Pain management adherence and barriers among regional head and neck cancer patients: A chart review study

Abstract

<h2>ABSTRACT</h2><h3>Background</h3> Head and neck cancer (HNC) patients experience considerable pain. Living outside a major urban area is associated with disparities in outcomes among cancer patients. <h3>Aim</h3> To examine factors influencing head and neck cancer patients' pain management adherence at a regional HNC multidisciplinary clinic. <h3>Methods</h3> Retrospective analysis of diagnostic and treatment categories, symptom scores, reported adherence with prescribed pain management and self-reported pain management concerns detailed in clinical records over a two-year period in a regional cancer clinic. <h3>Findings</h3> A total of 34 patients receiving treatment for head and neck cancer over the period (mean age of 64.5 years, SD 10.4; male/female ratio 30/4). Seventy percent of patients (n = 24) were non-adherent with their prescribed analgesia regimen. At the end of treatment, 64-65% of patients reported pain, fatigue and mucositis as severe. Three main reasons for non-adherence with pain management were reported: Fear of addiction and resistance to using opioids, administration or dose confusion, and difficulty organising medications (such as filling scripts). Fear of addiction and resistance to opioids was associated with analgesic non-adherence (<i>x</i>² 7.32 (1) (n = 34) p = .007) and severity of reported pain (<i>x</i>² 6.118 (1) (n = 32) p = .013). <h3>Discussion</h3> Our investigation identified non-cancer related factors, particularly opioid fear and stigma, as factors that negatively impacted treatment adherence. Regional populations are recognised to experience cancer treatment barriers. Our findings suggest there may be unique characteristics among regional patients that warrant attention as factors that limit pain management adherence. <h3>Conclusion</h3> Clinicians require early identification strategies to identify and intervene early to address opioid stigma and fear. In rural settings, the unique contextual factors which influence this fear and stigma need consideration.