Survey of Oncologists Suggests Lack of Progress in Cancer Pain ManagementResults of a national survey show that U.S. medical oncologists receive inadequate training in cancer pain management and perceive numerous barriers to managing pain optimally in their patients. The results of the survey, conducted by Dr. Brenda Breuer and her colleagues at Beth Israel Medical Center in New York, were published online November 15 in the Journal of Clinical Oncology (JCO).
The survey, which was modeled in part after a 1990 survey conducted by the Eastern Cooperative Oncology Group (ECOG), “demonstrated disturbingly little progress” in attitudes and practices related to pain management among medical oncologists over the last 20 years, according to an accompanying editorial.
Yet during this time, guidelines for managing cancer pain have been developed and disseminated, continuing medical education on the subject has become common, and access to pain specialists has increased, the study authors noted.
Dr. Breuer and her colleagues mailed the anonymous survey to a randomly selected, geographically representative sample of 2,000 medical oncologists, and 610 usable surveys (32 percent) were returned.
In the survey, oncologists gave their medical specialty good marks (a median rating of 7 on a scale of 0 to 10) for relieving cancer pain but rated their peers as more conservative than themselves in prescribing opioid drugs to manage pain. And although most respondents agreed with the basic principles of pain management, their responses to two challenging clinical scenarios presented in the survey suggest that a majority of oncologists are deficient in knowledge about opioids, the study authors reported.
As in the 1990 survey, “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,” Dr. Breuer and her co-authors wrote. Furthermore, “poor ratings of pain management training [during medical school and residency] have barely changed” in the two decades since the 1990 ECOG survey.
“There is a worldwide outcry for adequate cancer pain management, yet the skills of many oncologists remain inadequate in this domain,” commented the authors of the editorial, Dr. Jamie H. Von Roenn of Northwestern University, who was also the lead author of the ECOG survey, and Dr. Charles von Gunten of the Institute of Palliative Medicine at San Diego Hospice. “If we are to provide patients the care they deserve, we must not just integrate training in pain management into every fellowship program, we must expect oncologists to practice what they learn.”
(For more information, listen to this JCO podcast, in which Dr. Eduardo Bruera, chair of the Department of Palliative Care and Rehabilitation Medicine at the University of Texas M. D. Anderson Cancer Center, discusses the survey’s findings and offers recommendations on addressing some of the problems identified by the survey.)
NCI Cancer Bulletin for November 29, 2011 - National Cancer Institute