A pilot study, conducted by AIIMS to assess the “total pain” in cancer patients, has found that non-physical factors contribute to approximately 60% of pain. The study reveals that social, psychological and spiritual factors are the major contributors to “total pain” among cancer patients.
The study conducted by Dr B R A Institute Rotary Cancer Hospital, AIIMS — to evaluate “total pain” in cancer patients in the Indian context — has found that “physical aspects” contribute to nearly 40% and “non-physical factors like social, psychological and spiritual contribute to approximately 60%”.
“The study was performed on 100 patients. The objective was to develop an instrument to assess all components of the ‘total pain’ in cancer patients in India. The study reveals that all factors such as physical, social, spiritual and psychological pain should be considered while treating cancer pain in palliative care patients,” said Dr Sushma Bhatnagar, Head, Department of Onco-Anaesthesia, Pain and Palliative care, BRAIRCH.
The World Health Organisation defines palliative care for cancer as an approach that improves “quality of life of patients and their families” through the “prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”.
Dr Bhatnagar said the study was to understand “total pain” in cancer patients in the Indian context since there is no universally accepted tool to assess pain caused by cancer. “In India, majority of patients with cancer are diagnosed in advanced stages, and they suffer moderate to severe pain. The patient might be suffering physical pain due to chemotherapy or radiation. At the same time, the patient might also be suffering from social pain. The differences in culture and support systems may result in different palliative care needs. This might be different in the Indian context. The patient’s primary concern could be worries about the future of his or her family. The patient might be spiritual and might experience loss of faith due to the illness. While the treatment is important, the focus also has to be on the quality of life of the patient. All these factors need to be considered,” Dr Bhatnagar said.
As per WHO estimates, globally, each year, 40 million people are in need of palliative care and only 14% who need palliative care receive it currently. “The family does not always understand how a patient is feeling. The patient cannot communicate and it results in distress. The main aim of palliative care is to communicate to the patient and the family that most of the pain can be controlled and relieved. The specialist needs to make the patient understand what causes cancer pain,” said Dr Bhatnagar.
“Also, families deal with the emotions that come with a cancer diagnosis and cancer treatment. Depression, anxiety, and fear are common concerns that can be addressed through palliative care. Also, maintaining a standard of care at home is also important — for which home visits by trained specialists needs to be undertaken,” Dr Bhatnagar added.