Pain management adherence and barriers among regional head and neck cancer patients: A chart review study

Published:January 20, 2022DOI:



      Head and neck cancer (HNC) patients experience considerable pain. Living outside a major urban area is associated with disparities in outcomes among cancer patients.


      To examine factors influencing head and neck cancer patients' pain management adherence at a regional HNC multidisciplinary clinic.


      Retrospective analysis of diagnostic and treatment categories, symptom scores, reported adherence with prescribed pain management and self-reported pain management concerns detailed in clinical records over a two-year period in a regional cancer clinic.


      A total of 34 patients receiving treatment for head and neck cancer over the period (mean age of 64.5 years, SD 10.4; male/female ratio 30/4). Seventy percent of patients (n = 24) were non-adherent with their prescribed analgesia regimen. At the end of treatment, 64-65% of patients reported pain, fatigue and mucositis as severe. Three main reasons for non-adherence with pain management were reported: Fear of addiction and resistance to using opioids, administration or dose confusion, and difficulty organising medications (such as filling scripts). Fear of addiction and resistance to opioids was associated with analgesic non-adherence (x2 7.32 (1) (n = 34) p = .007) and severity of reported pain (x2 6.118 (1) (n = 32) p = .013).


      Our investigation identified non-cancer related factors, particularly opioid fear and stigma, as factors that negatively impacted treatment adherence. Regional populations are recognised to experience cancer treatment barriers. Our findings suggest there may be unique characteristics among regional patients that warrant attention as factors that limit pain management adherence.


      Clinicians require early identification strategies to identify and intervene early to address opioid stigma and fear. In rural settings, the unique contextual factors which influence this fear and stigma need consideration.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Australian Institute of Health & Welfare (2014). Head and neck cancers in Australia. Retrieved from Canberra: Available at:

        • Bressan V
        • Stevanin S
        • Bianchi M
        • Aleo G
        • Bagnasco A
        • Sasso L
        The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: A systematic review.
        Cancer Treatment Reviews. 2016; 45: 105-119
        • Brown JH
        • Torres HP
        • Maddi RD
        • Williams JL
        • Dibaj SS
        • Liu D
        • et al.
        Cancer patients' perceived difficulties filling opioid prescriptions after receiving outpatient supportive care.
        Journal of Pain and Symptom Management. 2020; 60: 915-922
        • Bulls HW.
        • Hoogland AI
        • Craig D
        • Paice J
        • Chang YD
        • Oberoi-Jassal R
        • et al.
        Cancer and Opioids: Patient Experiences With Stigma (COPES)—A Pilot Study.
        Journal of Pain and Symptom Management. 2019; 57: 816-819
      2. Elliott, V. (2018). Thinking about the coding process in qualitative data analysis. 23:2850-2861.

        • Giusti R
        • Bossi P
        • Mazzotta M
        • Filetti M
        • Iacono D
        • Marchetti P.
        The use of fentanyl in pain management in head and neck cancer patients: a narrative review.
        Br J Pain. 2018; 12: 155-162
        • Hammer JH
        • Vogel DL
        • Heimerdinger-Edwards SR.
        Men's help seeking: Examination of differences across community size, education, and income.
        Psychology of Men & Masullinity. 2013; 14: 65-75
        • Ireland MJ
        • March S
        • Crawford-Williams F
        • Cassimatis M
        • Aitken JF
        • Hyde MK
        • et al.
        A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia.
        BMC Cancer. 2017; 17: 95
        • Jackson LK
        • Ridner SH
        • Deng J
        • Bartow C
        • Mannion K
        • Niermann K
        • et al.
        Internal lymphedema correlates with subjective and objective measures of dysphagia in head and neck cancer patients.
        J Palliat Med. 2016; 19: 949-956
        • Junor E
        • Kerr G
        • Oniscu A
        • Campbell S
        • Kouzeli I
        • Gourley C
        • et al.
        Benefit of chemotherapy as part of treatment for HPV DNA-positive but p16-negative squamous cell carcinoma of the oropharynx.
        British Journal of Cancer. 2012; 106: 358-365
        • Kaukiainen A
        • Kõlves K.
        Too tough to ask for help? Stoicism and attitudes to mental health professionals in rural Australia.
        Rural and Remote Health. 2020; 20: 5399
        • Kennedy RE.
        • Hildebrand CJ.
        Coordinating pain control in newly diagnosed head/neck cancer: From a case report to a multi-disciplinary approach.
        Journal of Cancer Research and Practice. 2018; 5: 77-80
        • Mirabile A
        • Airoldi M
        • Ripamonti C
        • Bolner A
        • Murphy B
        • Russi E
        Pain management in head and neck cancer patients undergoing chemo-radiotherapy: Clinical practical recommendations.
        Critical Reviews in Oncology/Hematology. 2016; 99: 100-106
        • Pateman KA
        • Cockburn NL
        • Batstone MD
        • Ford PJ.
        Quality of life of head and neck cancer patients in urban and regional areas: An Australian perspective.
        The Australian Journal of Rural Health. 2018; 26: 157-164
        • Seangrung R
        • Ahuja M
        • Pasutharnchat K
        • Mahawan R.
        Factors influencing non-adherence to opioids in cancer patients: A mixed-methods cross-sectional study.
        F1000Research. 2020; 9: 1471
        • Semple C
        • Parahoo K
        • Norman A
        • McCaughan E
        • Humphris G
        • Mills M.
        Psychosocial interventions for patients with head and neck cancer. The Cochrane Database of Systematic Reviews.
        Qualitiatve Report. 2013; 7Cd009441
        • Smith JD
        • Shuman AG
        • Riba MB.
        Psychosocial issues in patients with head and neck cancer: an updated review with a focus on clinical interventions.
        Current Psychiatry Reports. 2017; 19: 1-11
        • Vanneste L
        • Lefebvre T
        • Tack L
        • Van Eygen K
        • Cool L
        • Schofield PA
        • et al.
        Pain medication adherence in patients with cancer: a pragmatic review.
        Pain Medicine. 2020; : pnab010
        • Wiffen PJ
        • Wee B
        • Derry S
        • Bell RF
        • Moore RA.
        Opioids for cancer pain - an overview of Cochrane reviews.
        Cochrane Database of Systematic Reviews. 2017; : 7
        • Yang K
        • Ward MC
        • Reddy CA
        • Burkey BB
        • Adelstein DJ
        • Koyfman SA
        Nationwide treatment patterns of oropharyngeal cancer in the human papillomavirus era.
        Journal of Clinical Oncology. 2019; 37: 17521