Pain intensity, quality of life, quality of palliative care, and satisfaction in outpatients with metastatic or recurrent cancer: A Japanese, nationwide, region-based, multicenter survey

Context: Increasing numbers of patients with advanced cancer are receiving anticancer and/or palliative treatment in outpatient settings, and palliative care for outpatients with advanced cancer is being recognized as one of the most important areas for comprehensive cancer treatment. Objectives: The aim of this study was to evaluate pain intensity, quality of life, quality of palliative care, and satisfaction reported by outpatients with advanced cancer. Methods: Questionnaires were sent to 1493 consecutive outpatients with metastatic or recurrent cancer from four regions in Japan; 859 responses were analyzed (58%). Questionnaires included the Brief Pain Inventory, Good Death Inventory, Care Evaluation Scale, and a six-point satisfaction scale. Results: Approximately 20% of the patients reported moderate to severe pain. Whereas more than 70% agreed or strongly agreed with "good relationship with medical staff" and "being respected as an individual," less than 60% agreed or strongly agreed with "free from physical distress," "free from emotional distress," "maintaining hope," and "fulfillment at life's completion"; 54% reported some agreement with "feel a burden to others." About 20% reported that improvement is necessary in physical care by physicians, physical care by nurses, psycho-existential care, help with decision making, and coordination/consistency of care; 13% reported some levels of dissatisfaction. Conclusion: A considerable number of outpatients with metastatic or recurrent cancer experienced pain, physical symptoms, emotional distress, and existential suffering, and advocated improvements in palliative care across multiple areas.