Meta-analysis of Cultural Differences in Western and Asian Patient-perceived Barriers to Managing Cancer Pain

Purpose: barriers to managing cancer pain contribute to cancer patients' reluctance to report pain and use prescribed analgesics, resulting in inadequate pain control. Patients' perceived barriers to managing cancer pain may be influenced by culture. This meta-analysis compared differences in Western and Asian patient-perceived barriers to managing cancer pain.

Methods: the literature was systematically reviewed to compare pain barriers in Western and Asian cancer patients in 22 studies that used Ward's Barrier Questionnaire. Differences in weighted barrier scores were compared by meta-regression analysis.

Results: Asian cancer patients had higher barrier scores than Western patients, except for barriers of 'good patient', 'side effects', 'distract physician', 'fear of injections', and 'addiction'. Meta-regression analysis indicated that Asian patients' perceived pain barriers differed significantly from those of Western patients for disease progression (weighted mean difference [WMD] = 1.32; 95% confidence interval [CI] 0.80, 1.84, p < 0.0001), tolerance (WMD = 1.63; 95% CI 0.91, 2.36, p < 0.0001), fatalism (WMD = 0.89; 95% CI 0.28, 1.52, p = 0.004), and total score (WMD = 0.82; 95% CI 0.36, 1.28, p < 0.0001).

Conclusion: Asian patients' perceived barriers to managing cancer pain were significantly higher than those for Western patients (especially for concerns about disease progression, tolerance, and fatalism). Asian cancer patients need to be assessed and carefully treated for perceived barriers to optimize cancer pain management.