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June 17, 1998

Undertreatment of Cancer Pain in Elderly Patients

Author Affiliations

From the Pain Research Group, M. D. Anderson Cancer Center, Houston, Tex.

JAMA. 1998;279(23):1914-1915. doi:10.1001/jama.279.23.1914

Undertreatment of pain is a persistent clinical problem. A leading indicator of inadequate pain management is the poor control of cancer pain, a condition for which every effort should be made to assure patient comfort. Cancer pain is feared by patients, their families, and the general public and this fear has helped to fuel the debate concerning assisted suicide.

In this issue of THE JOURNAL, the study by Bernabei and colleagues1 takes advantage of a large database to examine the treatment of pain in elderly patients with cancer who are cared for in nursing homes. Using the Resident Assessment Instrument and the Minimum Data Set, part of the Health Care Financing Administration's Demonstration Project, the investigators found that 38% of nursing home residents with cancer in a 5-state area complained of, or showed evidence of, daily pain. The study found that 26% of these patients with daily pain received no analgesics. Patients older than 85 years were more likely to receive no analgesia, as were patients in minority groups. Using as a standard the World Health Organization's guidelines for analgesic use in cancer pain (later endorsed by the Agency for Health Care Policy and Research clinical practice guideline on the management of cancer pain2) about half of the patients in pain and very few patients older than 85 years were receiving opioid analgesics.