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INTRODUCTION & PRINCIPLES OF CANCER PAIN MANAGEMENT

INTRODUCTION & PRINCIPLES OF CANCER PAIN MANAGEMENT. Clinical Practice Guidelines Management of Cancer Pain Development Group. Epidemiology of Cancer.

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INTRODUCTION & PRINCIPLES OF CANCER PAIN MANAGEMENT

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  1. INTRODUCTION & PRINCIPLES OF CANCER PAIN MANAGEMENT Clinical Practice Guidelines Management of Cancer Pain Development Group

  2. Epidemiology of Cancer • In Peninsular Malaysia, Age Standardised Incidence Rate = 131.3/100,000 population (annual incidence of cancer in Malaysia estimated 35,000 - 40,000)1 • Prevalence estimated at 90,0002 • Pain is among the commonest symptoms experienced by cancer patients 1NCR Cancer Incidence Report 2006 2GCC Lim 2001

  3. Cancer Pain Statistics • Paucity of data available in Malaysia • Based on global figures: • Cancer pain prevalence = 45,0001 (50% of cancer patients experience pain and 70% of advanced cancer patients experience pain – Bonica JJ 1985) • Moderate to severe cancer pain prevalence = 15,000 (1/3 of cancer pain patients have moderate to severe pain)2 1Lim R, Oncology, 2008 2van den Beuken-van Everdingen MH et al., Ann Oncol, 2007

  4. 15,000 patients with moderate to severe cancer pain “Have you seen this man?”

  5. Unrelieved painDESTROYS quality of life for both the cancer patient & the family

  6. “Relief of pain allows the person to live the rest of his/her life constructively & productively. PALLIATIVE CARE USING MORPHINE RELIEVES CANCER PAIN IN 90% OF PATIENTS.” WHO Cancer & Palliative Care Unit, Geneva

  7. 2005 Global Consumption of Morphine Malaysia (0.9230 mg) International Narcotics Control Board 2007

  8. 2005 Global Consumption of Fentanyl Malaysia (0.0122 mg) International Narcotics Control Board 2007

  9. Usage of Opioids in Malaysia 2005 Malaysian statistics on medicine 2005

  10. Interpretation • If the DDD for morphine of a country is 1 DDD/1000 population/day: 1 person in every 1000 population has received 100 mg of oral morphine daily

  11. Morphine Usage in Malaysia • Total population in Malaysia in 2005 = 26.13 million • 1 DDD/1000 population/day = 26,130 people receiving 100 mg of oral morphine daily • 26,130 x 0.1094 = 2,858Malaysians receive an average of 100 mg oral morphine daily

  12. Why is a CPG on Cancer Pain Management needed? 1Lim R, Oncology, 2008 It is estimated that <20% of cancer patients in Malaysia who experienced moderate to severe cancer pain received opioid analgesia1 Many healthcare providers are “uncomfortable” & unfamiliar with using opioid analgesia for treating cancer pain adequately The World Health Organization & the International Association for the Study of Pain have stated that “Pain Relief is a Basic Human Right”

  13. Principles of Cancer Pain Management Comprehensive pain assessment prior to treatment Understanding the concept of ‘total pain’ Reassessment & adjustment of treatment when indicated Inter-professional collaboration in multidisciplinary teams Participation of patients & their family members/carers

  14. Physical Psychological Total Pain Spiritual Social 1.Mehta A et al.., J Hospice & Palliative Nursing, 2008 2Clark, D. “Total pain,” disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Social Science and Medicine, 1999; 49: 727–736

  15. Four-pronged approach1 1Lickiss JN, Eur J Pain, 2001 Assess & reduce noxious stimuli. Treat the cancer – RT, Chemo, Surgery Raise threshold to pain – listen to the patient’s story. Reduce anxiety/depression Consider opioid therapy – WHO ladder Consider management of opioid poorly responsive opioid pain – adjuvants, nerve blocks

  16. Multidisciplinary Care & Involvement of Family 1San Martin-Rodriguez L et al., Cancer Nurs, 2008 2Lin CC, et al., Pain, 2006 • Inter-professional collaboration in managing cancer pain has shown:1, level III • Improvement in mean patient satisfaction (p<0.001) • Less uncertainty & concerns among patients (p=0.047) • Adequacy in pain management (p=0.016) • Involvement of patients & their family carers in the management of cancer pain reduces barriers to analgesic use (p<0.0001) & decreases the worst pain score (p<0.05)2, level I

  17. CPG Development CommitteeChairman: Dr. Richard Lim Boon Leong Consultant Palliative Medicine Physician Dr. Azizul Awaluddin, Consultant Psychiatrist, Hospital Putrajaya Dr. Azura Deniel, Clinical Oncologist , HKL A/P Dr. Choy Yin Choy, Senior Consultant Anaesthesiologist , PPUKM Matron Morna Chua Wui Lang, Hospital QE Dr. Eni Juraida Abdul Rahman,Senior Consultant. Paediatric Haemato-oncologist, HKL Dr. Ismail Aliyas, Consultant Gynae-oncologist,Hospital Sultanah Bahiyah Datuk Dr. Kuan Geok Lan, Senior Consultant Paediatrician,H. Melaka Dr. Lim Zee Nee, Palliative Medicine Physician, Hospis Malaysia Cik Lee Ai Wei,Pharmacist ,Hosp. Selayang Pn. Lim Khee Li, Physiotherapist ,HKL Dr. Mary Suma Cardosa, Sen. Consultant Anaesthesiologist & Pain Specialist,H. Slyg Professor Dr. Marzida Mansor,Senior Consultant Anaesthesiologist, PPUM Dr. Mohd. Aminuddin Mohd. Yusof, Public Health Physician. MaHTAS Dr. Ramesh R. Thangaratnam, Consultant Surgeon ,Hospital Serdang Pn. Rosaniza Zakaria, Medical Social Worker , Hospital Selayang Dr. Sinari Salleh,Consultant Clinical Haematologist,Hospital RPZ II Dr. Sri Wahyu Taher,Consultant Family Medicine Specialist,KK Bdr Sg. Petani Dr. Yeat Choi Ling,Palliative Medicine Physician,Hosp. Raja Perempuan Bainun Dr. Zubaidah Jamil, Clinical Psychologist, UPM

  18. Level of Evidence SOURCE: US / CANADIAN PREVENTIVE SERVICES TASK FORCE

  19. Grades of Recommendations SOURCE: MODIFIED FROM THE SIGN Note: The grades of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation

  20. THANK YOU

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