Development of a cancer pain assessment tool in Korea: a validation study of a Korean version of the brief pain inventory

OBJECTIVE: The aim of this study was to validate the Korean version of the Brief Pain Inventory (BPI-K), a pain assessment tool that has been validated in several languages. METHODS: The sample consisted of 132 patients in Seoul who had recurrent or metastatic cancer and who expressed pain. The Korean version of the Beck Depression Inventory (BDI-K), the Eastern Cooperative Oncology Group (ECOG) performance status score, the Pain Management Index (PMI), and the PMI-Revised (PMI-R) were used to further validate the BPI-K. RESULTS: Cronbach alphas, computed for the pain interference and pain severity item, were 0.93 and 0.85, respectively. Confirmatory factor analysis of the BPI-K items showed a two-common-factor solution for the BPI-K, consistently demonstrated in other language versions of the BPI. The mean pain interference score was more correlated with the BDI-K scale (r = 0.44) and ECOG (r = 0.39) than the mean pain severity score. Seventy-four percent of the patients in the Seoul sample had inadequate analgesia using the PMI. CONCLUSION: The BPI-K is a valid and useful instrument for assessing cancer pain and pain impact in Korea.     

Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial.

PURPOSE: Pain and symptom management is an integral part of the clinical practice of oncology. A number of guidelines have been developed to assist the clinician in optimizing comfort care. We implemented clinical guidelines for cancer pain management in the community setting and evaluated whether these guidelines improved care. PATIENTS AND METHODS: Eighty-one cancer patients, aged 37 to 76 years, were enrolled onto a prospective, longitudinal, randomized controlled study from the outpatient clinic settings of 26 western Washington-area medical oncologists. A multilevel treatment algorithm based on the Agency for Health Care Policy and Research Guidelines for Cancer Pain Management was compared with standard-practice (control) pain and symptom management therapies used by community oncologists. The primary outcome of interest was pain (Brief Pain Inventory); secondary outcomes of interest were all other symptoms (Memorial Symptom Assessment Scale) and quality of life (Functional Assessment of Cancer Therapy Scale). RESULTS: Patients randomized to the pain algorithm group achieved a statistically significant reduction in usual pain intensity, measured as slope scores, when compared with standard community practice (P < .02). Concurrent chemotherapy and patient adherence to treatment were significant mediators of worst pain. There were no significant differences in other symptoms or quality of life between the two treatment groups. CONCLUSION: This guideline implementation study supports the use of algorithmic decision making in the management of cancer pain. These findings suggest that comprehensive pain assessment and evidence-based analgesic decision-making processes do enhance usual pain outcomes.     

Adequacy of cancer pain management in a Japanese Cancer Hospital

BACKGROUND: Pain is one of the most frequent and deleterious symptoms in cancer patients. This study was carried out to investigate the adequacy of pain management at the National Cancer Center Hospital East, Japan. METHODS: The available data were obtained from 138 ambulatory cancer patients with pain. The data included pain severity, which patients reported using the Japanese version of the M. D. Anderson Symptom Inventory, along with such medical information as cancer and treatment information and currently prescribed analgesics. Adequacy of pain management was assessed using the Pain Management Index, which revealed whether prescribed analgesic drugs were congruent with pain severity. RESULTS: Physicians undertreated pain in 70% of patients. Patients with non-advanced cancer (local cancer or no evidence of any recurrent cancer) were more likely to receive inadequate treatment than those with advanced cancer [P = 0.009, odds ratio = 0.18, Exp (95% CI) lower = 0.05, higher = 0.64] in the exploratory logistic regression analysis. Additionally, we found significant differences among physicians in ability to manage cancer pain, unrelated to a physician's years of experience as an oncologist. CONCLUSIONS: This study suggests that cancer pain management is insufficient at the investigated institute. Remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice.     

Educational role of cancer pain rounds

Lack of appropriate physician education is one of several reasons for the recognized deficits in cancer pain management. This article describes the educational role of a weekly meeting, "Cancer Pain Rounds," attended by a multidisciplinary team of health professionals skilled in cancer pain management and student physicians caring for inpatients with cancer. Educational benefits occur in three spheres including factual information concerning assessment, treatment, and attitude issues, legitimization of the cancer pain problem, and role modeling. This type of educational experience will hopefully improve cancer pain management.     

