Title : Comparative evaluation of characteristics of neuropathic pain and its effect on quality of life in cancer patients in oncology ward and palliative care unit
Technological advancements and recent discoveries in cancer therapy have decreased cancer-related mortality. But the principal objective of improving quality of life through advanced cancer treatments is compromised by poor management of pain (especially Neuropathic Pain (NP)) in the oncology ward compared to palliative care unit. The quality of life of cancer patients can be effectively improved by treating NP and addressing physical, psychological, social, and environmental factors associated with the disease. This study attempts to characterize and quantify neuropathic pain in terms of quality of life and determine if treatment of NP can improve the overall quality of life in cancer patients. The study included 26 patients from the oncology ward and 20 patients from the palliative care unit at Safdarjung Hospital diagnosed with cancer and presenting with pain. The study utilized the Self Complete Leeds Assessment of Neuropathic Symptoms and Signs Scale (S-LANSS) Pain Score for NP assessment, Edmonton Symptom Assessment System (ESAS), and Short Form - Brief Pain Inventory (SF-BPI) were used for assessing pain characteristics, Eastern Cooperative Oncology Group - Performance Status (ECOG-PS) for determining the patient performance, and WHO Quality Of Life - BREF (WHOQOL-BREF) for assessing the quality of life.Based on the S-LANSS score, 57% (15) of the oncology patients and 70% of the palliative unit patients had NP. The non-NP patients were excluded from further analysis. The ESAS (#1) and the SF-BPI (#5) scores were lower in palliative unit patients than oncology ward patients. The ECOG-PS score was lower in palliative unit patients than oncology ward patients suggesting that patients in the palliative unit performed better than patients in the oncology ward. The WHOQOL-BREF scores (especially physical health and psychological) were higher in palliative patients than oncology patients. Cancer itself or the treatment modalities of cancer could be causing NP in patients which is evident from the high incidence of NP in both the groups. The data from this study also demonstrates that NP and quality of life has an inverse relationship and that the oncology ward patients are treated inadequately for NP and other factors affecting the quality of life of cancer patients are not addressed properly. The oncology ward patients need to be treated for their pain (especially NP) (with opioids, adjuvant analgesics, NSAIDs, Amitriptyline, Gabapentin, Pregabalin or a combination) and provided early palliative care in addition to their cancer treatment for improving the overall treatment efficacy and their quality of life.