Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

UT MD Anderson study finds cancer related pain often undertreated

17.04.2012
Minorities twice as likely not to receive appropriate analgesics

More than one third of patients with invasive cancer are undertreated for their pain, with minorities twice as likely to not receive analgesics, according to research from The University of Texas MD Anderson Cancer Center.

The study, published in Journal of Clinical Oncology, is the largest prospective evaluation of cancer pain and related symptoms ever conducted in an outpatient setting.

Almost 20 years ago, Charles Cleeland, Ph.D., professor and chair of the Department of Symptom Research at MD Anderson, published the first comprehensive study to look at the adequacy of pain management in cancer care.

"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," said Cleeland, the JCO's study's senior author. "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 MD Anderson-led study was conducted by the Eastern Cooperative Oncology Group; it enrolled patients with invasive breast, prostate, colon and lung cancers from 38 institutions across the country, at any point during their care. All were treated on an outpatient basis at either an academic medical center or community clinic. The outpatient setting represents a unique setting, explain the researchers. While those hospitalized with significant pain may be evaluated by pain specialists, those treated on an outpatient basis are typically managed by their treating oncologists.

Patients completed a questionnaire providing their demographic and clinical information. Using a symptom assessment tool developed by Cleeland, the patients' pain levels were assessed, as well the level of analgesic that had been prescribed, if any. Assessment was repeated approximately one month later. The study's primary objective was to assess the prevalence of pain medication in oncology outpatient practice.

The researchers indentified 3,023 patients at risk for pain, with 2,026 (67 percent), taking analgesics, or pain medications. Approximately one fourth of those analyzed were minority patients, including Hispanic (9 percent), black (12 percent), Asian (1 percent) and other (1 percent). Of the 2,026 patients at risk for pain, 1,356, or 67 percent, had adequate pain management. For example, 20 percent of the patients who reported feeling severe pain were not receiving any analgesics, and of the 406 patients that were undertreated at an initial assessment, 31 percent received appropriate treatment by the follow-up visit. The researchers found that the odds of a non-Hispanic white patient having inadequate treatment for their pain at both initial and follow-up assessments was approximately half that of a minority patient.

While no discrepancy for age or gender was noted, interestingly, cancer survivors with pain also were less likely to be treated adequately.

"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," said Michael Fisch, M.D., associate professor and chair of the Department of General Oncology at MD Anderson, and the study's lead author. "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."

The researchers cite a number of possible reasons for the discrepancy in findings, including: cultural and communication barriers; access to care; concerns about addiction and reluctance to admit pain; expert symptom management and access to effective patient education.

Implicit stereotyping and bias among healthcare providers, even in the absence of the providers' awareness or intention, may also be a factor, says Fisch. However, Cleeland notes that at underserved clinics, both whites and minorities were inadequately treated for their pain, thereby suggesting an overall lack of resources.

The study is not without its limitations, including the few number of disease types included, as well as that the researchers did not collect data on patients' comorbidities or socio-economic status.

Both Fisch and Cleeland agree that better symptom control must begin with open-minded physicians, appropriately gauging the needs of their patients, as well as more engaged patients and caregivers willing to communicate their pain level and other symptoms. The researchers plan to follow up these findings by looking at additional symptoms of patients as well as their emotional distress and fatigue.

In addition to Fisch and Cleeland, MD Anderson's Tito R. Mendeoza Ph.D., Department of Syptom Research, is also an author on the paper. Other authors include: Ju- Whei Lee and Judi B. Manola, Dana Farber Cancer Institute; Matthias Weiss, M.D., Ph.D., Marshfield Clinic; Lynne I. Wagner, Ph.D. and David Cella, Ph.D., both of Northwestern University Feinberg School of Medicine; Victor T. Chang, M.D., New Jersey Healthcare System; and Lori M. Minasian, M.D., and Worta McCaskill-Stevens, M.D., both of the National Cancer Institute (NCI).

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.

About MD Anderson

The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. MD Anderson is one of only 41 comprehensive cancer centers designated by the National Cancer Institute. For eight of the past 10 years, including 2011, MD Anderson has ranked No. 1 in cancer care in "Best Hospitals," a survey published annually in U.S. News & World Report.

Laura Sussman | EurekAlert!
Further information:
http://www.mdanderson.org

More articles from Studies and Analyses:

nachricht Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland

nachricht Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Northern oceans pumped CO2 into the atmosphere

27.03.2017 | Earth Sciences

Fingerprint' technique spots frog populations at risk from pollution

27.03.2017 | Life Sciences

Big data approach to predict protein structure

27.03.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>