Optimising Initial Pain Management and its Influence on Compliance and Treatment Abandonment in Newly Diagnosed Head-and-Neck Cancer Patients: A Real-world Experience.

Abstract

Objectives: Improper pain management is a significant contributing factor and a potential correctable factor for low cure rates of head-and-neck cancer (HNC) patients. This study aims to assess the significance of the Quantitative Improvement Programme (QIP) in evaluating pain levels and its correlation with treatment compliance in recently diagnosed HNC patients undergoing curative treatment at a surgical oncology outpatient department (OPD). The study was conducted from January 2022 to August 2023 at a tertiary cancer care centre in Northeast India.

Materials and methods: This cohort study used secondary data. We implemented the QIP in December 2022. There were 204 patients in the non-implemented group (NIG) (January 2022 to December 2022), and 110 patients were in the implemented group (IG) (January 2023 to August 2023).

Results: The study included 314 HNC patients. The mean age was 57 years, and the male-to-female ratio was 3:1. More than two-thirds (70%) of patients presented with pain. Pain assessment was carried out in 63% (120) of patients in the NIG and 86% (95) patients in the IG and was found to differ significantly (P < 0.0001) between the groups. Treatment abandonment (default before starting treatment) was reported amongst 23% in the NIG, compared to 16% in the IG. 41% (85) of patients in the NIG and 39% (43) in the IG reported non-compliance with treatment (breaks after commencing treatment). There were only 7% of patients from the NIG and 4% of patients from the IG who experienced unfavourable events (relapse, death and treatment failure). Of the various factors analysed, we found age as the single most significant predictor of compliance to treatment (age 18-39 years: Risk ratio [RR] = 2.482, 95% confidence interval [CI]: 0.88, 6.99 [P < 0.08]; age group 40-64 years: RR = 0.54, 95% CI: 0.33, 0.90 [P < 0.01]).

Conclusion: QIP for pain management resulted in efficient pain assessment, enhanced patient compliance and reduced rates of treatment abandonment. The study findings mandate QIP for effective pain management of HNC patients in all cancer centres.