Date of Award

5-2022

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Harrison Chuwa

Second Supervisor/Advisor

Mandela Makakala

Third Supervisor/Advisor

Davis Rubagumya

Department

Family Medicine (East Africa)

Abstract

Background: Cancer pain is a universal undesirable symptom among cancer patients that if not addressed causes suffering and impedes quality of life of both the patients and their family. Observational studies available have shown increase in palliative care programs in Tanzania but there is dearth of information regarding the adequacy of pain control among patients with cancer after the initiation of these programs and improvement of the available interventions.

Objectives: This study aimed to determine adequacy of pain management among advanced cancer patients with solid tumors as well as factors affecting adequate Cancer Related Pain management.

Methods: We conducted a prospective cross-sectional study from October 2021 to December 2021 at the Aga Khan Hospital and Ocean Road Cancer Institute in Dar es Salaam Tanzania. A two-part Interviewer administered questionnaire was used. The first part consisted of participants’ demographics and factors affecting adequate control of cancer related pain. The last part comprised of the Brief Pain Inventory Short Form (BPI-SF) a tool that measures both the intensity of pain (sensory dimension) and interference of pain in the patient's life (reactive dimension). Data were analyzed using SPSS version 25. Pain Management Index (PMI) was calculated to obtain adequacy of cancer related pain control. Factors associated with adequate Cancer Related Pain (CRP) management were evaluated for association using chi-square test and entered into a multivariable model and analyzed by multiple logistic regression for true association.

Results: Among the 332 participants included in this study, 199 (59.9%; 54.4% - 65.3%) had adequate pain management. The prevalence of adequate pain management was high among females, patients from Aga Khan Hospital, divorced, employed, and tertiary educated participants. In the multivariable analysis, sex, employment status and level of education was associated with the adequate pain management. Females were twice high to be adequately managed than males (OR: 1.96; 95%CI: 1.06-3.66; p=0.033). Participants who were self-employed had 0.08 times less adequate pain management compared to their employed counterparts (OR=0.08; 95%CI: 0.01- v 0.33; p=0.002). Similarly, those who were unemployed had 91% lower adequate pain management as compared to the employed participants (OR=0.09; 95%CI: 0.01-0.42; p=0.006). Participants with primary level of education were 2.47 times higher to report adequate pain management compared to those with non formal level of education (OR:2.47; 95%CI: 1.16-5.43; p=0.021).

Conclusion: This study shows that there is inadequate management of CRP in Tanzania. Patients’ factors such as sex, employment status and primary education plays a role in affecting adequate CRP management.

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