THURSDAY, Nov. 17 (HealthDay News) -- Oncologists think they are
good at managing cancer patients' pain, but a new survey shows
In response to two hypothetical vignettes describing a cancer
patient who was suffering from pain, the majority of oncologists
offered up a treatment plan that pain specialists would consider
"There are serious deficiencies in oncologists' knowledge of cancer pain management," said study author Brenda Breuer, director of epidemiologic research in the department of pain medicine and palliative care at Beth Israel Medical Center in New York City.
The study appears in the Nov. 14 issue of the
Journal of Clinical Oncology.
Depending on the type of cancer and how advanced it is, anywhere
from 14 percent to 100 percent of cancer patients experience pain,
according to background information in the study.
In recent years, there's been a growing understanding among
cancer experts about the importance of both properly assessing and
treating pain, and better techniques for doing so, said Dr. Len
Lichtenfeld, deputy chief medical officer for the American Cancer
Despite talk about a greater understanding of the importance of
treating pain, oncologists' attitudes toward pain management have
"demonstrated disturbingly little progress" since 1990, when a
similar survey was conducted, according to an accompanying journal
"The entire issue of pain management for patients with cancer has been a priority concern for many experts and organizations, particularly over the past several years," Lichtenfeld said. "We have begun to recognize that we are not managing pain adequately and this report and editorial go directly to the heart of the matter. Doctors think they are managing pain properly, but the results of the report suggest otherwise."
Under-treating pain can occur for multiple reasons, experts
said. Some patients are reluctant to complain too much, Breuer
said. "They don't want to be 'bad' patients, or they just think
pain goes with the territory and don't realize there may be help
for them," she said.
Others put their trust in their oncologist and don't realize he
or she may not know all there is to know about treating pain,
In some cases, oncologists may be focused on treating the
disease and not ask enough questions about a patient's pain,
In the study, researchers surveyed more than 600 U.S.
oncologists about their knowledge, attitudes and practices related
to pain management. Oncologists tended to rate themselves as less
conservative than their peers in administering pain
According to the oncologists, barriers to proper pain management
include patient reluctance to report pain; patient reluctance to
take opioids because of addiction fears or fears of adverse
reactions; excessive regulation of opioids; inadequate assessment
of patients' pain by doctors and nurses and patient inability to
pay for services or pain medications.
In one hypothetical scenario, oncologists were asked whether it
was a good idea to increase the dosage of morphine for a man with
lung cancer who was experiencing pain despite already being on a
relatively high dose of morphine.
The correct answer is "no," because the increase in dosage
suggested was unnecessarily high. Even so, 31 percent of
oncologists thought it would be a good idea. While the rest knew it
wasn't a good idea, only 13 percent chose both the right answer and
the right reason for avoiding such a large increase, which was the
risk of side effects such as excessive sleepiness and "mental
Wrong reasons cited for not giving the higher dose included
causing a dangerous decrease in respiration; because the higher
dose could lead to increasing tolerance and the medication to
become less effective over time; and because of a "regulatory
climate that puts doctors under scrutiny if relatively high doses
The study also found that few oncologists (16 percent) said they
frequently made referrals to pain or palliative medicine care
specialists, who specialize in treating people at the end of life,
"Patients need to know that there is such a thing as pain medicine and palliative care specialists. These are recognized specialities that you get board certification in. Patients can ask for consults. That is the best advice I can give them," she said.
American Cancer Society has more on pain control
for cancer patients.
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