Pain in Oncology Outpatients With Solid Tumors Remains Undertreated

Michael J. Fisch, MD

Pain is as prevalent in ambulatory oncology patients with common solid tumors as it was nearly two decades ago despite the dramatic increase in opioid prescriptions, new data suggest.

The results, which are from the largest prospective assessment of pain and other symptoms in ambulatory oncology in the United States, also bolster prior reports of a higher probability of inadequate pain management in minority patients than non- Hispanic whites.

Michael J. Fisch, MD, chairman of the Department of General Oncology at the University of Texas MD Anderson Cancer Center in Houston, and associates elsewhere determined the prevalence of pain and analgesic use in 3123 ambulatory patients with invasive cancer of the breast, prostate, colon/rectum, or lung. Patients were eligible for enrollment irrespective of their phase of care or disease stage.

Of 3023 who were identified as being at risk for pain during their initial assessment, 2026 (67%) reported having pain or receiving analgesic treatment. Of the 2026 patients, 670 (33%) had inadequate treatment for their pain.

The results were nearly the same at baseline assessment as they were at a follow-up assessment 4 or 5 weeks later (66% and 34%, respectively).

After controlling for other explanatory variables, the odds of a non-Hispanic whit e patient having inadequate pain treatment both at the initial assessment and follow-up were about half those of a minority patient (odds r atio, 0.51; 95% CI, 0.37- 0.70; P = .002).

Patients were also significantly more likely to have inadequate pain management if they had a good performance status, were treated at a minority treatment site, and had nonadvanced disease without concurrent treatment.

Fisch et al not ed that their findings parallel those reported in a landmark study by the Eastern Cooperative Oncology Group (ECOG) in 1994, which found that two-thirds of medical oncology outpatients with advanced cancer required or used analgesics and that analgesic prescribing was inadequate in about 40% of these patients. Notably, since the ECOG study, opioid prescribing in the United States has risen more than 10-fold.

The authors acknowledged that while their findings can be extrapolated to patients with common solid tumors who are cared for at facilities that are associated with a US clinical cooperative group, many ambulatory patients with cancer have less common solid tumors or hematologic malignancies and/or are cared for elsewhere besides the cooperative system.

In addition, they did not obtain information that might have affected pain management practice, such as patient comorbidities, insurance status, or socioeconomic status, or clinician characteristics like age, race, and sex.

Fisch MJ, Lee JW, Weiss M, et al. Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer. J Clin Oncol. 2012;30(16):1980-1988.