2013 San Antonio Breast Cancer Symposium (SABCS)

Pain relief in breast cancer patients in Vietnam

Johnny Nguyen - University of Toronto, Canada

I went to Vietnam for something completely unrelated, I was there for a karate tournament to compete and just because I was a medical student at the time I was really interested in going to the hospitals and seeing what healthcare was like. When I was there it just completely blew my mind – there were four patients per bed; there were breast exams being done in patient rooms with twenty people watching; there were patients with IVs in the hallways because there was no space in the hospital and it just completely blew my mind. It was at that point that I decided that I really wanted to get involved in looking at cancer and working in a hospital in Vietnam.

I got in contact with Dr Ophira Ginsburg, a wonderful medical oncologist from the Women’s College Research Institute and the Dalla Lana School of Public Health. She had previous contacts in Vietnam to do research with well-known doctors there so through working with her I was able to set up a project there and that’s when this whole thing started; that’s four years now. When I was there what really startled me was just the quality of life issues working in Vietnam with these patients. They were very sick, most of them had advanced stage cancer compared to what we would see in Canada. Because of early detection in Canada we see lots of T1 and T2 stage cancers and in Vietnam we were seeing T3, T4 primarily, some T2s as well. At the time I was speaking with patients and the funny thing was they weren’t worried about their survival as much as we think they would; they were worried more about the amount of pain that they were in, either from the cancer itself spreading to the bones causing bone mets and having a lot of bone pain or actually from the treatment itself, after their mastectomies or after their chemo and radiation. They were just in so much pain, they couldn’t function, they couldn’t go back to their lives, they couldn’t sleep and that’s when I was really interested in looking at the prevalence of pain and also the management of pain in Vietnam in breast cancer survivors, after their surgery, after their radiation, after their chemotherapy.

I went back to Canada that summer, I remember, and there was just so much on my mind so I looked at the literature and there is very little that is known about the prevalence of pain in breast cancer survivors in Vietnam and also about how it’s managed. There is no co-ordinated palliative care group there that’s country-wide that has a standard of care for treating breast cancer related pain. So we ended up going to a hospital called [?? 2:38], this is the National Cancer Institute in Vietnam, it sees patients from all over Vietnam and they do about 700 breast surgeries a year so it’s really one of the largest cancer centres there. I went there and I started a project looking at the prevalence of pain and compared it to the prevalence of pain in developed countries. We found that it was much, much higher in Vietnam than it was in developed countries. So, from my early research, it looks like, based on published data, the prevalence of moderate to severe pain in developed countries, anywhere from 30-50% based on the study, but from my research in Vietnam it was as high as 60-70% in breast cancer survivors five years after treatment.

Then I went to look at exactly why was it so much higher, was it related to the treatments, was it that patients didn’t have access to medications that can manage pain or was it just something else, a social issue? So that was another part of the project where I was interviewing patients, about 160 of them, directly. I also speak Vietnamese so it was possible to do that. I found that there were lots of different reasons but one of the big things was just the misconceptions about pain. A lot of patients have neuropathic pain related to their mastectomies and a lot of them felt that this type of pain couldn’t be treated, that it’s cancer so it’s something that they had to live with for the rest of their lives and they never even brought it up with their doctors. Other patients were scared to bring it up with their doctors because they were worried that the doctor would side-track the issue of their survival if they were worried about the pain. Other patients just couldn’t afford medication for pain, other patients lived too far from the major hospitals to see doctors and there were just a combination of issues regarding how their pain is managed. So that’s where the project took off and we’ll be presenting the data here in the conference.