Global cancer pain management: a systematic review comparing trials in Africa, Europe and North America

Aim: Despite the rise in cancer survivorship, few reviews have examined the quality of studies of cancer pain management and practices around the globe. With a void in trials spanning multiple geographical settings, this review evaluates the quality of cancer trials across three continents. Materials & methods: A literature review and search of established databases was conducted to identify eligible studies. The Cochrane method, the Jadad Score and a cancer pain-specific ad hoc tool were used to evaluate quality of studies. Results: Eighteen studies representing a total of 4693 individuals were included in the review. Study quality correlated positively with study sample size and palliative care index. Trials in all three continents were prone to use opioids for pain management, whereas trials in Europe and North America utilized other adjuvant therapies such as antidepressants and steroids. Conclusion: This review underscores the need for better multidimensional quality assessment tools for cancer pain trials.

Introduction

Although advances in cancer treatments have helped to increase cancer survivorship, there has not been a concomitant improvement in cancer pain outcomes globally [1,2]. The literature indicates that approximately 60% of survivors continue to have poor quality of life as a result of undertreated cancer pain [3]. Due to differences in geopolitical, financial-legal and sociocultural influences on evidence-based practice, there is a wide variability in treatment, which results in very disparate outcomes for patients [4–6].

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