Correlation between Anxiety with the Success of

Cancer Pain Management

Steven Theo

, and Wulan Fadinie

Universitas Sumatera Utara, Medan, Indonesia

Department of Anaesthesiology and Intensive Therapy, Medan, Indonesia

Keywords: Cancer Pain, Pain Management, Anxiety

Abstract: Pain is the most common symptom in cancer patients. The prevalence study states that 56–64% of patients

handle cancer pain. Generally, patients diagnosed with cancer have three forms of emotional responses that

arise such as rejection, anxiety, and depression. Guidelines for managing cancer pain are quite numerous,

but the results are inadequate, therefore often associated with anxiety. Anxiety can cause inadequate pain

management in cancer patients so that it needs to be diagnosed as soon as possible to maximize therapy.

This study was conducted to find the relationship of anxiety with the management of cancer pain. This

research is a descriptive analytic with a cross-sectional design. The study sample was cancer patients in the

pain clinic Haji Adam Malik General Hospital who had met the inclusion and exclusion criteria based on the

total sampling method. The research data is primary data directly taken from the subject using interview

techniques. The research instruments were the HADS, BPI, and PMI questionnaires. Fisher's Exact test

results show no association between anxiety and the adequacy of cancer pain management (p = 0.321, CI =

95%). There is no relationship between anxiety with the adequacy of cancer pain management.

1 INTRODUCTION

Pain is a protective mechanism meant to bring to

conscious awareness of tissue damage that is

occurring or is about to happen (Sherwood, 2014).

Pain is the most common symptom felt by cancer

patients. Prevalence studies suggest that cancer pain

is handled by 56 to 64% of patients per month

(Arslan et al., 2014).

In 2012, there were an estimated 14.1 million

new cancer cases and 8.2 million cases of cancer

deaths. And the incidence of 50 countries is around

400 per 100,000 men and 300 per 100,000 women

(Torre et al., 2016). The prevalence of cancer in

Indonesia is 14 per 10,000 people and the prevalence

of cancer in North Sumatra of 10 per 10,000

population (Kementerian Kesehatan RI, 2013).

In patients diagnosed with cancer, in general,

there are three forms of emotional responses that can

arise namely rejection, anxiety and depression. In

these circumstances, it is complicated for cancer

patients to be able to accept themselves because the

condition and treatment of cancer can cause

continuous stress so that it not only affects the

physical but also the adjustment of individual

psychology. Cancer patients generally will have low

self-acceptance, low self-esteem, feeling hopeless,

anxiety, and depression. Therefore, people living

with cancer generally experience twice the pain of

most other illnesses, in addition to suffering from

cancer itself also suffer from depression and anxiety.

Until now there has been no data on the occurrence

of anxiety in lung cancer patients when they first

found out about their illness (Harris et al., 2015).

Although there have been many guidelines for

managing cancer pain, cancer pain patients still get

inadequate treatment of cancer pain (Singh et al.,

2016). Anxiety was a psychological factor that can

cause inadequate pain management in cancer

patients so that they need to be diagnosed as soon as

possible to maximize therapy (Teodora et al., 2012).

Research in China states that 25% of cancer pain

patients do not get adequate management of cancer

pain and have a higher risk of anxiety than patients

who receive sufficient management of cancer pain.

So that if allowed to continue it will further

aggravate the success of managing cancer pain (Li et

al., 2017).

Theo, S. and Fadinie, W.

Correlation between Anxiety with the Success of Cancer Pain Management.

DOI: 10.5220/0009861701190122

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 119-122

ISBN: 978-989-758-469-5

119

2 METHODS

This research is descriptive analytic with a cross-

sectional approach, namely by taking samples of

cancer patients with pain. The relationship between

variables namely anxiety with the successful

management of cancer pain was determined based

on data collected from interviews at the pain

polyclinic at Haji Adam Malik General Hospital.

The population used in this study were all cancer

patients in the pain polyclinic of Haji Adam Malik

General Hospital. The research sample taken is a

subject from the selected population and has fulfilled

the inclusion and exclusion criteria. The sampling

technique in this study was total sampling. The data

used are primary data obtained from interviews in

the pain polyclinic of Haji Adam Malik General

Hospital. The collected data is then processed using

a computer statistics program. In this study, the

information is categorical, and the hypothesis will be

analyzed using Fisher's Exact statistical test.

