Background & Aims
The neuropathic cancer pain (NCP) is of complex management and it has a negative impact in the quality of life (QoL) of people in all aspects (physical, emotional, social and spiritual). The identification of the neuropathic component is fundamental for the adequate treatment; however, it is still underdiagnosed and undertreated, which is directly associated with the intense suffering of patients. Epidemiologic data about NCP are scarce and research suggests that one in every three patients with cancer presents pain with a neuropathic component; during chemotherapy treatment the prevalence may reach higher percentages. Thus, the objective of this study was to identify the prevalence and incidence of NCP and evaluate its impact on humor, functionality and sleep of oncological patients in a region of high social vulnerability in Brazil.
Methods
A cross-sectional study was conducted between 2019-2021, at the two public hospitals of reference in cancer in the state of Maranhão/Brazil. The sample was composed by adults of both sexes, lucid, with cancer diagnosis attested by a histopathology report and who consented to participating in the research. The instruments used were the Douleur Neuropathique 4 (DN4), Hospital Anxiety and Depression Scale, Mini-Sleep and Karnofsky Performance Status, in addition to a socioeconomic and clinical questionnaire. The sample was divided in two studies: PREVALENCE for patients who, at the moment of the interview, had chronic pain and INCIDENCE for the others, these being contacted 3 and 6 months after the interview. Those who did not present chronic pain until the second contact were excluded. A descriptive analysis of the groups was made crossing all the variables with the DN4, along with a Kruskall-Wallis test, followed by a logistical regression, with a CI of 95% and a p-value < 0,05.
Results
One thousand twenty (1020) patients took part in the study, most of them being women (61%), afro descendants (79%), with low education level (85%), monthly income of up to 1 minimal wage (65%), coming from the rural area (71%) and with a diagnosis of breast cancer (20%) and cervical cancer (17%). The prevalence of NCP was of 62.5% and the incidence was of 21.4%. The pain was daily in 90% of the sample and of moderate intensity in 53% of them. To control the NCP, ordinary painkillers were the most used (63%) and most of them patients (86%) used only one medication. Strong opioid was used by 24% of the patients, anticonvulsant by 3.6% and antidepressant by 6%. Anxiety was identified in 56% of the sample with NCP, depression in 51% and sleep alteration in 41%. The variables female sex, breast and cervical cancer, presence of metastasis, anxiety, depression, moderate sleep pattern alteration, spreading of pain and radiotherapy, presented a risk factor for NCP (p< 0.05; CI 95%).
Conclusions
The prevalence of NCP was of 62.5% and the incidence, 21.4%. The patients with NCP were, mostly, women, afro descendants, with low education level, low income, coming from the rural area, with a diagnosis of breast and cervical cancer, mainly. The pain interfered significantly in the daily life of the patients who had anxiety, depression, and sleep pattern alteration. The characteristics of the sample depict the reality of a population that lives in a region of high social vulnerability, with the worst HDI (Human Development Index) of the country (0.676). The cancer diagnosis often happens in later stages of the disease due to the difficult access to health care, in addition to the therapeutic limitation and scarcity of specialized professionals and services in all state.
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Presenting Author
João Batista Santos Garcia
Poster Authors
Rayanne Luiza Tajra Mualem Araújo
PhD
Federal University of Maranhão
Lead Author
Joao Batista Garcia
Federal University of Maranhao
Lead Author
José Osvaldo Barbosa Neto
MD
University CEUMA
Lead Author
Leonardo Silva dos Santos
medicine student.
Federal University of Maranhão
Lead Author
Marina Vaz Rodrigues
medicine student.
Federal University of Maranhão
Lead Author
Topics
- Epidemiology