Practices and Hindrances in Cancer Pain Management: Results of a National Multi-Cancer Center Survey Among Healthcare Professionals in China

Figures & data

Table 1 Demographics of the Respondents*

		Total	Physician	Nurse
Subjects, n		411	186	225
Age, 2y		32 (20–60)	34 (23–60)	30 (20–53)
Work experience, y		8 (1–44)	7 (1–44)	9 (1–35)
Gender	Male	79 (19.2)	68 (36.6)	11 (4.9)
	Female	332 (80.8)	118 (63.4)	214 (95.1)
Academic title	Junior	207 (50.4)	55 (29.6)	152 (67.6)
	Intermediate	154 (37.5)	90 (48.4)	64 (28.4)
	Senior	50 (12.2)	41 (22.0)	9 (4.0)
Department	Medical Oncology	236 (57.4)	97 (52.2)	139 (61.7)
	Surgery	86 (20.9)	33 (17.7)	53 (23.6)
	Others	89 (21.7)	56 (30.1)	33 (14.7)
CP training	Yes	355 (86.4)	168 (90.3)	187 (83.1)
	No	56 (13.6)	18 (9.7)	38 (16.9)

Note: *Data is reported as median (range), or n (%).

Table 2 Status of CP Among the Patients of the Respondents*

		n (%)
Incidence of CP	<10%	10 (2.4)
	10–30%	129 (31.4)
	30–50%	156 (38.0)
	50–70%	68 (16.5)
	70–90%	46 (11.2)
	>90%	2 (0.5)
Incidence of moderate to severe CP	<10%	18 (4.4)
	10–30%	185 (45.0)
	30–50%	136 (33.1)
	50–70%	49 (11.9)
	70–90%	22 (5.4)
	>90%	1 (0.2)
Percentage of undermanagement of CP	<10%	242 (58.9)
	10–30%	124 (30.2)
	30–50%	32 (7.8)
	50–70%	8 (2.0)
	70–90%	5 (1.2)
	>90%	0 (0.0)
Incidence of refractory CP	<10%	307 (74.7)
	10–30%	80 (19.5)
	30–50%	15 (3.7)
	50–70%	6 (1.5)
	70–90%	2 (0.5)
	>90%	1 (0.2)

Note: *Total n = 411.

