Introduction
General principles and management of cancer pain in adults
More than half of all cancer patients will experience pain, which may be associated with both the disease and its treatment. Generally, pain is moderate to severe and will significantly impact on emotional wellbeing, disability and quality of life. In long-term cancer survivors, it can become persistent and chronic.1
The prevalence of cancer pain increases with disease progression. More than three quarters of patients with advanced disease suffer from pain.2 A recent study in Uganda and South Africa indicated that pain was the most prevalent presenting symptom among cancer patients referred for palliative care, occurring in almost all.3
Palliative care, including effective management of cancer pain, is recognised under international law as a human right. Pain management can and should be delivered from the time of diagnosis. It is inexpensive, safe and effective and can be delivered in a variety of settings including hospitals, outpatient clinics, residential hospices, nursing homes, community health centers and at home.4,5 However, cancer pain is frequently inadequately treated. In South Africa palliative care has been a low priority among health care educators, policy makers and health administrators. Healthcare providers often feel insufficiently prepared to assess and manage cancer pain.1,6-8
Guidelines are necessary to guide a comprehensive multidisciplinary approach to the management of cancer pain and appropriate, effective and safe use of medication and other treatment modalities. Although it is not always fully achievable, the aim is ultimately to allow patients to be pain free.
Therefore the purpose of this guide is to assist members of all healthcare professions in South Africa to optimise patient care within the limitations of their resources, aiming to reduce suffering while maintaining quality of life and dignity.