EXPERTS SAY CANCER PAIN UNDERTREATED

WASHINGTON - Cancer patients often suffer needlessly because the nation's
medical system does a poor job of treating pain that is a common part of
the disease, according to experts who produced a study for the National
Institutes of Health.

"Cancer-related pain, depression and fatigue are undertreated and this
situation is simply unacceptable," said Dr. Donald Patrick, a medical
professor at the University of Washington, Seattle, and chairman of the
committee.

"We have to move to the point that patient comfort and care are a part of
the cancer treatment agenda," said Dr. Andrew T. Turrisi III, a radiation
oncologist at the Medical University of South Carolina, Charleston. "Some
patients are more fearful of pain than they are of death itself."

"Optimal pain relief for cancer patients needs to be a minimally accepted
standard," the committee statement said. "Inadequately treated pain can be
considered one indicator of poor quality of care."

The report was written after the 13-member panel analyzed a series of
studies over a two-day period at a conference organized by the NIH.

At a news conference where the report was released, Patrick said the group
found that many doctors lack the knowledge of how to control relentless
pain and that medical schools fail to provide adequate training in pain
management.

"The educational process needs to be rethought," said Patrick. "Students,
trainees and post graduates all need additional training in management,
assessment and treatment of pain."

There are also official barriers to bringing relief to suffering patients,
the panel said.

Dr. Paul S. Frame, a professor at the University of Rochester School of
Medicine in New York and a member of the committee, said some government
regulations require a three-copy report each time a doctor prescribes some
opiates commonly used for cancer pain relief.

"Sometimes practitioners don't want to go to the hassle of prescribing a
triplicate drug," he said. "They may use something less effective instead."

Even the day of the week can block pain relief for cancer patients, said L.
Douglas Ried, a professor at the college of pharmacy, University of
Florida, Gainesville.

Ried said regulations require that a patient get a new prescription for
some opiates used for pain relieve. If, for instance, a patient runs out of
morphine on a weekend, "it is very difficult for him to get another
prescription" because his doctor is not available and a pharmacist is not
allowed to sell more of the drug without a doctor's approval.

"Sometimes pharmacists will fill the prescription and then call the doctor
on Monday, but they are putting their license at risk," said Ried. "Most
pharmacists, though, follow the regulations to the letter," which leaves
the patient still in pain.

Even the size of the pain problem is uncertain, the committee said. The
report estimated that there are nearly 9 million people in the United
States with a history of cancer, with about 1.3 million additional patients
diagnosed each year. About 60 percent of these patients will live at least
five years.

The committee said some researchers studying pain management said that only
about 14 percent of cancer patients have persistent pain. Other studies
found that relentless pain affected virtually every cancer patient. The
most common estimates found that pain was poorly controlled in 26 to 41
percent of all cancer patients.

One obstacle to measuring the scope of the problem is that patients,
themselves, often give their doctors poor insight into their pain, with
some believing that it is just part of the cancer experience and must be
tolerated.

"They sometimes feel there is not much that can be done about it," said Frame.

Other patients have an unrealistic fear about opiates and often choose to
suffer instead of asking for the drugs, he said.

"There is a feeling that the drugs are bad," said Frame. "They are worried
about addiction. People don't want to become junkies."

On the Net:

NIH Report: http://consensus.nih.gov