PHYSICIAN ATTITUDES AND PRACTICE IN CANCER PAIN MANAGEMENT - A SURVEYFROM THE EASTERN-COOPERATIVE-ONCOLOGY-GROUP

Objective: The Eastern Cooperative Oncology Group (ECOG) conducted a g roupwide survey to determine the amount of knowledge about cancer pain and its treatment among physicians practicing in ECOG-affiliated inst itutions and to determine the methods of pain control being used by th ese physicians. Design: Survey. Setting. A questionnaire was sent to a ll ECOG physicians with patient care responsibilities (medical oncolog ists, hematologists, surgeons, and radiation therapists), practicing i n university institutions, Community Clinical Oncology Program (CCOP) institutions, and Cooperative Group Outreach Programs (CGOP) instituti ons. Measurements: A physician cancer pain questionnaire developed by the Pain Research Group at the University of Wisconsin was used. The q uestionnaire was designed to assess physicians' estimates of the magni tude of pain as a specific problem for cancer patients, their percepti ons of the adequacy of cancer pain management, and their report of how they manage pain in their own practice setting. Results: The study an alyzed responses to 897 of 1800 surveys. In regard to the use of analg esics for cancer pain in the United States, 86% felt that the majority of patients with pain were undermedicated. Only 51% believed pain con trol in their own practice setting was good or very good; 31% would wa it until the patient's prognosis was 6 months or less before they woul d start maximal analgesia. Adjuvants and prophylactic side-effect mana gement should have been used more frequently in the treatment plan. Co ncerns about side-effect management and tolerance were reported as lim iting analgesic prescribing. Poor pain assessment was rated by 76% of physicians as the single most important barrier to adequate pain manag ement. Other barriers included patient reluctance to report pain and p atient reluctance to take analgesics (both by 62%) as well as physicia n reluctance to prescribe opioids (61%). Conclusions. Professional edu cation needs to focus on the proper assessment of pain, focus on the m anagement of side effects, and focus on the use of adjuvant medication s. A better understanding of the pharmacology of opioid analgesics is also needed. Physicians also need to educate patients to report pain a nd to effectively use the medications that are prescribed for pain man agement.