Many Cancer Patients Undertreated for Pain

Many Cancer Patients Undertreated for Pain

Over a third of patients with invasive cancer are undertreated for their pain, and minorities are twice as likely not to receive pain medication, according to researchers at the University of Texas MD Anderson Cancer Center.

Their study, published in the Journal of Clinical Oncology, is the largest evaluation of cancer pain ever conducted in an outpatient setting.

“Pain is one of the most feared symptoms of cancer. The fear is perhaps warranted as pain is commonly under-recognized, under-assessed and under-treated. This has been well documented by multiple investigations over the last 20 years,” said Jamie H. Von Roenn, MD, Professor of Medicine at NorthwesternUniversity’s Feinberg School of Medicine. “But sadly, pain management for patients with cancer has not improved since the mid 1990’s.”

The MD Anderson study included over 2,000 patients with invasive breast, prostate, colon and lung cancers who were being treated for pain at 38 medical centers or clinics across the country. The patients completed a questionnaire about their demographics, health and treatment. Their pain levels were also assessed.

Two-thirds of the patients were taking analgesics, or pain medications, to adequately control their pain. The remaining 33% were not receiving enough pain medication and 20% of those in severe pain were not receiving any analgesics. Blacks, Asians and Hispanics were nearly 50% more likely than whites to receive inadequate treatment for their pain.

“These findings represent a significant discrepancy in treatment adequacy, with minority patients being twice as likely to be undertreated,” said Michael Fisch, M.D., associate professor and chair of the Department of General Oncology at MD Anderson, and the study’s lead author. “This critical observation awakens us to a major opportunity in healthcare - to work hard to resolve this striking disparity.”

The researchers cited a number of possible reasons for the discrepancy in treatment of minorities, including cultural and communication barriers, access to care, concerns about addiction, reluctance to admit pain and patient education. Stereotyping and bias among health care providers may also be a factor, although researchers noted that at underserved clinics, both whites and minorities were inadequately treated for their pain.

“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 Charles Cleeland, PhD, professor and chair of the Department of Symptom Research at MD Anderson and the study’s senior author. Cleeland published the first comprehensive study of pain management in cancer care nearly 20 years ago.

“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,” Cleeland said.
The study was conducted by the Eastern Cooperative Oncology Group. It was funded, in part, by grants from the NCI, National Institutes of Health and the Department of Health and Human Services. Further information can be found at the study’s web site.

Authored by: Pat Anson, Editor