Not Much Gain on Pain Front

Cancer pain still not well managed by oncologists

(RxWiki News) The pain of cancer can leave a person screaming. And while oncologists understand this torment, they're not doing a very good job in offering patients the relief they need and deserve.

In a recent survey, medical oncologists admit having received little training in managing cancer pain. They also see a number of barriers to adequately providing the pain relief their patients so desperately need and want.

"If you're in  pain, tell your doctor."

The survey was conducted by Dr. Brenda Breuer and her colleagues at Beth Israel Medical Center in New York, and the report was published in the November 15, 2011 Journal of Clinical Oncology.  An accompanying editorial said the study “demonstrated disturbingly little progress” among medical oncologists in their attitudes and practices relating management of pain over the past 20 years.

Researchers randomly mailed anonymous surveys to 2000 medical oncologists around the country, and received 610 responses. The survey was similar to one conducted in 1990 by Eastern Cooperative Oncology Group (ECOG). Here's what was learned.

  • Respondents graded their specialty with good marks (7 out of 10) for cancer pain management.
  • Many suggested their peers were more conservative than they are about prescribing opioid drugs.
  • Authors report responses to two challenging clinical scenarios suggest that the majority of oncologists are lacking knowledge and understanding of opioids.
  • Training in pain management during medical school and residency is inadequate and has changed very little in 20 years.

Dr. Breuer and co-authors wrote, “oncologists continue to perceive that the most significant barriers to adequate pain management are poor pain assessment, patient reluctance to report pain, and patient reluctance to take analgesics."

In an accompany editorial, Dr. Jamie H. Von Roenn of Northwestern University, who was the lead author of the ECOG survey, and Dr. Charles von Gunten of the Institute of Palliative Medicine at San Diego Hospice talked about  "a worldwide outcry for adequate cancer pain management," saying that to provide the care patients deserve, "we must not just integrate training in pain management into every fellowship program, we must expect oncologists to practice what they learn.”

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Review Date: 
December 2, 2011