Table 3 Management Rates of Patients with CP*

	Total (%)	Work Experience (%)		P^b
		< 8 Years n=190	≥ 8 Years n=221
Routine screening for CP				>0.05
<10%	48 (11.7)	23 (12.1)	25 (11.3)
10–30%	66 (16.1)	31 (16.3)	35 (15.8)
30–50%	30 (7.3)	12 (6.3)	18 (8.1)
50–70%	35 (8.5)	16 (8.4)	19 (8.6)
70–90%	42 (10.2)	23 (12.1)	19 (8.6)
>90%	190 (46.2)	85 (44.7)	105 (47.5)
Pain assessment within 8 hours of admission				>0.05
<10%	39 (9.5)	22 (11.6)	17 (7.7)
10–30%	41 (10.0)	18 (9.5)	23 (10.4)
30–50%	15 (3.7)	5 (2.6)	10 (4.5)
50–70%	28 (6.8)	14 (7.4)	14 (6.3)
70–90%	54 (13.1)	31 (16.3)	23 (10.4)
>90%	234 (56.9)	100 (52.6)	134 (60.6)
Assessment using pain assessment tools				>0.05
<10%	35 (8.5)	16 (8.4)	19 (8.6)
10–30%	46 (11.2)	21 (11.1)	25 (11.3)
30–50%	32 (7.8)	15 (7.9)	17 (7.7)
50–70%	33 (8.0)	15 (7.9)	18 (8.1)
70–90%	51 (12.4)	26 (13.7)	25 (11.3)
>90%	214 (52.1)	97 (51.1)	117 (52.9)
Titration for first administration of opioid				>0.05
<10%	102 (24.8)	46 (24.2)	56 (25.3)
10–30%	87 (21.2)	41 (21.6)	46 (20.8)
30–50%	62 (15.1)	31 (16.3)	31 (14.0)
50–70%	43 (10.5)	19 (10.0)	24 (10.9)
70–90%	44 (10.7)	21 (11.1)	23 (10.4)
>90%	73 (17.8)	32 (16.8)	41 (18.6)
Adequate pain control within 3 days				>0.05
<10%	18 (4.4)	10 (5.3)	8 (3.6)
10–30%	28 (6.8)	13 (6.8)	15 (6.8)
30–50%	47 (11.4)	24 (12.6)	23 (10.4)
50–70%	97 (23.6)	46 (24.2)	51 (23.1)
70–90%	109 (26.5)	48 (25.3)	61 (27.6)
>90%	112 (27.3)	49 (25.8)	63 (28.5)
Long-acting opioid prescription for moderate-to-severe CP				>0.05
<10%	63 (15.3)	29 (15.3)	34 (15.4)
10–30%	81 (19.7)	37 (19.5)	44 (19.9)
30–50%	81 (19.7)	39 (20.5)	42 (19.0)
50–70%	92 (22.4)	48 (25.3)	44 (19.9)
70–90%	52 (12.7)	23 (12.1)	29 (13.1)
>90%	42 (10.2)	14 (7.4)	28 (12.7)
Referral to multidisciplinary team				>0.05
<20%	146 (35.5)	62 (32.6)	84 (38.0)
20–40%	102 (24.8)	56 (29.5)	46 (20.8)
40–60%	74 (18.0)	34 (17.9)	40 (18.1)
60–80%	47 (11.4)	18 (9.5)	29 (13.1)
>80%	42 (10.2)	20 (10.5)	22 (10.0)
Adequate attention for adverse effects of analgesic				<0.05
<20%	81 (19.7)	44 (23.2)	37 (16.7)
20–40%	79 (19.2)	40 (21.1)	39 (17.6)
40–60%	59 (14.4)	29 (15.3)	30 (13.6)
60–80%	72 (17.5)	32 (16.8)	40 (18.1)
>80%	120 (29.2)	45 (23.7)	75 (33.9)
Routine patient CP education				>0.05
<10%	38 (9.3)	19 (10.0)	19 (8.6)
10–30%	42 (10.2)	22 (11.6)	20 (9.0)
30–50%	36 (8.8)	14 (7.4)	22 (10.0)
50–70%	52 (12.7)	22 (11.6)	30 (13.6)
70–90%	58 (14.1)	31 (16.3)	27 (12.2)
>90%	185 (45.0)	82 (43.2)	103 (46.6)
Follow-up of patients with CP				>0.05
<20%	70 (17.0)	30 (15.8)	40 (18.1)
20–40%	53 (12.9)	30 (15.8)	23 (10.4)
40–60%	69 (16.8)	34 (17.9)	35 (15.8)
60–80%	73 (17.8)	34 (17.9)	39 (17.6)
>80%	146 (35.5)	62 (32.6)	84 (38.0)
Who is in charge of follow-up				>0.05
Physician	51 (12.4)	26 (13.7)	25 (11.3)
Nurse	133 (32.4)	49 (25.8)	84 (38.0)
Clinician and nurse	227 (55.2)	115 (60.5)	112 (50.7)
Frequency of CP assessment during titration period				>0.05
Every assessment cycle	135 (32.9)	58 (30.5)	77 (34.8)
Some times of a day	50 (12.2)	25 (13.2)	25 (11.3)
Once a day	218 (53.0)	102 (53.7)	116 (52.5)
Almost not	8 (2.0)	5 (2.6)	3 (1.4)
Contents of CP assessment
Location of pain	386 (93.9)	181 (95.3)	205 (92.8)	>0.05
Characteristics	385 (93.7)	177 (93.2)	208 (94.1)	>0.05
Interference with activities	338 (82.2)	158 (83.2)	180 (81.4)	>0.05
Severity	395 (96.1)	182 (95.8)	213 (96.4)	>0.05
Onset, duration, and frequency	345 (83.9)	157 (82.6)	188 (85.1)	>0.05
Record pain at each assessment				>0.05
Yes	361 (87.8)	170 (89.5)	191 (86.4)
No	50 (12.2)	20 (10.5)	30 (13.6)