Pain and cancer Information dedicated to cancer patients and relatives

Patient information is a major challenge for public health. It has become part of the patients' rights, in response to their need for information and involvement in medical decision-making. Since 1998, the French National Federation of Comprehensive Cancer Centres (FNCLCC) has developed an information and education program dedicated to patients and relatives: the SOR SAVOIR PATIENT program. The methodology of the program adheres to the quality criteria established for the elaboration of documents containing patient information. The SOR SAVOIR PATIENT guide Pain and Cancer aims to answer patients' questions regarding cancer specific pain and to help them become actively involved in their care. It was elaborated by a multidisciplinary workgroup, which included methodologists, one linguist, pain specialists and twenty patients and relatives. Patients' information needs and personal experience of pain were assessed using focus groups, semi-structured interviews and questionnaires. Through eight chapters, which can be read in an independent way, Pain and cancer provides key information on the causes, the mechanisms, the evaluation, the prevention and the treatment of pain. The guide also presents advices and practical tools to facilitate the assessment of the pain and the communication between patients and professionals. Finally, this guide aims to overcome ideas such as that morphine is synonymous of end of life or drug addiction, that pain is a sign of aggravation of cancer and that nurses know how to detect the pain. Intended first for the patients and their close relations, Pain and Cancer is also a useful tool for health professionals. Indeed, it presents knowledge based on the most recent recommendations developed for clinical practice. Thanks to a wide distribution of the guide to patients, their families and the professionals, we trust that this guide will facilitate dialogue around pain, and ultimately its care. This article is an abstract of the guide. The complete SOR SAVOIR PATIENT guide can be downloaded from the SOR website at: www.sor-cancer.fr.     

普通癌痛及“围放疗期”癌痛患者规范化治疗进展

癌痛是困扰恶性肿瘤患者的主要症状之一,如不及时治疗,将会形成难治性疼痛,增加个体和社会负担。虽然中国已经开展“癌痛规范化治疗示范病房”活动近7年,医务人员癌痛评估和治疗水平整体提高,但癌痛的治疗仍未达到满意的疗效。放疗是治疗恶性肿瘤的重要手段,更是治疗癌痛的主要方法之一。笔者首次提出“围放疗期”的概念,强调对癌痛患者放疗前、放疗中、放疗后的全程持续镇痛治疗。本文在阐述国内外癌痛治疗现状的基础上,对“围放疗期”癌痛的规范化评估和治疗进行综述。     

The Economic Burden of Cancer in Korea in 2009

Background: Cancer imposes a significant economic burden on individuals, families and society. The purposeof this study was to estimate the economic burden of cancer using the healthcare claims and cancer registry datain Korea in 2009. Materials and Methods: The economic burden of cancer was estimated using the prevalence datawhere patients were identified in the Korean Central Cancer Registry. We estimated the medical, non-medical,morbidity and mortality cost due to lost productivity. Medical costs were calculated using the healthcare claimsdata obtained from the Korean National Health Insurance (KNHI) Corporation. Non-medical costs included thecost of transportation to visit health providers, costs associated with caregiving for cancer patients, and costs forcomplementary and alternative medicine (CAM). Data acquired from the Korean National Statistics Office andMinistry of Labor were used to calculate the life expectancy at the time of death, age- and gender-specific wageson average, adjusted for unemployment and labor force participation rate. Sensitivity analysis was performed toderive the current value of foregone future earnings due to premature death, discounted at 3% and 5%. Results:In 2009, estimated total economic cost of cancer amounted to $17.3 billion at a 3% discount rate. Medical careaccounted for 28.3% of total costs, followed by non-medical (17.2%), morbidity (24.2%) and mortality (30.3%)costs. Conclusions: Given that the direct medical cost sharply increased over the last decade, we must striveto construct a sustainable health care system that provides better care while lowering the cost. In addition, acomprehensive cancer survivorship policy aimed at lower caregiving cost and higher rate of return to work hasbecome more important than previously considered.     

