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| |  Many Elderly Cancer Patients Go Without Pain Medication CHICAGO, IL -- June 16, 1998 -- About 40 percent of nursing home patients with cancer have daily pain and 25 percent of these receive no analgesics (painkillers), according to an article in tomorrow’s issue of The Journal of the American Medical Association. Roberto Bernabei, M.D., of the Universita Cattolica del Sacro Cuore in Rome, Italy, Giovanni Gambassi, M.D., of Brown University in Providence, R.I., and colleagues studied the adequacy of pain management in elderly and minority cancer patients admitted to nursing homes. The study included 13,625 cancer patients aged 65 and older in Medicare and Medicaid-certified nursing homes in five states. The study reveals that between 25 percent to 40 percent of elderly cancer patients experienced daily pain. Of patients with daily pain, 16 percent received a non-narcotic, 32 percent received weak opiates and only 26 percent received morphine or like substances. More than a quarter of patients in daily pain did not receive any pain-killing agent. The researchers found a strong inverse correlation between the presence of pain and increasing age and an equally strong relationship between pain and belonging to a minority group. Financial issues were unlikely to play a role in whether pain medications were provided since all the patients, regardless of their own health insurance, had Medicare coverage extended to include all medication costs. "As age increased, a greater proportion of patients in pain received no analgesic drugs,” they write. “Patients older than 75 years were more likely to have no analgesia relative to patients aged 65 to 74. Patients aged 85 years or older received morphine or other strong opiates one third more frequently than patients aged 65 to 74 years. "Elderly and minority cancer patients may receive inadequate analgesia in part due to an underestimation or underreporting of pain. The presence of multiple concurrent medical problems, the increased likelihood of cognitive and sensory impairment, and the presence of depression may all contribute to underreporting of pain. Elderly may experience more pain than younger people, although they may be less likely to complain about it." Patients from racial or ethnic minority groups were less likely to have pain recorded relative to whites and minority patients were more likely to receive no analgesia. Minority patients were also less likely than whites to have pain recorded. "The prevalence of cancer increases with age and pain is one of cancer's most frequent and disturbing symptoms,” they write. “Despite the widespread dissemination of the World Health Organization's three-level stepladder and the demonstration that its appropriate use can relieve pain in more than 90 percent of cases, pain management remains poor."
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