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Pain and Treatment of Pain in Minority Patients with Cancer: The Eastern Cooperative Oncology Group Minority Outpatient Pain Study

Charles S. Cleeland, PhD; Rene Gonin, PhD; Luis Baez, MD; Patrick Loehrer, MD; and Kishan J. Pandya, MD
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From the University of Texas M.D. Anderson Cancer Center, Houston, Texas; St. Mary's Hospital, Rochester, New York; Indiana University Medical Center, Indianapolis, Indiana; Westat, Rockville, Maryland; and San Juan Community Clinical Oncology Program, San Juan, Puerto Rico. Acknowledgments: The authors thank Dori Kalish-Black, MS, for leading the coordination of this study; Wendy Wonson for directing data management; Tito Mendoza, MS, for statistical support; and Vickie Williams, BS, for editorial suggestions. Grant Support: In part by Public Health Service grants from the National Cancer Institute to the Eastern Cooperative Oncology Group (CA 21076, CA 23318, CA 49883, CA 37403) and to the Pain Research Group (CA 26582); National Institutes of Health, and the Department of Health and Human Services. Requests for Reprints: Charles S. Cleeland, PhD, Pain Research Group, 1100 Holcombe Boulevard, Box 221, Houston, TX 77030. Current Author Addresses: Dr. Cleeland: Pain Research Group, 1100 Holcombe Boulevard, Box 221, Houston, TX 77030.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(9):813-816. doi:10.7326/0003-4819-127-9-199711010-00006
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Background: Clinics that primarily see members of ethnic minority groups have been found to provide inadequate treatment of cancer-related pain. The extent of undertreatment of pain in these patients and the factors that contribute to undertreatment are not known.

Objectives: To evaluate the severity of cancer-related pain and the adequacy of prescribed analgesics in minority outpatients with cancer.

Design: Prospective clinical study.

Setting: Eastern Cooperative Oncology Group.

Patients: 281 minority outpatients with recurrent or metastatic cancer.

Measurements: Patients and physicians independently rated severity of pain, pain-related functional impairment, and pain relief obtained by taking analgesic drugs. Analgesic adequacy was determined on the basis of accepted guidelines.

Results: 77% of patients reported disease-related pain or took analgesics; 41% of patients reporting pain had severe pain. Sixty-five percent of minority patients did not receive guideline-recommended analgesic prescriptions compared with 50% of nonminority patients (P < 0.001). Hispanic patients in particular reported less pain relief and had less adequate analgesia.

Conclusions: The awareness that minority patients do not receive adequate pain control and that better assessment of pain is needed may improve control of cancer-related pain in this patient population.





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