Optimization of Pain Management Protocols in Cancer Patients at Oncology Units of Teaching Hospitals in South West Nigeria

Cancer pain is a prevalent and undertreated clinical problem in Nigerian oncology settings, where opioid availability, prescriber training, and patient education remain significant challenges. Pharmacist involvement in cancer pain management can meaningfully improve protocol adherence and patient quality of life. This study evaluated pain management protocols and the role of pharmacists in their optimization at oncology units of teaching hospitals in South West Nigeria, involving sites in Lagos, Oyo, and Osun States. A mixed-methods study design was employed, including review of 180 oncology patient records, structured interviews with 25 oncologists and 18 pharmacists, and direct assessment of pain management protocol documentation. Results showed that the WHO analgesic ladder was formally referenced in only two of six facilities. Strong opioid analgesics were prescribed in fewer than 30 percent of patients with documented severe pain scores, reflecting suboptimal pain assessment and opioid prescribing practices. Pharmacist participation in oncology ward rounds was limited to two sites. Opioid availability was cited as a barrier in four hospitals, related to procurement restrictions and regulatory documentation burdens. Patient-reported pain scores were underdocumented. The study proposes a pharmacist-led cancer pain management optimization model, including pain assessment standardization, opioid procurement facilitation, and palliative care pharmacotherapy training. Advocacy for revised opioid procurement guidelines at the national level is also recommended. Keywords: cancer pain management, oncology pharmacy, teaching hospitals, South West Nigeria, opioid availability