Study finds cancer related pain often undertreated
More than one third of patients with invasive cancer are undertreated for their pain, with minorities twice as likely to not receive analgesics, according to research from The University of Texas MD Anderson Cancer Center.
Almost 20 years ago, Charles Cleeland, Ph.D., professor and chair of the Department of Symptom Research at MD Anderson, published the first comprehensive study to look at the adequacy of pain management in cancer care.
"We've known for years that the undertreatment of pain is a significant public health problem in the cancer treatment process, and that minorities are at greatest risk for not receiving appropriate pain care," said Cleeland, the JCO's study's senior author. "This new research tells us that our progress has been limited, with only a 10 percent overall reduction in inadequacy of pain management from our findings almost two decades ago."
The MD Anderson-led study was conducted by the Eastern Cooperative Oncology Group; it enrolled patients with invasive breast, prostate, colon and lung cancers from 38 institutions across the country, at any point during their care. All were treated on an outpatient basis at either an academic medical center or community clinic. The outpatient setting represents a unique setting, explain the researchers. While those hospitalized with significant pain may be evaluated by pain specialists, those treated on an outpatient basis are typically managed by their treating oncologists.
Patients completed a questionnaire providing their demographic and clinical information. Using a symptom assessment tool developed by Cleeland, the patients' pain levels were assessed, as well the level of analgesic that had been prescribed, if any. Assessment was repeated approximately one month later. The study's primary objective was to assess the prevalence of pain medication in oncology outpatient practice.
The researchers indentified 3,023 patients at risk for pain, with 2,026 (67 percent), taking analgesics, or pain medications. Approximately one fourth of those analyzed were minority patients, including Hispanic (9 percent), black (12 percent), Asian (1 percent) and other (1 percent). Of the 2,026 patients at risk for pain, 1,356, or 67 percent, had adequate pain management. For example, 20 percent of the patients who reported feeling severe pain were not receiving any analgesics, and of the 406 patients that were undertreated at an initial assessment, 31 percent received appropriate treatment by the follow-up visit. The researchers found that the odds of a non-Hispanic white patient having inadequate treatment for their pain at both initial and follow-up assessments was approximately half that of a minority patient.
While no discrepancy for age or gender was noted, interestingly, cancer survivors with pain also were less likely to be treated adequately.
"Pain is one of the most feared symptoms of cancer and it has tremendous impact on the quality of life and function of our patients," said Michael Fisch, M.D., associate professor and chair of the Department of General Oncology at MD Anderson, and the study's lead author. "These findings represent a significant discrepancy in treatment adequacy, with minority patients being twice as likely to be undertreated. This critical observation awakens us to a major opportunity in healthcare - to work hard to resolve this striking disparity."
The researchers cite a number of possible reasons for the discrepancy in findings, including: cultural and communication barriers; access to care; concerns about addiction and reluctance to admit pain; expert symptom management and access to effective patient education.
Implicit stereotyping and bias among healthcare providers, even in the absence of the providers' awareness or intention, may also be a factor, says Fisch. However, Cleeland notes that at underserved clinics, both whites and minorities were inadequately treated for their pain, thereby suggesting an overall lack of resources.
The study is not without its limitations, including the few number of disease types included, as well as that the researchers did not collect data on patients' comorbidities or socio-economic status.
Both Fisch and Cleeland agree that better symptom control must begin with open-minded physicians, appropriately gauging the needs of their patients, as well as more engaged patients and caregivers willing to communicate their pain level and other symptoms. The researchers plan to follow up these findings by looking at additional symptoms of patients as well as their emotional distress and fatigue.
Provided by University of Texas M. D. Anderson Cancer Center
- Study: Patients often don't report pain Feb 13, 2006 | not rated yet | 0
- Black patients, women miss out on strongest medications for chronic pain Aug 17, 2010 | not rated yet | 0
- Researchers find anti-depressants reduce pain in opioid-dependent patients Nov 03, 2011 | not rated yet | 0
- Journal Sleep: Advanced cancer patients have less quality sleep Jun 01, 2007 | not rated yet | 0
- Cancer patients' pain can be helped by psychosocial interventions, say researchers Jan 30, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
How can there be a term called "intestinal metaplasia" of stomach
9 hours ago Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
Alcohol and acetaminophen
May 13, 2013 Edit: sorry for the typo in the title , can't edit I looked around on google quite a bit and it's very hard to find precise information on the...
- More from Physics Forums - Medical Sciences
More news stories
A study of veterans at high risk for developing lung cancer shows that low-dose computed tomography (LDCT) can be highly effective in helping clinicians spot tiny lung nodules which, in a small number of patients, may indicate ...
Cancer 41 minutes ago | not rated yet | 0
An attack on glioblastoma brain tumor cells that uses a modified poliovirus is showing encouraging results in an early study to establish the proper dose level, researchers at Duke Cancer Institute report.
Cancer 2 hours ago | not rated yet | 0
The surgical management of non-small cell lung cancer (NSCLC) in U.S. hospitals varies widely depending on the race of the patient, according to a new study.
Cancer 6 hours ago | not rated yet | 0
Treatment with an Alpha-1 proteinase inhibitor (A1-PI), a naturally occurring protein that protects lung tissue from breakdown and protects the lung's elasticity, is effective in slowing the progression of emphysema in patients ...
Cancer 6 hours ago | not rated yet | 0
Scientists from Nanyang Technological University (NTU) and Lund University, Sweden, have bioengineered a novel molecule which has been proven to successfully kill tumour cells.
Cancer 6 hours ago | 5 / 5 (1) | 0
A drug commonly used to treat depression and anxiety may improve a stress-related heart condition in people with stable coronary heart disease, according to researchers at Duke Medicine.
18 seconds ago | not rated yet | 0 |
(HealthDay)—The overall health of Americans isn't improving much, with about six in 10 people either overweight or obese and large numbers engaging in unhealthy behaviors like smoking, heavy drinking or ...
10 minutes ago | not rated yet | 0
(HealthDay)—In 2008 to 2010, the prevalence of key health behaviors among U.S. adults varied, with about one in five adults current smokers and 62.1 percent overweight or obese, according to a report presented ...
19 seconds ago | not rated yet | 0
Early use of tracheostomy for mechanically ventilated patients not associated with improved survival
For critically ill patients receiving mechanical ventilation, early tracheostomy (within the first 4 days after admission) was not associated with an improvement in the risk of death within 30 days compared to patients who ...
14 seconds ago | not rated yet | 0
(HealthDay)—The monstrous tornado that devastated Moore, Okla., on Monday, killing dozens of adults and children, is a stunning example of violent weather that can affect a child's mental well-being.
20 minutes ago | not rated yet | 0
The globe remains unprepared to deal with the risk of a massive virus outbreak, the deputy chief of the World Health Organization warned Tuesday, amid fears that H7N9 bird flu striking China could morph into a form that spreads ...
20 minutes ago | not rated yet | 0