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Management of Cancer Pain Has Improved but Remains Inadequate

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Key Points

  • The proportion of patients undertreated for cancer pain was reduced in studies reported in 2008 to 2013 compared with those reported in 2007 and before.
  • However, data from 2008 to 2013 indicate that 31.8% of patients remain undertreated.

In a study reported in the Journal of Clinical Oncology, Greco et al updated a 2008 systematic review on cancer pain management. Improvements were seen between 2008 and 2013, but approximately one-third of patients still do not receive pain medication adequate for reported pain intensity.

Changes in Undertreatment

In the study, data on pain management from 20 studies published between 2008 and 2013 were analyzed, along with data from 26 studies reported in 2007 or before that were included in a 2008 systematic review.

In the 2008 review, it was found that 43.4% of patients with cancer pain were undertreated according to the Pain Management Index (PMI). According to data published between 2008 and 2013, 31.8% were undertreated, representing a 25% reduction in undertreatment compared with the period of 2007 and earlier. The 31.8% figure for undertreatment was better than the undertreatment rates of 41.5% for 2001 to 2007 and 46.6% for 1996 to 2000 (P < .001 vs 2008–2013). Univariate analysis showed a decrease of approximately 1% per year of study (P = .09).

Associated Factors

On multivariate analysis adjusting for setting (specific = hospice and oncologic wards, nonspecific = general wards or general practice, or mixed) size of study, mean age of patients, study quality score, and economic level of the country of study, the decrease in undertreatment was still approximately 1 point per year (P = .14). Nonspecific vs specific setting (P = .048) and lower vs higher economic level (P = .006) were significantly associated with undertreatment based on PMI score.

The investigators concluded: “Analysis of 46 articles published from 1994 to 2013 using the PMI to assess the adequacy of analgesic therapy suggests the quality of pharmacologic pain management has improved. However, approximately one third of patients still do not receive pain medication proportional to their pain intensity.”

Maria Teresa Greco, MD, of University of Milan, is the corresponding author for the Journal of Clinical Oncology article.

Silvio Cavuto, MSc, reported a consultant or advisory role with Roche and Pfizer. Oscar Corli, MD, reported honoraria from Grünenthal Italia and Mundipharma.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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