Page 19 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
1. INTRODUCTION

World Health Organization (WHO) reported that there were 48,639 new
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cancer cases in Malaysia in 2020. Cancer accounted for over 10% of
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with cancer, pain is a common and distressing symptom that affects
their quality of life.
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associated with, or resembling that associated with, actual or potential
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tissue damage”. &DQFHU SDLQ RU FDQFHU UHODWHG SDLQ LV SDLQ H[SHULHQFHG
by patients with cancer due to cancer itself or its treatment. A large
meta-analysis showed prevalence rates of cancer pain at 39.3% after
curative treatment, 55.0% during anticancer treatment and 66.4%
in advanced, metastatic or terminal disease. Moderate to severe
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patients. 4, level III This indicates that cancer pain is still prevalent despite
treatment and about a third of the patients suffer from more than just
mild pain. There is no local data on the prevalence of cancer pain.
However, a local study found that recognition of cancer symptoms
which included pain was relatively low across Malaysia. 5, level III

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fentanyl etc.), which are essential for managing moderate to severe
cancer pain, is relatively low in Malaysia compared with other countries.
A recent local study found that the total strong opioid consumption
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(DDD) per 1000 inhabitants per day in 2005, which increased to 0.126
DDD in 2014. However, this was lower than the global average of 32.8
DDD/1000 inhabitants/day. 6, level III

The main barriers to effective pain control in Malaysia relate to
physicians’ and patients’ attitudes towards the use of opioids. In one
survey among physicians, 46% felt they lacked the knowledge to
manage patients with severe pain, 40% were concerned about opioid
addiction and 38% were worried about legal issues. In a survey of
patients, 62% reported that they did not want to take opioids because
they believed that opioids were only for terminal cases, 54% feared
adverse effects (AEs) e.g. constipation and nausea and 48% feared
becoming addicted. 7, level III These misconceptions and fears may
prevent patients from reporting their pain or requesting opioids, and
physicians from prescribing adequate doses or using appropriate
routes of administration.

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services that provide cancer pain management increased in hospital,
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