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Rehab Abdelwahab, Anas Hamad, Shereen El Azzaz, Randa Al Okka, Mohd A. Wahid, Khalil Ullah Shibli, Ahmed El Geziry, Fathi Saleh, Kakil Rasul and Wael Saleem

Background: Studies showed that 40%–50% of patients with cancer pain receive insufficient analgesia due to different factors (Beyeler et al, Support Care Cancer 2008; Salminen et al, Support Cancer Care 2008), beside the challenges to accurately assess pain, which might affect drug selection and pain control (Stewart, Ulster Med J 2014). In NCCCR, the treating primary physicians (PP) may prescribe analgesics to their patients or refer them to the Pain Management Team (PMT), based on evaluation or as requested by patients. This study will address the clinical concerns of PP, which may lead to refer the patients to PMT, moreover the clinical judgement of PMT on the referred cases whether they need to be refereed or not. Objectives: To determine the efficiency of the referral pathway to the pain clinic by PMT. Methods: PMT is going to assess the referred patient to their clinics according to pain assessment methods. Patients will be evaluated whether they have been appropriately referred or not, any unnecessary referral will be documented based on the following;

  • • If the patient was referred by hematologist or oncologist

  • • If the patient required specialized treatment

  • • If the patient required urgent treatment/prescription or advanced pain management techniques

  • • If the patient required further consultation by pain management

  • • If the patient could be managed by PP

Results: 195 patients were newly referred to the pain clinic during the period from March 8, 2018 to August 31, 2018. 12% (23/195) were deemed as unnecessary referrals based on PMT assessment; 43% (10/23) of them were hematology patients, while 57% (13/23) were oncology. The majority was for breast cancer and sickle cell disease patients with 35% for each. According to the PMT assessment, 61% (14/23) patients (95% CI, 40.79%–77.84%) considered unnecessary referrals due to improper basic pain assessment and management by PP, while 30% (7/23) patients (95%CI, 15.60%–50.87%) asked for refill medications. Conclusion: There is 12% unnecessary referrals to PMT, which need further improvement in the referral pathway, via the development of a definite referral criteria to PMT. PP should be encouraged to provide basic pain treatment and to consider multidisciplinary management with appropriate coordination for better improvements in patients’ quality of life.

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Rehab Abdelwahab, Anas Hamad, Randa Al Okka, Mohd A. Wahid, Khalil Ullah Shibli, Wael Saleem, Ahmed El Geziry, Fathi Saleh, Kakil Rasul and Shereen Elazzazy

Background: Up to 70% of cancer patients experience pain during the course of illness (Fallon, Support Care Cancer 2008). Studies showed that 40%–50% of patients with cancer pain receive insufficient analgesia due to different factors. Physicians are facing different challenges to accurately assess pain which might affect drug selection and pain control (Beyeler et al, Support Care Cancer 2008; Salminen et al, Support Cancer Care 2008; Stewart, Ulster Med J 2014). In NCCCR, treating physicians may prescribe analgesics to their patients or refer them to the Pain Management Service (PMS) based on their evaluation or as requested by patients. This study explored the factors which might lead to undertreatment of cancer pain in Qatar. In addition, focused on cancer patients’ pain management satisfaction and PMS awareness. Objectives: To assess the existing PMS at NCCCR from patients' perspective. Methods: In this study, we evaluated patients’ pain management perception via a validated written (Arabic and English) questionnaire (SF-MPQ-2; available at https://eprovide.mapi-trust.org/instruments/short-form-mcgill-pain-questionnaire#DESCRIPTIVE_INFORMATION; Gauthier et al, J Pain 2014) and a structured interview by outpatient pharmacists at a single point of time, to assess patients` awareness towards the PMS, if they are receiving pain medications or not, if they are experiencing any pain regardless on pain medications or not, pain severity, and patients’ level of satisfaction towards their medications. A sample of 400 patients was randomly selected amongst the total cancer population visiting NCCCR Pharmacy over a specific period of time. Participants were consented and interviewed. Results: 400 patients agreed to participate; the median age was 50. Male to female ratio was 3 to 7. Data showed that 61% (245/400) of participants were not aware of the existence of the PMS. Only 20% (78/400) were aware and followed by PMS, with a satisfaction rate of 76% (59/78). Although 69% (276/400) of the patients were on pain medications, only 70% (191/276) were satisfied with their current medications. However from the satisfied patients, 57% (109/191) rated their pain as 4–10 at the time of interview (ATI). In the 31% (124/400) that were not taking any pain medications; 77% (96/124) didn’t know about the PMS, and 44% (55/124) had 4–10 pain severity (ATI). Conclusion: These findings provide clear evidence that factors leading to undertreating of cancer pain in Qatar might be unawareness of the PMS existence, pain treatment by unspecialized physicians, and patients’ reluctance to express their pain. Thus, raising patients’ awareness and standardizing the referral criteria can improve pain control and quality of life amongst cancer patients.