Analgesic Prescribing Remains Inadequate for Ambulatory Oncology Patients

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(ChemotherapyAdvisor) – Pain remains undertreated in the ambulatory oncology setting, with racial minorities twice as likely as non-Hispanic whites to receive inadequate pain management, according to the largest prospective evaluation of pain in this setting, published in the Journal of Clinical Oncology online April 16.

Results of this study show that “in the United States, pain is as prevalent in ambulatory oncology patients with common solid tumors as it was more than 20 years ago, despite the fact that opioid prescribing in the United States has increased more than 10-fold since 1990.” The authors noted: “The magnitude and scope of pain treatment inadequacy has not decreased substantially in the past two decades in the United States despite a long-standing awareness of this problem is surprising.”

The prospective observational study of pain and analgesic prescribing enrolled 3,123 ambulatory patients with invasive cancer of the breast, prostate, colon/rectum or lung regardless of phase of care or stage of disease. Patients completed a 25-item measure of pain, functional interference, and other symptoms at their initial assessment and four to five weeks later. Providers recorded analgesic prescribing and the pain management index was calculated to assess treatment adequacy.

“Of the 3,023 patients identified to be at risk for pain, 2,026 (67%) reported having pain or requiring analgesics at initial assessment; of these, 2,026 patients, 670 (33%) were receiving inadequate analgesic prescribing,” they noted. No difference was observed in treatment adequacy between the initial and follow-up visits. The odds of a non-Hispanic white patient having inadequate pain treatment were approximately half those of a minority patient after adjusting for other explanatory variables (OR, 0.51; P=0.002).

Having a good performance status, being treated at a minority treatment site, and having nonadvanced disease without concurrent treatment were found to be other significant predictors of inadequate pain treatment.

An accompanying editorial notes: “Improving our management of cancer-related pain 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.”



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