MANY ELDERLY CANCER PATIENTS LEFT IN PAIN

To the researchers who recently studied cancer pain in more than
13,000 nursing home patients, one finding stuck out like the
proverbial sore thumb.

Not that nearly one-third of the patients were in daily pain. Nor that
some received mild analgesics such as Aspirin, while others were given
stronger drugs like codeine or morphine.

What stunned the researchers was that one out of four of the patients
in day-in, day-out pain received no pain medication at all.

"We thought we'd find a more ambiguous issue of undertreatment of pain
- - but not no treatment," says Vincent Mor of the Centre for
Gerontology and Health Care Research at Brown University and co-author
of the pain study. "That's the most disturbing finding -the absence of
even very mild analgesics for 26 per cent of the patients in pain."

The study, reported in the Journal Of The American Medical
Association, collected data on 13,625 cancer patients age 65 and
older. All had been recently discharged from a hospital to a nursing
home in one of five states: Kansas, Maine, Mississippi, New York and
South Dakota.

Of the patients who reported being in daily pain, 16 per cent received
a mild pain reliever such as Aspirin, acetaminophen (Tylenol) or
ibuprofen (Advil); 32 per cent received codeine or a similar drug; 26
per cent received morphine; and 26 per cent received nothing at all.

"Daily pain is prevalent among nursing home residents with cancer and
is often untreated, particularly among older and minority patients,"
the study concludes.

Previous studies also found that pain is widely undertreated in both
hospitals and nursing homes. The largest study ever conducted of how
patients die in hospitals reported in 1995 that half the patients
experienced moderate or severe pain in the last days of their lives.

"Pain management has been a problem in health-care delivery for a long
time," says Paul Willging, executive vice-president of the American
Health Care Association, which represents more than 11,000 nursing
homes and assisted-living facilities. "It's not unique to nursing homes."

Researchers offer several reasons why pain goes untreated,
particularly in older patients. They include poor communication,
inadequate training of doctors and exaggerated fears about addiction.

Not unlike incontinence, unrelieved pain in nursing home patients is a
subject that few like to talk about, says Bruce Ferrell, associate
professor of geriatrics at UCLA and chalrman of the American
Geriatrics Society panel that recently drew up guidelines for treating
chronic pain in older people.

"It's a complex problem that doesn't have a simple answer," Ferrell
says. "It's been a 10-year struggle just getting people to start
talking about it."

Doctors are inadequately taught about pain in medical school, Mor
says. "There may be a pain lecture. It's not much." Most clinical
training comes in a hospital setting that emphasizes curative
treatment, such as surgery, rather than the palliative care.

"Drugs, particularly narcotic painkillers, are not viewed positively"
by nurses and doctors, Mor adds. "There's a very strong worry about
addiction."

Yet the American Geriatrics Society guidelines, issued in March,
concluded that addiction "appears to be very low" in such patients.
"This is not to suggest that morphine and other opioid drugs should be
used indiscriminately, but only that fear of addiction and other side
effects does not justify failure to treat severe pain, especially in
those near the end of life."

"Here you've got an 85-year-old who's going to be dead in three months
and, believe it or not, the physician is worried about her getting
addicted to morphine," Willging says. "Give me a break."

Patients themselves some-times are reluctant to speak up about their
pain, lest they become addicted to painkillers or come across as whiners.

-------------------------------------------------------------------------
- -------------------------------
-- Dave Haans Graduate Student, University of Toronto
WWW: http://www.chass.utoronto.ca:8080/~haans/

Checked-by: "Rich O'Grady"