Pain and its Interference with Daily Activities among Patients with Cancer in Vinh Phuc Province and Some Related Factors

ABSTRACT


INTRODUCTION
Cancer is a malignant disease of cells, cells proliferate indefinitely, are disorganized, and do not follow the control mechanisms of the body's development [1].In recent years, The incidence of cancer in the world is increasing rapidly and alarmingly. According to the International Organization for Research on Cancer GLOBOCAN 2020, there are about 19.3 million new cases and nearly 10 million deaths from cancer worldwide. In Vietnam, in 2020, there are about 182,000 new cancer cases, about 122,690 deaths, and about 353,826 people living with cancer, the mortality rate is relatively high (126,04/100,000 people) [7]. Cancer is a burden and rapidly increasing in Vietnam and around the world [6]. Pain is the most common, common, and most feared symptom in patients with cancer. Pain occurs in 59% of patients being treated; 64% in advanced, metastatic, end-stage patients; 33% in patients after the treatment is cured; 53% of patients in all disease stages; Of those with pain, more than a third classified the pain as moderate or severe. The overall pain rate is over 50% in all tumor types [21]. Although, there are many treatments for cancer pain: Painkillers, surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, etc… most of these methods aim to reduce or eliminate pain. However, complete and permanent eradication of pain is rarely achieved, which remains a persistent problem in cancer patients. Uncontrolled cancer pain will negatively affect daily activities, psychological well-being, increase the severity of the disease and reduce the patient's quality of life, even death from pain. exhausted [1]. In Vietnam today, the issue of palliative care is increasingly focused. On May 19, 2006, the Ministry of Health issued Decision No 3483/QD -BYT on national guidelines on palliative care for NBUT and AIDS [3] and updated and promulgated according to Decision No. 183 /QD-BYT dated 25/01/2022 on guidelines for palliative care [4]. This is the legal basis for implementing comprehensive care and treatment activities to meet the needs of palliative care and help NBUT reduce suffering and improve quality of life. Vinh Phuc is a province in the key economic region of the Northern Delta, a bridge connecting the Northern Midlands and Mountains with the capital Hanoi. In recent years, along with socio-economic development, NBUT in the province is increasing day by day. At the beginning of 2023, Vinh Phuc Province has 2362 cancer patients, and the number of cancer patients per 100,000 population is 202 higher than the national average, so palliative care (pain) needs attention and attention. Therefore, a survey study to provide an overview of the pain and pain interference with the daily activities of cancer patients is essential in palliative care. We conducted a study on "Pain and its pain interference with daily activities among patients with cancer in Vinh Phuc province and some related factors." The study aimed to determine the pain severity, pain interference severity with daily activities, and pain-related factors, pain interference-related factors among patients with cancer in Vinh Phuc province.

Participants
Participants are patients with cancer in Vinh Phuc province, who meet the following criteria: Selection criteria Criteria for selecting research subjects:(1) Age 18 years or older, (2) cancer diagnosis, (3) pain, (4) no cognitive disorder,(5) able to listen, speak, read, and write in Vietnamese, (6) agree to participate in the study.

Exclusion criteria
The following patients are not selected for the study because it affects the accuracy of the research results:(1) Having other chronic diseases such as diabetes, chronic obstructive pulmonary disease , mental illness, arthritis, etc…, (2) surgery ≤ 01 months.

= 96
Sampling methods: Select all patients with cancer that met the selection criteria at the time of data collection. The study has selected 116 patients to participate in the study.

Data collection
The study used a brief pain checklist (BPI -SF) consisting of 9 questions to assess pain severity, pain location, impact of pain on daily activities, analgesics used, and effective pain relief in the last 24 hours. Question 2 about the location of pain (head, face, neck, chest, abdomen, limbs...). Questions 3-6 about worst, average, least, and pain now intensity; each pain intensity was measured by an 11-point NRS: 0 (no pain) to 10 (unbelievably painful). Question 7 about painkillers used. Question 8 on analgesic efficacy as measured by NRS 11 percentiles: 0% (no pain relief) to 100% (complete pain relief). Question 9 is the interference of pain with 07 daily activities (general Activity, mood, walking ability, normal work, erlations with other people, sleep, and enjoyment of life); Pain hindrance to each activity was measured by an 11point NRS: 0 (no interference) to 10 (complete interference) [12]. The data in the study were collected through direct interviews with patients and by reference to medical records.

Assessment standards Pain assessment criteria:
Pain level based on pain intensity score of each item 3-6. The pain level of each pain condition is classified: No pain (0 points), mild pain 1-3 points, moderate pain 4-6 points, and severe pain 7-10 points [22]. Mean pain score: Total score of pain conditions/4. Classification of general pain level based on the average pain score: Mild pain [1.4); moderate pain [4.7); severe pain [7, 10] points [20].

Interference of pain with daily activities:
Difficulty level: based on the score of each item A-G, sentence 9 and the level of difficulty of each item is classified: No pain interference (0 points), mild: 1-3 points, moderate 4-6 points, severe 7-10 points [22]. Mean pain interference score: Total score of items/7. Classify the level of general pain interference based on the mean pain interference score: No pain interference [0-1) points, Mild [1.4) points; moderate [4.7) points, and severe [7.10] points [20].
Data analysis: Use SPSS 22.0 for analysis. Using frequency, percentage, and mean to describe pain, pain interference; using the Kruskall-Wallis One-way Anova test, the Mann-Whitney test identifies the factors related to pain, and interference of pain with daily activities.

