Pain Management Strategies Among Cervical Cancer Patients in Zimbabwe

Abstract

Aim: To describe pain management regulations, prevalence of pain and pain management practices in a Zimbabwean setting. Materials & methods: A multi-methods approach was used, consisting of: policy and guideline review; review of 410 cervical cancer patient records for pain symptoms and pain management data; and semistructured interviews with oncology healthcare practitioners. Results: We found a lack of policies that are specific for cervical cancer pain management. Although prevalence of pain was 68% (n = 278), only 42% of the patient records indicated pain drugs had been prescribed. Barriers to pain management included inadequate use of pain assessment tools, inaccessibility of key drugs and limited capacity. Conclusion: Cancer pain management in Zimbabwe can be improved by tailoring assessment protocols, improving drug accessibility and strengthening healthcare systems.

Lay abstract

Although cancer pain has potential life-altering impact, it is not well studied in developing countries. This study aims to report on cancer pain management in Zimbabwe by reviewing policies of pain management, patient records for prevalence and assessing the practices of cancer pain management, using 410 cervical cancer patients as a model. In total, 278 (68%) cancer patients presented with pain, yet only 42% of patient records had documented prescribed pain management. We report that these findings can be consequences of restrictive policies, inadequate patient pain assessment, inaccessible pain drugs, unrecorded prescriptions and limitations of resources in the facility. Our study is important because it identifies gaps that can be addressed to improve care for cancer patients in resource-limited settings.

Keywords::

• Africa
• cancer pain
• chronic pain
• LMICs
• quality of life
• Zimbabwe

Author contributions

O Kuguyo, A Matimba and N Tsikai contributed to conceptualization of the study. O Kuguyo, A Matimba, C Nhachi and N Tsikai contributed to manuscript writing. FD Misi contributed to data collection. O Kuguyo contributed to data analysis. FD Misi, S Chibonda, A Matimba, C Nhachi and N Tsikai contributed to manuscript editing. N Tsikai approved the final version.

Acknowledgments

The authors would like to acknowledge Parirenyatwa Group of Hospitals Radiotherapy Centre for the support to carry out this research. The authors thank the Organization for Women in Science (OWSD) for partially funding this work through a fellowship for O Kuguyo. The authors would like to acknowledge C Dandara from University of Cape Town for supporting the pharmacogenomics of cervical cancer project.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.