2.1 Inclusion Criteria

Outpatient cancer pain in the Pain Polyclinic of

Anaesthesiology and Intensive Therapy Department

at Haji Adam Malik General Hospital which has at

least three months of treatment.

2.2 Exclusion Criteria

a. Cancer pain patients who are getting pain

medication to undergo chemotherapy.

b. Patients cannot be interviewed, and no

guardian accompanies the patient.

The minimum sample size is taken based on the

number of cancer patients who have received

therapy for at least three months.

3 RESULTS

Of the 50 research subjects consisting of 17 subjects

with anxiety and 33 subjects without anxiety, and 5

subjects received inadequate management.

Table 1: Distribution based on patients’ socio-

demographic profile.

Age Frequency

Percentage

(%)

16-20 0 0

21-30 5 10

31-40 3 6

41-50 15 30

51-60 16 32

>60 11 22

Sex

Men 26 52

Women 24 48

Education

Elementary school 13 26

Junior secondary school 16 12

Senior high school 31 62

Occupation

State employees 4 8

Private employees 4 8

Pastor 1 2

Farmer 8 16

Driver 1 2

Do not work 20 40

Entrepreneur 12 24

Status

Married 44 88

Single 6 12

Total

50 100

From table 1, most cancer pain patients are

found in the age range of 51-60 years (32%), more

in men (52%) than women (48%), with senior high

school education background (62%), in non-working

samples (40%), and married people (88%).

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Table 2: Distribution of cancer pain patients based on the

type of cancer

Cancer Frequency Percentage (%)

Prostate

Adenocarcinoma

1 2

Rectum

Adenocarcinoma

8 16

Gastric

Adenocarcinoma

1 2

Pulmonary

adenocarcinoma

6 12

Cervical Carcinoma 5 10

Colon Carcinoma 2 4

Ear Canal Carcinoma +

Sinonasal Carcinoma

1 2

Tongue Carcinoma 1 2

Breast carcinoma 2 4

Nasopharyngeal

carcinoma

5 10

Ovary Carcinoma 1 2

Thyroid Carcinoma +

BPH

1 2

Vulva Carcinoma 1 2

Rectosigmoid

Carcinoma

1 2

Sinonasal Carcinoma 1 2

Chordomal Sacrum 1 2

Hepatocellular

Carcinoma

1 2

Hepatoma 1 2

Melanoma Palatum 1 2

Non Hodgkin

Lymphoma

1 2

Non Hodgkin

Lymphoma Colon

1 2

Primary Bone Tumor 1 2

Pulmonary Squamous

Cell Carcinoma

1 2

Tongue Squamous Cell

Carcinoma

1 2

Bladder transitional cell

carcinoma

3 6

Submandibular

Tumor

1 2

Total 50 100

From table 2, most patients in the pain

polyclinic of Anaesthesiology and Intensive Therapy

Department at Haji Adam Malik General Hospital

were rectum adenocarcinoma (16%).

Table 3: Anxiety with the success of managing

cancer pain.

Adequate Not adequate

P value

Anxiety (+)

14 3

0,321

Anxiety (-)

31 2

Total

45 5

From table 3, it can be concluded that there is

no relationship between anxiety and the success of

managing cancer pain or vice versa (P value> 0.05).

4 DISCUSSION

This study was a cross-sectional study to see the

relationship between anxiety with the success of

cancer pain management.

In this study, there was no association between

anxiety and the success of cancer pain management

(p = 0.321).

The results of this study are not compatible with

the study of Teodora et al., (2012) which states that

anxiety, depression, and other psychosocial factors

are associated with the failed management of cancer

pain. The study also revealed that patients who get

adequate treatment of cancer pain also need to be

treated with anxiety, depression, and other

psychosocial factors because cancer experienced by

patients can also have an impact on the patient's

psychological condition (Teodora et al., 2012).

The results of this study are by the research

conducted in the Portuguese Cancer Institute, and it

was found that there was no relationship between

anxiety with the success of managing cancer pain

with P value = 0.42 (Reiz et al., 2017). Teodora's

study also mentioned that there was no reciprocal

relationship between the two variables (Li et al.,

2017).

