359: Patient Reported Medication Need Outperforms Prescription Metrics in Identifying Cancer Pain Burden

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute cancer related pain, Pharmacological treatments, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Despite advances in analgesia, cancer pain remains undertreated, especially in low-resource settings where prevalence and care gaps are greatest[1,2]. Barriers to effective pain control worsen functional decline and quality of life [3, 4]. Recent reviews and patient‑reported outcome studies recommend personalized, multimodal strategies and policy action [5,6]. Clinicians require better assessment tools that capture pain intensity and related outcomes to support implementation. We therefore investigated demographic and treatment factors linked to higher pain burden and poorer quality of life, and assessed how the prescription‑based pain management index (PMI) corresponds with patient-reported outcomes in a multi‑site Ghanaian oncology cohort.

Methods: A prospective hospital-based cohort study enrolled 189 adults with cancer-related pain receiving treatment at three Ghanaian tertiary oncology centres from February 2022 to July 2024. Participants provided demographic information and completed the Brief Pain Inventory Long Form (BPI-LF) and WHO Quality of Life (WHOQoL) instruments. Clinical records captured cancer type and prescribed medications. We calculated the pain management index and documented patients’ perceived need for stronger or additional analgesia. Data were analysed using descriptive statistics, independent t-tests, ANOVA with Tukey post hoc comparisons, and nonparametric tests when statistical assumptions were not met. It aimed to relate clinical metrics to outcomes.

Results: Pain was common, with 56.1% reporting pain at diagnosis and 95.2% attributing it to the primary disease. A negative PMI was present in 55.3% of participants. Sex was the main demographic correlate, with men and women showing similar pain severity index (PSI) scores but men reporting substantially greater functional interference (FI) and lower WHOQoL domain scores. Analgesic class mirrored clinical selection patterns. Patients' self‑reported need for stronger or additional medication most reliably identified those with the highest burden. Directly asking whether patients needed stronger or more analgesia flagged individuals with higher PSI, greater FI, and lower percent relief.

Conclusions: PMI and similar prescription-based metrics alone fail to capture the lived burden of cancer pain. Brief patient reported outcome measures (PROs) asking whether patients need stronger or more medication offer a simple powerful screen for unmet need and should be integrated into routine assessment. Combining these self reports with standard pain intensity measures improves triage for specialist referral and prompts timely multimodal review.

References: 1. Paice, J.A., Lacchetti, C. & Bruera, E., 2016. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 34(27), pp.3325–3345.
2. Abruquah, A.A., Biney, R.P., Osei‑Bonsu, E.B., Boamah, K.M. & Woode, E., 2017. Cancer pain assessment and management in ambulatory patients at a tertiary hospital in Ghana. International Journal of Community Medicine and Public Health, 4(6), pp.1793–1799.
3. Obaid, A., Al Hroub, A., Al Rifai, A., Alruzzieh, M., Radaideh, M. and Tantawi, Y., 2023. Barriers to effective cancer pain management, comparing the perspectives of physicians, nurses, and patients. Pain Management Nursing, 24(5), pp.498-505.
4. Orujlu, S., Hassankhani, H., Rahmani, A., Sanaat, Z., Dadashzadeh, A. and Allahbakhshian, A., 2022. Barriers to cancer pain management from the perspective of patients: A qualitative study. Nursing open, 9(1), pp.541-549.
5. Sørensen, J., Sjøgren, P., Stine, C., Sørensen, T.V., Heinecke, K., Larsen, H., Eidemak, I. and Kurita, G.P., 2022. Patient-reported outcome measures (PROMs) and palliative-care clinician reported outcomes (ClinROs) mutually improve pain and other symptoms assessment of hospitalized cancer-patients. Scandinavian Journal of pain, 22(3), pp.569-577.
6. Balitsky, A.K., Rayner, D., Britto, J., Lionel, A.C., Ginsberg, L., Cho, W., Wilfred, A.M., Sardar, H., Cantor, N., Mian, H. and Levine, M.N., 2024. Patient-reported outcome measures in cancer care: an updated systematic review and meta-analysis. JAMA Network Open, 7(8), p.e2424793.

Presenting Author: Emily Brownhill
Submitting Author: Emily Brownhill

Senior Author: Charles Benneh

IASP 2026 Global Year theme of Neuropathic Pain: No

• Harrison Awuttey - Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
• Joseph Kweku Otoo - Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
• Banahene Kwaku Yeboah - Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
• Charles Kwaku Benneh - School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, Cromore Road, United Kingdom
• Emily Brownhill - School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, Cromore Road, United Kingdom