Cancer pain relief lacking, especially for minorities
NEW YORK (Reuters Health) - Many people being treated for cancer may still be getting inadequate pain relief, particularly black and Hispanic patients, a new study suggests.
Almost 20 years ago, a landmark U.S. study found that pain management in cancer was far from ideal -- with 42 percent of patients getting inadequate pain medication.
Since then, much more attention has been paid to the problem. But it's stubbornly persisting, according to the new research, published in the Journal of Clinical Oncology.
Researchers found that of more than 2,000 cancer patients who were in pain and needed medication for it, one-third were not getting adequate treatment.
Of 584 patients with moderate or severe pain, for example, 41 percent were not on an opioid painkiller -- strong medication that would be appropriate for that level of pain. And 20 percent of patients in severe pain were not getting any pain medication at all.
What's more, those numbers were about the same a month later -- suggesting that the problem is not a temporary one for most patients.
Opioids, which are also called narcotic painkillers, include drugs like morphine, oxycodone and fentanyl.
It's not clear from this study why so many patients were not on narcotic painkillers -- or, in some cases, were on no pain medication, according to Dr. Michael J. Fisch, of the University of Texas MD Anderson Cancer Center in Houston, who led the study.
"I think, though, that it's related to communication," Fisch said in an interview.
In this study, half of black and Hispanic patients had inadequate pain treatment, compared with about 30 percent of white patients.
In general, some cancer patients and doctors may worry about the side effects of narcotics, or the risk of overdose or addiction, according to Fisch.
Other patients, he said, may have the attitude that pain is part of cancer, and it's something they can live with.
Some of those attitudes, Fisch said, may be more common among minorities, or doctors may not communicate as well with black or Hispanic patients.
As an example, he said education materials about narcotic painkillers may not be available in Spanish.
And historically, minority patients have had less trust in the medical establishment compared with white patients -- which could also be a factor, Fisch said.
"If I were asking you to take 10 or more medications, you can imagine that you'd have to trust me," he said.
Whatever the reasons for the findings, they show that inadequate pain relief remains a major problem in cancer treatment, even after years of attention to the issue.
"I was surprised by the findings," Fisch said. "And I wouldn't have predicted this kind of (racial) disparity."
An editorial published with the study echoed that sentiment. The findings should "surprise and disappoint" cancer specialists, write Drs. Martin Stockler and Nicholas Wilcken of the University of Sydney in Australia.
They also agree that better communication is needed.
"Improving our management of cancer-related pain," they write, "might be as simple as ensuring that every consultation includes the patient's rating of pain, that the oncologist pays attention to the answer, and that there is an agreed-upon plan to increase analgesia when it is inadequate."
There are times when it may be right to pass on a narcotic, Fisch said.
"If, for example, I'm a bus driver and I'm not allowed to take a narcotic, but I need to work," he said, a non-narcotic medication may be best.
The possible side effects of narcotics include drowsiness, mental confusion, nausea and constipation.
The bottom line, according to Fisch, is that cancer patients' pain should be fully assessed -- and then reassessed over time -- and doctors and patients should discuss the different treatment options.
There are some non-drug choices that might help with pain relief, like behavioral therapies or exercise. "But the truth is, drug therapy is the linchpin," Fisch said.
The patients in this study were all treated at one of 38 centers that are part of the Eastern Cooperative Oncology Group -- a network of university and community cancer centers that conducts clinical trials.
So if anything, their care, including pain management, is likely to be better than the norm, Fisch noted, and the true level of inadequate pain treatment may be higher.
SOURCE: http://bit.ly/HDacUJ and http://bit.ly/I1ES2p Journal of Clinical Oncology, online April 16, 2012.
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