Notes: *Total n = 411; data reported as n (%); ^bComparison between respondents with work experience <8 years and ≥8 years.

Table 4 Barriers to CP Management^a

Respondents’ Belief Regarding the Barriers of CP Management	n (%)
Three major obstacles for patients using opioids
Patients’ economic concerns	116 (28.2)
Patients’ rejection of opioids	237 (57.7)
Patients’ concerns about drug addiction	316 (76.9)
Clinicians’ reluctance to drug adjustment and titration	119 (29.0)
Healthcare professionals’ concerns about adverse effects	244 (59.4)
Prescription of opioid is cumbersome	109 (26.5)
Medical factors for undermanagement of CP
Empiric prescription without personalized treatment	262 (63.8)
Knowledge deficiency of CP	208 (50.6)
Healthcare professionals’ concerns regarding drug addiction	92 (22.4)
One-time dose of opioids is unsatisfactory	155 (37.7)
Inadequate educational interventions for patients	193 (47.0)
Poor drug efficacy against refractory CP in complex condition	293 (71.3)
Others	6 (1.5)
Patient-related factors in undermanagement of CP
Misconceptions about CP treatment	296 (72.0)
Low opioid adherence and random medication	331 (80.5)
Inaccuracy of pain description	193 (47.0)
Lack of objectivity of pain intensity rating	163 (39.7)
Fear of opioid addiction	259 (63.0)
Uncontrollable factors among outpatients^b	250 (60.8)
Personal financial situation	102 (24.8)
Concerns about adverse effects of opioids	201 (48.9)
Support from family members	157 (38.2)
Others	16 (3.9)

Notes: ^aTotal n = 411. ^bSuch as changes of work and residential location.

Table 5 Rates of Correct Response Regarding CP-Related Professional Knowledge^a

	All	Physicians	Nurses	P^b
All questions	26 (6.3)	14 (7.5)	12 (5.3)	>0.05
1. Should we believe patients’ reports of pain?	406 (98.8)	185 (99.4)	221 (98.2)	>0.05
2. Can patients with CP receive pethidine for analgesia?	224 (54.5)	120 (64.5)	104 (46.2)	<0.05
3. Is there a high risk of addiction in patients with CP receiving opioids?	311 (75.7)	156 (83.9)	155 (68.9)	<0.05
4. What is timing of efficacy assessment after administration of oral short-acting morphine sulfate?	168 (40.9)	64 (34.4)	104 (46.2)	<0.05
5. Is there a dose cap for opioids?	258 (62.8)	141 (75.8)	117 (52.0)	<0.05
6. Is it necessary to administer prophylactic laxatives with opioid treatment?	257 (62.5)	109 (58.6)	148 (65.8)	>0.05
7. Can adverse events of dizziness, nausea, and vomiting caused by opioids be tolerated?	345 (83.9)	172 (92.5)	173 (76.9)	<0.05
8. Is respiratory depression caused by opioid common?	349 (84.9)	164 (88.2)	185 (82.2)	>0.05
9. What is the preferred analgesic drug for moderate CP?	182 (44.2)	95 (51.1)	87 (38.7)	<0.05
10. A cancer patient complains of dull pain with inaccurate positioning in abdomen. What kind of pain is it?	370 (90.0)	176 (94.6)	194 (86.2)	<0.05

Notes: ^aTotal (all) n = 411; data reported as n (%). ^bComparison between physicians and nurses.