Optimal pain management for patients with cancer in the modern era

Pain is a common symptom among patients with cancer. Adequate pain assessment and management are critical to improve the quality of life and health outcomes in this population. In this review, the authors provide a framework for safely and effectively managing cancer‐related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer‐related pain, how to manage pain in patients at risk of substance use disorder, and considerations when managing pain in a survivorship population. CA Cancer J Clin 2018;68:182–196 . © 2018 American Cancer Society .     

The National Cancer Screening Program for Breast Cancerin the Republic of Korea: Is it Cost-Effective?

This goal of this research was to evaluate the cost-effectiveness of the National Cancer ScreeningProgram (NCSP) for breast cancer in the Republic of Korea from a government expenditure perspective. In2002-2003 (baseline), a total of 8,724,860 women aged 40 years or over were invited to attend breast cancerscreening by the NCSP. Those who attended were identified using the NCSP database, and women weredivided into two groups, women who attended screening at baseline (screened group) and those who did not(non-screened group). Breast cancer diagnosis in both groups at baseline, and during 5-year follow-up wasidentified using the Korean Central Cancer Registry. The effectiveness of the NCSP for breast cancer wasestimated by comparing 5-year survival and life years saved (LYS) between the screened and the unscreenedgroups, measured using mortality data from the Korean National Health Insurance Corporation and theNational Health Statistical Office. Direct screening costs, indirect screening costs, and productivity costs wereconsidered in different combinations in the model. When all three of these costs were considered together,the incremental cost to save one life year of a breast cancer patient was 42,305,000 Korean Won (KW)(1 USD=1,088 KW) for the screened group compared to the non-screened group. In sensitivity analyses,reducing the false-positive rate of the screening program by half was the most cost-effective (incrementalcost-effectiveness ratio, ICER=30,110,852 KW/LYS) strategy. When the upper age limit for screening wasset at 70 years, it became more cost-effective (ICER=39,641,823 KW/LYS) than when no upper age limitwas set. The NCSP for breast cancer in Korea seems to be accepted as cost-effective as ICER estimates werearound the Gross Domestic Product. However, cost-effectiveness could be further improved by increasingthe sensitivity of breast cancer screening and by setting appropriate age limits.     

North Korea Must be Global Scale Cohort,Not a Galapagos in the Medical Research Field

Objective: This study aimed to compare the research trend regarding gynecologic malignancies in North Korean medical journal and South Korean medical journal. Methods: Articles published in the journal of “Pediatrics, Obstetrics, and Gynecology” in North Korea and “Obstetrics & Gynecology Science” in South Korea from 2006 to 2016 were analyzed by using frequency analysis. Studies on gynecologic malignancies were classified by international classification of disease (ICD-10). Results: Out of 3361 reviewed articles, 116 articles published in North Korean journal and 519 articles published in South Korean medical journal were classified as gynecologic oncology. We found a distinct difference between North and South Korean medical journals regarding research trends on gynecologic oncology. The proportions of gestational trophoblastic disease, cervical cancer, and anogenital warts were higher in North Korean medical journal, but proportions of ovarian cancer, fallopian tube cancer, peritoneal cancer, corpus uterine cancer, and vulvar cancer were higher in South Korean medical journal. Conclusion: This study enforced an analysis of research trends on gynecologic malignancies in North Korean and South Korea medical journals, and a distinct difference was observed in this regard. In the future, grand scale cohort study in the genetic identical two Korean population is needed for research of environmental effect on gynecologic cancer.     

Management of cervical cancer

HUGHES C. (2011) European Journal of Cancer Care 20 , 5
Management of cervical cancer This module provides an overview of cervical cancer which will help health professionals provide evidence‐based patient‐centred care.     

Knowledge and attitudes of physicians in Iran with regard to chronic cancer pain.