The current research constraint is that the

results are not significant due to the use of potent

opioids by 45 samples so that the PMI results from ≥

0. Although the sample has a high BPI value, the

drug given is a potent opioid will produce a PMI

value ≥ 0 which means Cancer pain treatment is

given adequately even though not all samples have

high BPI values. In addition to strong opioid

Correlation between Anxiety with the Success of Cancer Pain Management

121

administration factors, researchers suspect that

family and environmental factors of patients also

have a significant influence on anxiety experienced

by patients, this is because when interviewing

patients, the patient's family response is perfect and

the patient's family also pays attention to the

patient's psychological state (Susilawati, 2013).

According to research conducted at Dr. Sarditjo

General Hospital in Yogyakarta, family support is

closely related to the level of anxiety experienced by

patients. Patients who receive positive support from

the family show a decrease in the level of anxiety

experienced, but family support does not sufficiently

affect the patient's anxiety level. The anxiety

experienced by the patients based on internal factors

such as a factor of maturity, personality type, and

physical condition. The external factors are social

support and family support. The psychological

profile of cancer patients such as cervical cancer that

comes during a medical examination shows a high

level of anxiety, anger, and alienation. Hospital care

is also one of the worrying factors for patients. In

patients with cervical cancer who undergo treatment

at the hospital when going to surgery, chemotherapy,

radiotherapy or other treatment measures, also often

experience anxiety. Also, because of the non-

personal attitude of doctors, nurses or other hospital

staff, sufferers feel that they are the object of

examination. Such conditions often make the

sufferer feel a loss of self-identity, and lose control

of his body, making the patient feel uncomfortable

undergoing treatment at the hospital. Due to the

many factors that influence anxiety in cancer

patients, it is necessary to educate people who care

for patients to always pay attention to their bio-

psycho-socio and spiritual needs through health

education and counseling to patients and families

(Susilawati, 2013).

5 CONCLUSIONS

There was no association between anxiety and the

success of cancer pain management (p = 0.321, CI =

95%).

REFERENCES

Arslan, D., Koca, T., Akar, E., Tural, D. & Ozdogan, M.,

2014. Cancer pain prevalence and its management.

Asian Pac J Cancer Prev,

Haris, A., Syahruddin, E., Susanto, M., & Kekalih, A.,

2015, ‘Insiden dan Tingkat Anxiety-Depression pada

Pasien Kanker Paru’, J Respir Indo.

Kementerian Kesehatan RI 2013, Riset Kesehatan Dasar,

Badan Penelitian dan Pengembangan Kesehatan,

Jakarta.

Li, X.M., Xiao, W.H., Yang, P. & Zhao, H.X., 2017,

‘Psychological distress and cancer pain: Results from

a controlled cross-sectional survey in China’,

Scientific Reports.

Reiz-Pina, P., Lawlor, P. G., Barbosa, A. 2017, ‘Adequacy

of cancer-related pain management and predictors of

undertreatment at referral to a pain clinic’, Journal of

Pain Research.

Sherwood, L. 2014, Fisiologi Manusia: Dari Sel ke Sistem

,8th edn, EGC, Jakarta.

Singh, H., Banipal, R.P.S. and Singh, B. 2016,

‘Assessment of adequacy of pain management and

analgesic use in patients with advanced cancer using

the brief pain inventory and pain management index

calculation’, Journal of global oncology.

Susilawati, Dwi 2013, ‘Hubungan Antara Dukungan

Keluarga dengan Tingkat Kecemasan Penderita

Kanker Serviks Paliatif di RSUP Dr. Sardjito

Yogyakarta’, Jurnal Keperawatan.

Teodora, B.A., Ianovici, N. and Băncilă, S. 2012,

‘Modifying Faktors of Chronic Pain Perception in

Oncological Patients’, Therapeutics, Pharmacology &

Clinical Toxicology.

Torre, L. A., Siegel, R. L., Ward, E. M., & Jemal, A.

2016, ‘Global Cancer Incidence and Mortality Rates

and Trends—An Update’, Cancer Epidemiology,

Biomarkers, & Prevention.

APPENDIX

BPI: Brief Pain Inventory

HADS: Hospital Anxiety and Depression Score

PMI: Pain Management Index

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