Researchers determined pain is undertreated in more than one-third of patients with invasive cancer, with minorities twice as likely to not receive analgesics, according to a study published in Journal of Clinical Oncology.
The research from The University of Texas MD Anderson Cancer Center is the largest evaluation of cancer pain and related symptoms ever performed in an outpatient setting.
The Eastern Cooperative Oncology Group conducted the MD Anderson–led study. Patients with invasive breast, colon, lung, and prostate cancers from 38 institutions across the United States were enrolled in various stages of treatment in an outpatient setting. According to the researchers, the outpatient setting is unique. This is because pain specialists may assess those hospitalized with substantial pain, while oncologists usually manage those treated on an outpatient basis. The main objective of the study was to evaluate the prevalence of pain medication in oncology outpatient practice.
During the study, patients completed a questionnaire providing their demographic and clinical information. Then, using a symptom assessment tool, the patients’ pain levels were evaluated, as well as the level of analgesic that had been prescribed, if any. Approximately 1 month later, assessment was repeated.
Approximately one-fourth of those analyzed were minority patients, including Hispanic (9%), black (12%), Asian (1%), and other (1%). The patients at risk for pain numbered 3023, with 2026 (67%) taking analgesics. Researchers discovered that 20% of the patients who reported feeling severe pain were not receiving any analgesics. Of the 406 patients who were undertreated at the first assessment, 31% received suitable treatment by the follow-up visit. The researchers also found that the odds of a non-Hispanic white patient receiving inadequate treatment for pain at both initial and follow-up evaluations was approximately half that of a minority patient.
“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, MD, 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.”
Many possible reasons exist for the inconsistency in findings. According to the researchers, these reasons include: cultural and communication barriers; access to care; concerns about addiction and reluctance to admit pain; expert symptom management and access to effective patient education.
To follow up, researchers plan to examine additional symptoms of patients, including emotional distress and fatigue.
Source: UT MD Anderson.