Researchers from The University of Texas MD Anderson Cancer Center have found that over 33.3% of individuals suffering from invasive cancer do not receive sufficient pain medication, with minorities twice as likely not to receive analgesics.

Published in Journal of Clinical Oncology, the study is the largest prospective assessment ever conducted in an outpatient setting regarding cancer pain and related symptoms.

This first comprehensive study to examine the adequacy of pain management in cancer care was published nearly two decades ago by Charles Cleeland, Ph.D., professor and chair of the Department of Symptom Research at MD Anderson. Cleeland, the JCO’s study’s senior author, explained:

“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.

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.”

The study was conducted by the Eastern Cooperative Oncology Group. The researchers enrolled individuals with invasive breast, colon, lung, and prostate cancers at any point during their care, from 38 institutions across the nation to participate in the study.

All study participants received treatment on an outpatient basis, at either a community clinic, or an academic medical center. According to the researchers, the outpatient setting represents a unique experience. Patients with significant pain who receive treatment on an outpatient basis generally have their pain assessed by their treating oncologists, whereas patients who are hospitalized may be assessed by pain specialists.

Participants were required to provide their clinical and demographic information. Using a tool developed by Cleeland to evaluate symptoms, the researchers evaluated the participants pain levels and the level of analgesic they had been prescribed, if any. The evaluation was conducted again around one month later.

The primary objective of the study was to evaluate the prevalence of pain medication in oncology outpatient practice.

Of the 3,023 participants identified at to be at risk for pain, 67% (2,026) were taking pain medications or analgesics. Minority patients accounted for around one fourth of those analyzed:

  • 12% Black
  • 9% Hispanic
  • 1% Asian
  • 1% Other

The researchers found that 67% (1,356) of the 2,026 patients at risk for pain had adequate pain management. For instance, 31% of the 406 patients that were undertreated at an initial evaluation received adequate treatment by the follow-up visit, and 20% of those who reported significant pain were not receiving any analgesics.

Furthermore, the team discovered that a non-Hispanic white patient was nearly 50% less likely to have inadequate treatment for their pain at both initial and follow-up evaluations than a minority patient.

Although no discrepancy for age or gender was reported, the team found that cancer survivors with pain were also less likely to receive adequate treatment.

Michael Fisch, M.D., associate professor and chair of the Department of General Oncology at MD Anderson, and lead author of he study, explained:

“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.

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.”

According to the researchers, access to care; cultural and communication barriers; expert symptom management and access to effective patient education; concerns about addiction and reluctance to admit pain, could all be reasons for the discrepancy in the findings.

Fisch notes that another factor may be implicit stereotyping and bias among healthcare providers, even in the absence of the providers’ awareness or intention. According to Cleeland at underserved clinics there is an overall lack of resources as the study found that both whites and minorities were inadequately treated for their pain.

Limitations of the study included:

  • The few number of disease types included
  • No data collection on patients’ comorbidities or socio-economic status

The researchers state that in order to improve symptom control, physicians need to open-minded, appropriately gauging the needs of their patients, and patients and caregivers need to be more willing to to communicate their pain level and other symptoms.

In order to follow up on these study findings, the team plan to study additional symptoms of patients in addition to their emotional distress and fatigue.

The study was funded, in part, by grants from the NCI, National Institutes of Health and the Department of Health and Human Services. None of the authors reports potential conflicts of interest. Further information about the study can be found at the study’s web site, www.ecogsoapp.org.

Written By Grace Rattue