Survey of patients shows that cancer pain still undertreated
Authors: S. Mayor
Journal: BMJ (2000)

Pain in cancer continues to be inadequately managed, according to a report of a survey of UK patients with cancer published this week.

More than two thirds (70%) of the 157 patients with cancer taking part in the survey reported that they had experienced pain as a result of their cancer. An even higher proportion (77%) had experienced pain as a result of their treatment.

Many study participants had been inadequately prepared for this pain and many did not ask for help. Just under half (46%) of the participants had been told to expect pain, and more than a third of said they had not been given sufficient information on pain control. Less than half (43%) of the participants reported that they had not asked for pain relief.

The survey was carried by CancerBACUP, a national cancer information charity. Questionnaires were sent to patients requesting information from the charity's telephone helpline, and a second group of patients was approached by a specialist nurse visiting cancer clinics.

The overall response rate was only 28.1% (81% in the group approached directly by the nurse), but the charity considered that the results were useful, as they similar in the two groups.

Despite the growing recognition of the need for doctor-patient partnerships in healthcare decision making, 54% of the survey participants said that they had not been sufficiently involved in decision making about their treatment for pain.

The study also warned of the high level of side effects that patients with cancer experienced as a result of the drugs used to treat their pain. Nearly two thirds (64%) of participants reported that they had experienced adverse effects from their pain relief, with nausea, vomiting, constipation, and drowsiness being the commonest problems. Less than half (46%) of participants, however, had been warned of these potential side effects.

Dr John Ellershaw, consultant in palliative medicine at the Royal Liverpool University Hospitals, Liverpool, commented:  is worrying that so many cancer patients seem unaware that it is reasonable for them to ask for appropriate drugs to relieve their pain. It is even more worrying that so many patients actually need to do this. Previous research has shown that 80-90% of cancer pain—even in advanced disease—can be controlled with effective treatments.

He considered that many patients were unaware of the treatment options available so failed to ask for help with pain relief. We need education of patients—to expect and ask for more—and of health professionals, to be aware of available treatments and to use them appropriately, he suggested, arguing that undergraduate and postgraduate medical training should include more courses of pain management.

CancerBACUP fears that many patients accept pain as an inevitable part of cancer and do not seek sufficient help to relieve this pain. In response to the survey findings, CancerBACUP has developed a new information leaflet for anyone affected or concerned by pain from cancer or its treatment. This includes information on the range of treatments for pain relief in cancer, together with a guide for patients on how to ask for help.

More information is available from CancerBACUP http://www.cancerbacup.org.uk(www.cancerbacup.org.uk). For a copy of the leaflet, Freedom from Pain , phone CancerBACUP (020 7696 9003).