Background & Aims

In India, 1 million new cancer cases are reported annually with 80% of these cases presenting in advanced stages, amenable only to Palliative care (PC). Majority of these patients suffer from moderate- severe pain. PC services in India are focused in urban areas that too concentrated in tertiary hospitals which explains why accessing PC services is challenging for those living in rural areas. For pain and PC services to be context-specific, it is important to first identify the local needs and barriers/facilitators to PC implementation. The aim of this research was to assess unmet pain needs and barriers to accessing care among cancer patients.

Methods

A cross-sectional, mixed-method study design was adopted in the participatory action research approach, in which need assessment of the patients and the factors and challenges that impact the community based PC were analyzed. The study was conducted in one rural block of Punjab, North India from July 2023 and October 2023. A participatory action research (PAR) approach was employed where cancer patients, their caregivers, community health workers, medical officers, village sarpanch and local nongovernmental organization contributed as participants. Community Sensitization Workshops (CSWs) were organized in 27 sub-centers and sessions were audio recorded, transcribed verbatim and back translated. ESAS was used to assess symptom severity among cancer patients identified.

Results

Seventy-six percentage of community dwelling cancer patients had pain with 9.9% having moderate-severe pain. Thematic analysis revealed two main themes:1) unmet needs, and 2) barriers and challenges. Physical pain emerged as one of the major contributor to suffering; restraining them from daily activities of life. Lack of healthcare facilities nearby meant long-distance travels to access treatments and pain relief which compounded and was hindered by physical pain. This was worsened by unavailability of essential medicines and opiophobia among healthcare professionals.

Conclusions

Our findings emphasise high burden of unrelieved pain compounded by unavailability of essential medicines and opiophobia in rural north India.

References

Alsirafy, S. A. et al. High symptom burden among patients with newly diagnosed incurable cancer in a developing country. J. Pain Symptom Manage 51, e1-5. https:// doi. org/ 10. 1016/j. jpain symman. 2016. 02. 003 (2016).

Presenting Author

Mayank Gupta

Poster Authors

Mayank Gupta

MD, MSc

All India Institute of Medical Sciences, Bathinda

Lead Author

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Topics

  • Access to Care