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November 29, 2001

Insufficient Prescriptions And Poor Adherence Are Key Factors In Poor Cancer Pain Management

Many cancer patients are not achieving adequate pain relief because they do not
adhere to pain medication regimens and do not receive adequate pain medication
prescriptions, according to a new UCSF study.

In one of the first studies to observe cancer patients using long-term pain
management regimens in their homes, researchers in the UCSF schools of
Nursing, Medicine and Pharmacy found that many cancer patients were not taking
around-the-clock and as-needed pain medicines as prescribed by their
physicians. The study appears in the December issue of the Journal of Clinical

Over the five weeks of the study, 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.

Most patients cited adverse side effects (such as constipation) as the reason
for their lack of adherence, said Chris Miaskowksi, PhD, professor and chair of
the UCSF department of physiological nursing and lead author on the study. "The
old message was people weren't taking their pain medication because of fear of
addiction. Our study debunks that explanation and reinforces the need for
patients to talk to their physicians about he management of side effects,"
said Miaskowski. She explained that physicians can often reduce constipation
side effects, for example, by prescribing laxatives.

Researchers noted that current practice guidelines for cancer pain management
recommend that patients with chronic cancer pain (like pain from bone
metastases) receive a long-acting opioid analgesic for their constant pain and
a short-acting opioid on an as-needed basis for breakthrough pain.

However, only 29.2 percent of patients in this study (which focused on oncology
patients with baseline pain and evidence of bone metastases) received both
kinds of medication. Just over 13 percent were prescribed only opioid
analgesics on an around-the clock basis and nearly 57 percent were prescribed
only opioid analgesics on an as-needed basis.

"This suggests that more aggressive pain management strategies might be in
order for cancer patients," said Miaskowski. In addition, she explained that
effective pain management requires repeated assessment and dosage adjustment.

"Health providers need to consistently ask patients if they are taking their
medication and if it is working. If necessary, providers need to appropriately
adjust prescriptions to make them more effective." she said.

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

Co-researchers on this study include: Marylin J. Dodd, PhD, professor and
associate dean in the UCSF School of Nursing; Claudia West, RN, professor in
the UCSF department physiological nursing; Steven M. Paul, PhD, senior
statistician in the UCSF School of Nursing; Debu Tripathy, MD, UCSF associate
professor of hematology and oncology; Peter Koo, PharmD, pain management
specialist in UCSF pharmaceutical services; and Karen Schumacher, PhD,
assistant professor in the University of Pennsylvania School of Nursing.

This study was supported by a grant from the National Cancer Institute.
Additional support was provided through grants from Janssen Pharmaceutica and
Purdue Pharma LP.

UCSF News Release: Maureen McInaney


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