BACKGROUND AND AIM: The knowledge and attitudes of health care professionals with regard to pain and its impact on the patient are among identified barriers that prevent health care professionals from providing effective treatment for pain. The purpose of the present study was to evaluate knowledge about and attitudes towards cancer pain and its management in Iranian physicians with patient care responsibilities. METHODS: We surveyed 122 physicians in six university hospitals in Tehran. Fifty-five (45.1%) questionnaires were completed. RESULTS: The majority of physicians (76%) recognized the importance of pain management priority and about one half of the physicians acknowledged the problem of inadequate pain management in their settings. Most cited inability to access professionals who practice specialized methods in this field, and inadequate staff knowledge of pain management as barriers to good pain management. A large majority of them expressed dissatisfaction with their training for pain management in medical school and in residency. Furthermore a considerable widespread knowledge deficit among all medical subspecialties and all levels of experience was noted which was significantly more profound in the non-oncologists group and only correlated poorly with number of total treated patients in past 6 months. CONCLUSION: The most significant barrier to the effective management of pain in cancer patients in Iran is deficit in knowledge as identified in this survey. A combination of an active continuing education program on both the international guidelines with routine professional education and dissemination of guidelines is needed to bring about significant improvement in cancer pain control.     

Report from the 21st Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Calgary,Alberta; 20–21 September 2019

The 21st annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Calgary, Alberta, 20–21 September 2019. The WCGCCC is an interactive multi-disciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists, pathologists, radiologists, and allied health care professionals such as dietitians and nurses participated in presentation and discussion sessions to develop the recommendations presented here. This consensus statement addresses current issues in the management of hepato-pancreato-biliary (HPB) cancers.     

Pain and health-related quality of life in a geographically defined population of men with prostate cancer

In order to provide baseline data on pain and health-related quality of life, to explore factors predicting pain and reduced quality of life, and to find potentially undertreated cases in men with prostate cancer, we undertook a population-based questionnaire study. The questionnaire, which included the EuroQo1 instrument, the Brief Pain Inventory form and 8 specially designed questions, was sent to all men with prostate cancer in the county of Östergötland, Sweden. Of the 1442 men included in the study, 1243 responded to the questionnaire. Altogether 42% had perceived pain during the previous week and 26% stated their quality of life to be 50% or lower on a visual analogue scale. A high rating of health care availability and short time since diagnosis were found to significantly predict lower ratings of pain (P< 0.05). Pain was found to be a significant predictive factor for decreased quality of life together with high age, low rating of health care availability and palliative treatment (P< 0.05). In conclusion, assessment and treatment of pain is essential for a good quality of life in men with prostate cancer. The monitoring of prostate cancer patients should be individualized to fit the demands of the groups with the greatest need for support. © 2001 Cancer Research Campaign http://www.bjcancer.com     

Cancer pain assessment – Can we predict the need for specialist input?

We can anticipate that failure to assess cancer pain adequately will inevitably lead to inappropriate application of pain management options. However, it is not always standard practice to teach the limitations of the question ‘How bad is the pain?’, as well as the need to consider what may complicate pain management or be a poor prognostic factor for pain control. These issues may complicate cancer pain assessment and require specialist consultation. An internationally accepted classification system for cancer pain could provide the basis for a multidimensional assessment and a common language for clinical and research work. Research dating back to the late 1980s has resulted in the development of the Edmonton Classification System for Cancer Pain. This includes many of the factors that may be prognostic for the complexity of cancer pain management and can assist an inexperienced clinician in anticipating the need for specialist advice.     

Cancer control activities in the Republic of Korea

South Korea has a population of 47.3 million. The whole population is covered by a mandatory social insurance system (the National Health Insurance Program) that is financed through the contributions paid by the insured and their employers. Cancer has been the leading cause of death in Korea since 1983. About 130 000 people develop cancer annually with 66 000 deaths in 2006. Cancer patients' 5-year survival rates between 1998 and 2002 were 37.8 and 57.0% for men and women, respectively. The five leading primary cancer sites were stomach, lung, liver, colon and rectum, and bladder among males, whereas the most common cancers were stomach, breast, colon and rectum, uterine cervix and lung among females. With the rapidly aging population, reducing cancer burden at the national level has become one of the major political issues in Korea. The government formulated its first 10-year plan for cancer control in 1996. In 2000, the National Cancer Center was created and the Cancer Control Division was set up within the Ministry of Health and Welfare. The Cancer Control Act was legislated in 2003. Korea's major national cancer control programs are anti-smoking campaigns, hepatitis B virus vaccination, cancer registration and networking, promotion of R&D activities for cancer control, education and training for cancer control and prevention, operation of the national cancer information center, operation of the mass screening program for five common cancers, management of cancer patients at home, financial support for cancer patients and designation of regional cancer centers.     

