Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group.
ABSTRACT The Eastern Cooperative Oncology Group (ECOG) conducted a groupwide survey to determine the amount of knowledge about cancer pain and its treatment among physicians practicing in ECOG-affiliated institutions and to determine the methods of pain control being used by these physicians.
A questionnaire was sent to all ECOG physicians with patient care responsibilities (medical oncologists, hematologists, surgeons, and radiation therapists), practicing in university institutions, Community Clinical Oncology Program (CCOP) institutions, and Cooperative Group Outreach Programs (CGOP) institutions.
A physician cancer pain questionnaire developed by the Pain Research Group at the University of Wisconsin was used. The questionnaire was designed to assess physicians' estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of cancer pain management, and their report of how they manage pain in their own practice setting.
The study analyzed responses to 897 of 1800 surveys. In regard to the use of analgesics for cancer pain in the United States, 86% felt that the majority of patients with pain were undermedicated. Only 51% believed pain control in their own practice setting was good or very good; 31% would wait until the patient's prognosis was 6 months or less before they would start maximal analgesia. Adjuvants and prophylactic side-effect management should have been used more frequently in the treatment plan. Concerns about side-effect management and tolerance were reported as limiting analgesic prescribing. Poor pain assessment was rated by 76% of physicians as the single most important barrier to adequate pain management. Other barriers included patient reluctance to report pain and patient reluctance to take analgesics (both by 62%) as well as physician reluctance to prescribe opioids (61%).
Professional education needs to focus on the proper assessment of pain, focus on the management of side effects, and focus on the use of adjuvant medications. A better understanding of the pharmacology of opioid analgesics is also needed. Physicians also need to educate patients to report pain and to effectively use the medications that are prescribed for pain management.
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ABSTRACT: Patients with cancer are burdened with pain, ranging in prevalence from 14 to 100% in this population, and with comorbid behavioural symptoms such as depression and cognitive decline. However, the complex relationships between cancer pain, depression and cognitive decline, as well as their causes, still need to be clarified. Here, the existing literature on pain and its relationships with depression and cognitive decline in adult patients with cancer is reviewed, in order to understand the impact of pain on these interrelated symptoms, and the importance of its correct assessment and management. From the literature, it emerges that pain in cancer patients has a multidimensional phenomenology, which is the final product of a complex process involving emotional, cognitive, and sensory components. There is a substantial agreement that cancer patients with pain are at higher risk of having depression and cognitive decline. However, it is still controversial if these symptoms may fit into the same cluster, due to the paucity of studies exploring the simultaneous impact of pain on the psychological and cognitive well-being of patients with cancer, which would be consequential on their treatment and management. Finally, recent advances in immunology/oncology have provided novel insights into the pathophysiologic mechanisms supposedly underlying pain-related symptoms. Particularly, immune dysfunction may represent a common pathogenic ground of pain, depression and cognitive decline in cancer patients. In clinical practice, an appropriate assessment of pain should take into account the relationships with depression and cognitive decline, in order to develop more personalised and effective therapies for its management.Surgical Oncology 12/2009; 19(3):160-6. DOI:10.1016/j.suronc.2009.11.006 · 2.37 Impact Factor
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ABSTRACT: Cancer pain management is still reported to be inadequate despite of recent developments in medicine, resulting in serious outcomes. This study is to evaluate opinions, knowledge and attitudes of doctors working and/or being trainedg in surgical and medical departments in our university hospital, towards cancer pain management via a questionnaire. Of all doctors approached, eighty percent could be reached and 83% of them completed the questionnaire. In this group of doctors, reportedly 60% evaluating cancer patients with pain at least once in a week, most had not have any formal education about cancer pain management during their medical school or residency training and the ones reporting "any" education, described this as "limited in quality and as hours of lessons" and were not satisfied. The results of this survey suggest specific targets for the strategic and educational projects to overcome some of the barriers against the optimal cancer pain management. Most of the doctors believe that barriers originating from health professionals and systems are more important than the ones resulting from patients and give high priority to treatment of cancer pain relative to the treatment of cancer; but still half of them report that legal regulations have some influence on opioid prescription; and almost three quarters of them believe that opioid use may cause high rates of psychological addiction or abuse. Two thirds of the doctors feel themselves "insufficient" in cancer pain management, being more prominent in tasks requiring knowledge, skill, education and experience about opioid use.Agri: Agri (Algoloji) Dernegi'nin Yayin organidir = The journal of the Turkish Society of Algology 05/2008; 20(2):20-30.
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ABSTRACT: Standard guidelines for cancer pain treatment routinely recommend training patients to reduce barriers to pain relief, use medications appropriately, and communicate their pain-related needs. Methods are needed to reduce professional time required while achieving sustained intervention effectiveness. In a multisite, randomized controlled trial, this study tested a pain training method versus a nutrition control. At six oncology clinics, physicians (N=22) and nurses (N=23) enrolled patients (N=93) who were over 18 years of age, with cancer diagnoses, pain, and a life expectancy of at least 6 months. Pain training and control interventions were matched for materials and method. Patients watched a video followed by about 20 min of manual-standardized training with an oncology nurse focused on reviewing the printed material and adapted to individual concerns of patients. A follow-up phone call after 72 h addressed individualized treatment content and pain communication. Assessments at baseline, one, three, and 6 months included barriers, the Brief Pain Inventory, opioid use, and physician and nurse ratings of their patients' pain. Trained versus control patients reported reduced barriers to pain relief (P<.001), lower usual pain (P=.03), and greater opioid use (P<.001). No pain training patients reported severe pain (>6 on a 0-10 scale) at 1-month outcomes (P=.03). Physician and nurse ratings were closer to patients' ratings of pain for trained versus nutrition groups (P=.04 and <.001, respectively). Training efficacy was not modified by patient characteristics. Using video and print materials, with brief individualized training, effectively improved pain management over time for cancer patients of varying diagnostic and demographic groups.Pain 03/2008; 135(1-2):175-86. DOI:10.1016/j.pain.2007.10.026 · 5.84 Impact Factor