Pain of patients with cancer
The pain status includes worst pain, pain least, pain moderate, and pain now.  Table 3.2 show that pain affects all daily activities of patients. Pain interference to general activity, Table 3.2 shows that NBUT has no pain interference (1.7%), mild (41.4%), moderate (33.6%), and severe (23.3%). Thus, cancer patients have a very high rate of difficulty from mild to severe, accounting for 98.3%. Cielito C. Reyes-Gibby's results were higher with mild to severe obstruction accounting for 60% (23% mild, 15% moderate, and 23% severe) [17]. This difference is because we conducted on 100% of patients with pain, while this author studied inpatient and outpatient cancer patients, and had both pain and no pain, so cancer patients who did not interfere with general activities often account for a high percentage (40% compared to 1.7%). The rate of no pain interference in general activity in the study was also lower than that of Tu Van Nguyen (16.03% without interference and mild to severe problems 83.97%) in elderly cancer patients but included: Both patients have pain and no pain, so a higher rate of no interference is appropriate. The Moderate interference in this general activity is similar to the results of this author and Klepstad P[15] (4.59±2.23 compared to 4.70±2.67 compared to 4.8±3.6). In addition, some results of other authors have higher or lower thresholds in this activity than in our study specifically: Kalyadina, SA (3.0±2.8 ) [14].
Pain interference to mood: No pain interference (12.9%), mild (58.6%), moderate (23.3%), severe (5.2%). This result has a different ratio of difficulty levels than some previous authors: The Cielito C. Reyes-Gibby study had 43%, 25%, and 13% difficulty levels from no interference to severe, and 18% Pain interference to relations with other people: No interference 3.4%, mild to severe 96.6%. While there are no interference and the interference from mild to severe by Cielito C. Reyes-Gibby (52%, and 48%)[17] and Tu Van Nguyen (41.98%, and 58.02%) [5]. From this result, it is shown that the study of cancer patients with pain presentation has a higher degree of an obstruction than the study of cancer patients in general, which is consistent with the fact that when patients with pain will limit their daily activities. The general mean score is 4.63±2.4, higher than that of Kalyadina Another study by S L. Beck in NBUT with pain interference had our higher general mean score (4.32 ±2.64 compared to 3.64 ±1.5) possibly due to the sample size being more (410 compared to 116) [9].

Factors related to pain and its interference with daily activities Factors related to pain in patients with cancer
The results of Table 3.3 show that there is a relationship between academic level and pain of cancer patients, the difference in pain is statistically significant between the groups of academic level (p=0.024 ). Broemer's study (2023) also had a difference in pain between the groups (p=0.028)[10]. However, academics did not have a relationship with pain in Sun Hee Lee's study (F=2.11,p=0.11)[16]. The stage of the disease is related to pain, pain results have a statistically significant difference between groups (χ 2 =11.79,p=0.008). This result is similar to the study of Lam Thanh Nguyen(2019), and Broemer (2023). These authors also show that pain has a statistically significant difference in the disease stage groups (p=0.001)[2], and (p<0.001)[10]. The results in Table 3.3 also show that pain has a statistically significant difference between the level of analgesic used (χ 2 =74.56,p=0.00). The results are similar to those of Sun Hee Lee (p<0.001) [16]. However, the study of Lam Thanh Nguyen(2019) did not have a relationship between pain and the group of analgesics used. In addition, in some previous authors, this relationship has not been mentioned in the research results[10], [48]. This relationship needs to be further determined in further studies. The results of Table 3.3 show that there is a relationship between pain and performance status (ECOG). The level of pain has a difference between the good and bad groups, the difference is statistically significant (p=0.00). The good performance status group had a lower mean pain score than the poor group (3.07 ± 1.12 compared to 4.4 ± 1.62). Patients in performance status can be more active and involved in pain care and treatment activities than poor perfomance status, so pain control is better. This result is also shown in the study of Young Ho Yun (r=0.24,p<0.01)[23], Cielito C Reyes-Gibby (r=0.403,p<0.004) [17], and Luo-Ping Ger (OR=10,95%CI: 3.85-30.32, p<0.01) [13]. From the above analysis, it is shown that to well control pain for cancer patients, medical facilities need to pay attention to improving physical condition along with pain control for cancer patients.

Factors related to pain interference with daily activities
The results of Table 3.4 show that there is a relationship between academic level and pain interference in cancer patients, the difference in pain interference is statistically significant between groups (p=0.027). In Tegegn's study, there was a difference in pain interference between the groups of academic, but there was no statistical significance (χ 2 =7.38,p=0.22) [20]. Cancer type and stage are associated with pain interference. There was a statistically significant difference between pain interference results between groups of cancers (χ 2 =13.16 , p=0.04) and stage groups (χ 2 =9.88, p=0,02). While pain interference difference between disease groups and disease stages in Tegegn's study has not been mentioned or has no statistical significance (χ 2 =9.54,p=0.10) [20]. The pain interference has a statistically significant difference between the analgesic used (χ 2 =15.75,p = 0.00). This result has not been mentioned by previous authors. Also in Table 3.4, the results identify a statistically significant difference between the good performance status and poor perfomance status, the difference is statistically significant (Z=-7.1,p=0,00). The statistically significant difference in mean scores between the performance status groups was also shown in Young Ho Yun's study (r=0.39,p<0.001)[23]. From the above analysis, we found that along with pain control, treatment facilities need to pay attention to improving the performance status of cancer patients.

Relationship between pain and Interference of pain with daily activities
According to Cleveland, Charles S acute pain associated with cancer treatment is usually well treated and well tolerated, but disease pain or persistent post-treatment pain can persist for weeks or months, affecting badly for almost every aspect of a patient's life. Pain can affect activity and appetite, having a direct impact on the course of the disease [11]. The results of our study in Table 3.5 have also determined the relationship between pain and pain interference. There was a statistically significant difference between the levels of pain interference (χ 2 =17.16,p=0.000).