Viral Hepatitis and Liver Cancer in Korea: an Epidemiological Perspective

In the past, hepatitis B virus (HBV) infection was endemic in the general Korean population. The associationof HBV infection with the occurrence of liver cancer has been well demonstrated in several epidemiologic studies.While the mortality rates of liver cancer in Korea have decreased steadily over the last decade, the presenceof hepatitis B surface antigen (HBsAg) in mothers remains high at 3-4%, and 25.5% of these HBsAg positivemothers are positive for hepatitis B e antigen (HBeAg). HBV infection caused almost a quarter of hepatocellularcarcinoma (HCC) cases and one-third of deaths from HCC. These aspects of HBV infection prompted the Koreangovernment to create a vaccination program against HBV in the early 1980s. In 1995, the Communicable DiseasePrevention Act (CDPA) was reformed, and the government increased the number of HBV vaccines in the NationalImmunization Program (NIP), driving the vaccination rate up to 95%. In 2000, the National Health InsuranceAct (NHIA) was enacted, which provided increased resources for the prevention of perinatal HBV infection.Then in 2002, the Korean government, in conjunction with the Korean Medical Association (KMA), launchedan HBV perinatal transmission prevention program. The prevalence of HBsAg in children had been high (4-5%)in the early 1980s, but had dropped to below 1% in 1995, and finally reached 0.2% in 2006 after the NIP hadbeen implemented. After the success of the NIP, Korea finally obtained its first certification of achievement fromthe Western Pacific Regional Office of the World Health Organization (WPRO-WHO) for reaching its goal forHBV control. An age-period-cohort analysis showed a significant reduction in the liver cancer mortality ratein children and adolescents after the NIP had been implemented. In addition to its vaccination efforts, Korealaunched the National Cancer Screening Program (NCSP) for 5 leading sites of cancer, including the liver, in1999. As a consequence of this program, the 5-year liver cancer survival rate increased from 13.2% (1996-2000)to 23.3% (2003-2008). The development of both the primary and secondary prevention for liver cancer includingHBV immunization and cancer screening has been of critical importance.     

Prevalence,Awareness, Control,and Treatment of Hypertension and Diabetes in Korean Cancer Survivors: A Cross-Sectional Analysis of the Fourth and Fifth Korea National Health and Nutrition Examination Surveys

Background: Management of hypertension and diabetes in cancer survivors is an important issue; however,not much is known about the level of management of such chronic disease in Korea. This study therefore assessedthe prevalence, awareness, control, and treatment of hypertension and diabetes in Korean cancer survivorscompared to non-cancer survivors. Materials and Methods: A cross-sectional design was employed, whereindata were obtained from standardized questionnaires completed by 943 cancer survivors and 41,233 non-cancersurvivors who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys(2007-2011). We calculated adjusted proportions for prevalence and management of hypertension and diabetesin non-cancer survivors and cancer survivors. We also assessed the associated factors with prevalence andmanagement of cancer survivors. Results: Cancer survivors are more likely than the general population to havehigher prevalence, awareness, treatment, and control of hypertension. However, diabetic management was notsignificantly higher in cancer survivors than in non-cancer survivors, despite their having a higher prevalence.Several factors, such as, age, drinking, years since cancer diagnosis, self-perceived health status, and specificcancer types were found to affect to management of hypertension and diabetes. Conclusions: These data suggestthat cancer survivors appear to be better than non-cancer survivors at management of hypertension, but notdiabetes. There is a need for healthcare providers to recognize the importance of long-term chronic diseasemanagement for cancer survivors and for the care model to be shared between primary care physicians andoncologists.     

Cancer Pain Prevalence and its Management

Pain is a public health problem affecting more than half of cancer patients. Despite the success of the protocolscurrently used, pain cannot still be reduced satisfactorily in the large majority of patients. In order to improvepain management, all healthcare professionals involved with pain should have sufficient knowledge on painassessment and treatment, and should inform patients to prevent patient-related barriers. In this compilation,the prevalence values and the treatment methods of cancer pain, and the barriers to pain management havebeen assessed.