancers and is one of the initial symptoms that motivate the patients to seek medical opinion, health care professionals concentrate solely on the surgical aspects, radiotherapy and chemotherapy. The management of chief complain of the patient i.e. pain is neglected which leads to poor quality of life. therefore an evaluation of cancer patients before initiating any antineoplastic treatment is critical to because most of the studies concentrate on the assessment of pain during or after treatment.ConclusionThe average time from the admission of patients to palliative care unit and their death is usually less than a month thus indicating that palliative care is usually initiated only in the terminally ill patients, An assessment of quality of life of cancer patients before treatment will draw the attention of the clinic ian to the most symptomatic and feared aspect of cancer i.e. pain.Thus appropriate measures for pain relief along with supportive and palliative care can be instituted right from the beginning of the treatment which will greatly enhance the quality of life of cancer patients.ReferencesParkin DM, Bray F, Ferlay J, Pisani PGlobal cancer statistics, 2002. 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