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Asiedu-Ofei Akua Afriyie.Pdf CANCER PAIN ASSESSMENT, MANAGEMENT AND EFFECT ON THE QUALITY OF LIFE OF PATIENTS AT A TERTIARY HOSPITAL IN GHANA A THESIS SUBMITTED IN FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN PHARMACOLOGY in the Department of Pharmacology Faculty of Pharmacy and Pharmaceutical Sciences College of Health Sciences by AKUA AFRIYIE ASIEDU-OFEI KWAME NKRUMAH UNIVERSITY OF SCIENCE & TECHNOLOGY, KUMASI JUNE , 2019 DECLARATION I declare that I am the sole author of this thesis, and that this work has not been submitted for any other degree anywhere. This is a true copy of the thesis, including any required final revisions, as accepted by my examiners. I accept that my thesis may be made electronically available to the public. ………………………….. ………………………….. Akua Afriyie Asiedu-Ofei Date (PG2355414) Certified by: ………………………….. ………………………….. Prof. Eric Woode Date (Principal Supervisor) Certified by: ………………………….. ………………………….. Prof. Dr. David Darko Obiri Date (Head of Department) ii ABSTRACT Background: Despite extensive technological advancements in medicine in recent years, cancer still remains poorly managed resulting in pain and affecting adversely the quality of life (QoL) of patients. Additionally, evidence suggests that effective cancer pain management is largely inadequate in low and middle income countries such as Ghana. Aim: This study seeks to assess the severity and management of cancer pain at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods: Using a structured questionnaire, the socio-demographic data, clinical characteristics, and drug history of 204 consenting ambulatory oncology patients, aged 18 years or older, attending clinic at the Oncology Directorate, KATH were obtained from medical folders and the Hospital Administration Management System (HAMS) from January – December, 2015. Structured interviews were also conducted for the patients using the Brief Pain Inventory Long Form (BPI-LF) and the World Health Organization Quality of Life-Brief version (WHOQoL- Bref) to evaluate patients‘ level of self-reported pain and how pain affects their quality of life. Data obtained was analysed using reliability and validity tests, parametric and non-parametric tests. Results: Majority of patients were females (82.8%), married (56.6%), Christians (89.3%), and employed (86.8%), with mean age and parity of 53.54 years (SD = 15.457) and 4.39 children (SD = 3.118) respectively. Most patients (81.4%) subscribed to the National Health Insurance Authority (NHIA) registration to cover medical expenses. Diagnosis for breast cancer (37.7%), stage III/ IV disease (63.3%) and metastases (32.5%) were predominantly identified. Only 9.1% of patients had positive family history of cancer while 8 in 10 (79.6%) patients had Eastern Cooperative Oncology Group performance status of 1. Hypertension was the predominant comorbid condition identified in 19.6% of the patients. Dual chemotherapeutic agents combination therapy (46.5%) and mono analgesic therapy (51.1%) were most used. Internal consistency reliability of the BPI-LF and WHOQoL-Bref were 0.876 and 0.910 respectively. More than half of the patients (63.7%) reported moderate pain while 28.4% reported severe pain. Cancer pain interfered highly with sleep (46.2%) and general activity (42.5%) of patients. Common sites of cancer pain reported by patients were abdomen (20.3%) and left breast (12.4%). A set of patients‘ factors did not predict their overall quality of life and the regression model did not adequately fit the data (R2= 0.44). Conclusion: Patients predominantly reported moderate cancer pain. Pain management was mostly inadequate in the patients and pain significantly affected the quality of life of the patients. iii ACKNOWLEDGEMENTS My greatest thanks and appreciation go to God Almighty for the grace to go through this study. I wish to show special appreciation to my principal supervisor, Professor Eric Woode for his encouragement, containment, and supervision. My profound gratitude also goes to Dr. Ernest Bawuah Osei-Bonsu and Pharm. Dr. Kofi Boamah Mensah for their useful comments, insights and guidance. I am also grateful to Dr. Robert Peter Biney for his insightful reviews of this work. My humble thanks go to all patients who took part in the study. For many of them, it is a life threatening situation and a personal crisis but notwithstanding these, they sacrificed their time to share their stories. I am honoured and extremely humbled to have had the opportunity of listening to the experiences of those who endure pain in their daily lives and the struggles that this brings in their lives. I am very thankful to my Head of Department, Prof. Dr. David Obiri Darko and all lecturers in the Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, KNUST especially Prof. George Asumeng Koffuor for their words of encouragement and support. To all my ―pharmacology comrades‖ especially Mrs. Theresa Frimpong and Dr. Mrs. Linda Gyanfosu Asamoah, I say a very big thank you for all the love and encouragement. To all staff at the Oncology Directorate, Komfo Anokye Teaching Hospital, I say a big thank you. I am particularly indebted to my family especially my dear husband; Mr. Gerhard Asiedu-Ofei, my mum; Ms. Mercy Ofori, my sister; Akua Kusiwaa Karikari, my aunties; Sarah Ofori Armaah and Janet Antwi and my father-in-law; Mr Albert Asiedu- Ofei for their unflinching love and support over the years. I am also thankful to all staff at Kumasi Technical University especially Dr. Francis Mainoo-Sarpong, Prof. Ing. Osei Wusu-Achiaw, Mr. Kwadwo Ntiamoah-Sarpong, Dr. Mrs. Patricia Owusu-Darko, Dr. Amina Abubakar and Mr. Edmund Ayensu. I am also appreciative of the help offered to me by Dr. Cedric Amengor, Mr. Bede Yaw Ansiri- Asafoakwaa, Dr. Nicolas Oppong-Mensah and Dr. Alfred Owusu. To Harold, Jeremy and my beautiful daughter; Zara Giselle, you guys are my pride, inspiration and source of strength to achieve greatness. Thanks for being there for me and being so loving. To all loved ones and well- wishers, I am grateful and thanks for all your help. I love you all!! iv TABLE OF CONTENTS DECLARATION .............................................................................................................. ii ABSTRACT ...................................................................................................................... iii ACKNOWLEDGEMENTS ........................................................................................... iv TABLE OF CONTENTS ................................................................................................. v LIST OF TABLES ........................................................................................................... ix LIST OF FIGURES ......................................................................................................... xi ABBREVIATIONS/ ACCRONYMS .......................................................................... xiii CHAPTER ONE ............................................................................................................... 1 1.0 GENERAL OVERVIEW ........................................................................................ 1 1.1 Background of the study .......................................................................................... 1 1.2 Problem statement ................................................................................................... 1 1.3 Justification of the study .......................................................................................... 2 1.4 Research hypothesis of the study ............................................................................ 2 1.5 Aim and specific objectives of the study ................................................................ 2 CHAPTER TWO .............................................................................................................. 3 2.0 LITERATURE REVIEW ........................................................................................ 3 2.1 Epidemiology of cancer and cancer pain ................................................................ 3 2.2 Concept of cancer .................................................................................................... 3 2.2.1 Carcinogenesis ................................................................................................... 4 2.2.2 Types of cancer .................................................................................................. 7 2.2.3 Signs and symptoms of cancer .......................................................................... 7 2.2.4 Classification of cancer ...................................................................................... 7 2.2.4.1 Carcinomas ................................................................................................. 7 2.2.4.2 Sarcomas .................................................................................................... 7 2.2.4.3 Myelomas ................................................................................................... 7 2.2.4.4 Lymphomas ................................................................................................ 8 2.2.4.5 Leukemias .................................................................................................. 8 2.2.4.6 Mixed types of cancer ................................................................................ 8 2.2.5 Staging of cancer ...............................................................................................
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