Referral Pattern to a Tertiary Care Cancer Pain Clinic in India

The study aimed to identify patterns of patient referral from oncology services, including pain severity, prior analgesics, impact of patient's literacy on referral, and adequacy of pain relief offered by the pain clinic. A retrospective analysis of pain clinic data from August 2014 to February 2015 at the Tata Memorial Hospital was carried out, wherein adult cancer patients referred for the first time to the pain clinic were included. Two thousand patients were included: 38.1% of the referred were at pretreatment stage, 28.8% advanced. Most referrals were from head and neck (27.3%), gastrointestinal (26.2%), and thoracic (18.3%) disease management groups (DMGs); 88% had moderate to severe pain, only a third were prescribed analgesics. The earliest referrals were from gastrointestinal and thoracic DMGs; 75%-80% had advanced disease. The majority referred from bone and soft tissue DMG had early disease. There were few referrals from hemato-oncology and medical oncology. Among the patients, 88% had moderate to severe pain, a third were on analgesics, and less than a fifth were on opioids. Suboptimal opioid use was similar to prior studies from Asia and Europe. Pain scores were lower in the literate group, and this group were referred significantly earlier than the illiterate. Our findings demonstrate that the lack of awareness about cancer pain persists even among oncologists in a tertiary care center, and emphasizes the need for pain education of patients and doctors alike.