Oncologists need to sharpen their pain-management skills

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The results of a recent survey suggest that pain-related knowledge and practice may not be up to par within the oncology community.

A team led by Brenda Breuer, PhD, MPH, of Beth Israel Medical Center in New York, New York, mailed surveys to a geographically representative sample of 2,000 medical oncologists randomly selected from the American Medical Association's Physician Master File. The original effort garnered 354 respondents, with 256 responding to one of two subsequent shortened versions of the questionnaire. The participants were demographically similar to all US medical oncologists, and their responses were anonymous.

Oncologists rated their specialty highly for the ability to manage cancer pain: On a scale of 0 to 10, the median score was 7. However, they rated their peers as more conservative prescribers than themselves.

In response to two vignettes describing challenging clinical scenarios, 60% and 87% of the oncologists, respectively, endorsed treatment decisions that would be considered unacceptable by pain specialists. Only 14% of the respondents made frequent referrals to pain specialists and only 16% to palliative care specialists.

The respondents identified the most important barriers to pain management as poor assessment, patient reluctance to take opioids, and patient reluctance to report pain. Other barriers included physician reluctance to prescribe opioids, and perceived excessive regulation.

In their report in the Journal of Clinical Oncology, Breuer and colleagues concluded that more efforts are needed to achieve meaningful progress in addressing the perception of treatment barriers or limitations in pain-related knowledge and practice among medical oncologists.

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