Patients Don't Follow Cancer Pain Prescriptions

In one of the first studies to observe cancer patients in their homes, researchers from the Schools of Nursing, Medicine, and Pharmacy at the University of California at San Francisco have found that two of the main reasons that cancer patients do not achieve adequate pain relief are: lack of patient adherence to recommended dosages, and inadequate analgesic prescriptions by doctors.

Writing in the Journal of Clinical Oncology, Christine Miaskowski, RN, PhD and colleagues noted that a fear of addiction was not the main reason that cancer patients did not take their prescribed pain medications.

"Our study debunks that explanation," she said, "and finds that the side effects caused by most opioid analgesics were a key reason why cancer patients did not adhere to their pain medication regimen."

Many patients in the study told the researchers that they would rather experience pain than deal with side effects such as constipation and sedation. This finding is unfortunate, the researchers noted, because side effects like these can be easily treated.

The randomized five-week study included 65 adult oncology patients who rated their level of pain intensity and recorded their pain medication intake on a daily basis. Adherence rates for opioid analgesics prescribed on an around-the-clock and an as-needed basis were calculated weekly.

Overall adherence rates ranged from 84.5 to 90.8 percent for around-the-clock opioid analgesics and 22.2 to 26.6 percent for as-needed analgesics. There were no significant changes in adherence rates, pain intensity or duration of pain during the course of the study.

Furthermore, federal guidelines recommend that all cancer patients with chronic cancer pain be prescribed an around-the-clock analgesic regimen, as well as a short-acting supplement for breakthrough pain. However, not all patients received both types of medication.

In the study, 13.9 percent of the patients were prescribed opioid analgesics on an around-the-clock basis; 56.9 percent were prescribed opioid analgesics on an as-needed basis; and 29.2 percent were prescribed both around-the-clock and as-needed analgesics.

"Poor adherence may therefore in part reflect … inadequate analgesic prescriptions," noted Dr. Jamie von Roenn of Northwestern University Medical Center in an accompanying editorial.

SOURCES:
Journal of Clinical Oncology, December 1, 2001; 19:4275-4279
American Society of Clinical Oncology (http://www.asco.org)

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