Aged Cancer Patients Lack Painkillers

Despite the availability of painkillers, daily pain is prevalent among nursing home residents with cancer and is often untreated, particularly among older and minority patients, researchers say.

In a study of 13,625 cancer patients in nursing homes, up to 40 percent were in pain every day, and a quarter of them received no painkiller whatsoever.

This "is no longer acceptable and should be considered a first-line indicator of poor quality of medical care," the researchers wrote in Wednesday's Journal of the American Medical Association.

Older patients and minorities were even less likely to receive painkillers, in part because they are less likely to reveal their suffering, the researchers found.

"As age increased, a greater proportion of patients in pain received no analgesic drugs," the researchers wrote.

The study said blacks were 63 percent more likely than whites to be untreated for pain. Among patients 65 to 74 years old, more than 20 percent received no painkiller. The number rose to 30 percent for patients 85 and older.

The researchers pointed to other studies that found that fear of side effects and addiction as well as less knowledge about medicines could account for reduced use of painkillers among these patients.

The ability to pay for the medication was not an issue because all the patients were covered by Medicare.

The researchers, led by Dr. Roberto Bernabei, a visiting professor at Brown University, said there is a range of explanations for poor pain control, including doctors poorly trained in pain management and an unwillingness of many nursing homes to stock opiates.

In an accompanying editorial, a cancer pain specialist said doctors get almost no training in pain management. However, even with improved training, total success will be difficult, wrote Charles S. Cleeland of the Pain Research Group at the M.D. Anderson Cancer Center in Houston.

"The best pain management requires an informed patient who is willing to report pain and to voice complaints if pain is not controlled," he said.

Until recently, Cleeland said, people have expected cancer to be painful and have not insisted on drugs to control the suffering. But, he said, this is changing and "patients, their families and the public are becoming less tolerant of poor pain management.

"That intolerance may prove to be the ultimate driving force behind improving care of patients with pain," he said.

The study was done among patients 65 and older at nursing homes in Kansas, Maine, Mississippi, New York and South Dakota between 1992 and 1995.