Many Patients with Cancer Need Better Treatments for Pain
Inadequate pain treatment in patients with cancer remains a significant problem and appears to be more frequent among minorities, according to a new study. The findings were published online April 16, 2012, in the Journal of Clinical Oncology.
Dr. Michael Fisch of the University of Texas MD Anderson Cancer Center and his colleagues surveyed more than 3,000 patients with invasive forms of breast, prostate, lung, and colorectal cancer who were likely to have pain. The patients were treated at academic medical centers and community-based hospitals.
More than two-thirds of patients reported pain or requiring analgesics for pain control at their initial oncology appointment. Based on reported pain levels and the type and/or dose of prescribed pain medication, the researchers found that one-third of these patients received inadequate treatment for their pain.
Approximately 40 percent of patients who experienced moderate to severe pain did not receive the proper pain medication, and 20 percent of patients with severe pain received no pain medication. In surveys done after follow-up visits with their oncologists 4 to 5 weeks later, patients reported little improvement in pain management. One month is a fairly short follow-up period, the authors acknowledged, as effective pain management usually requires monitoring and adjustments.
Minority patients were nearly twice as likely as white patients to receive inadequate pain treatment, the researchers found. The disparity in adequate pain treatment among minority groups could be due to multiple factors, they wrote, including communication problems and patient trust issues, as well as “system issues,” such as drug availability.
In addition, patients with earlier stages of cancer reported inadequate pain management at different time points after diagnosis. This indicates not only that patients with early-stage cancers need better pain management, but that the medical profession should better characterize pain symptoms and identify pain sources, noted Dr. Worta McCaskill-Stevens of NCI’s Division of Cancer Prevention (DCP) and a co-author of the study.
“This study is a stepping stone to better evaluation of pain,” she said, noting that doctors adhere more closely to other treatment guidelines than to pain management guidelines.
“Only one in six responding medical oncologists [in the study] reported frequent referrals to specialists in either pain or palliative care,” wrote Drs. Martin Stockler and Nicholas Wilcken in an accompanying editorial. “Clearly more work is needed, perhaps in medical school, but certainly in residency and fellowship programs.”
This is an issue that goes beyond physicians, noted Dr. Ann O’Mara, head of palliative care research in DCP and a co-author of the study. Nurses and other health care staff should also receive more training in this area, she advised.