A high number of patients with cancer have been found not to be assessed routinely for pain. They then receive inadequate analgesia
This outcome of a single-center retrospective analysis was reported last week at the virtual 11th Research Congress of the European Association of Palliative Care (EAPC).
André Valois, MD, and José Ferraz Gonçalves, MD, PhD, MSc, of the Instituto Português de Oncologia do Porto Francisco Gentil, Porto, set out to determine the frequency and quality of pain assessment in oncology consultations of a Portuguese hospital. Subsequent analgesic prescriptions were also analyzed.
Dr. Valois explained to Elsevier’s PracticeUpdate, ‘We wanted to investigate reasons for the high proportion of cancer patients with uncontrolled pain in recent studies.”
He continued: “We are faced with an apparent paradox: existing guidelines for treatment of cancer pain are proven effective for controlling pain in up to 90% of patients. In reality, however, around 40% still report high levels of pain. When we consider those with advanced, metastatic, and terminal disease, this number rises even higher, to around 50%.”
“When we searched the literature for possible causes, studies from different countries suggested that, in many instances, pain is not evaluated correctly. Insufficient treatment ensues. So we wanted to determine whether this occurs in our context as well.
“Identifying specific causes of under-treatment affords us the opportunity to propose evidence-based interventions that would help patients to receive better treatment. For instance, if we established a program that promoted active screening for pain during all medical encounters, pain would no longer go unrecognized during the patient’s initial consultations.”
The medical records of 350 randomly selected adult outpatients of an oncology hospital, with a confirmed diagnosis of cancer, were analyzed retrospectively.
The first and second scheduled consultations of each patient were reviewed for any qualitative description of pain and for measurements using validated scales.
Additionally, data regarding pain relief prescriptions were extracted.
A record of pain documentation during the first medical visit was noted in 46.9% of patients; during the second visit, 51.1%. In 21.7%, pain was documented during both visits.
Only 2.8% of assessments employed a validated tool such as the numeric rating scale.
Of patients who reported pain during admission, 49% had not initiated analgesic medication and only 33% had received around-the-clock prescriptions.
Dr. Ferraz Gonçalves explained that the literature states that 38% of cancer patients suffer from moderate to severe pain, and that 31.8% receive insufficient pain treatment.
Inadequate therapy for pain burdens their quality of life. Poor symptom assessment is a main cause of unrelieved pain. Many physicians do not ask about pain routinely and validated scales are used rarely in consultations.
The quality of cancer pain measurement by Portuguese physicians, and how such measurement affects their prescriptions, have not been evaluated recently.
Dr. Ferraz Gonçalves concluded that an alarming number of patients were shown not to have had their pain documented routinely. Many had received inadequate analgesia. Patients with cancer should be assessed for symptoms using validated measurement tools at each medical encounter.
Additional actions are needed to improve undertreatment, such as better training on pain management and early integration of palliative care.
Dr. Valois said: “Our results suggest that a program of active screening for pain during all medical encounters could be beneficial in our setting.
“Even when pain was correctly identified, however, patients did not always receive adequate treatment. This shortcoming showed that pain screening and documentation alone would not solve the problem. Better training in pain management for physicians treating cancer patients would also be necessary.”