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Medline ® Abstract for Reference 16

of 'Pain assessment and management in the last weeks of life'

How well do medical oncologists manage chronic cancer pain? A national survey.
Breuer B, Chang VT, Von Roenn JH, von Gunten C, Neugut AI, Kaplan R, Wallenstein S, Portenoy RK
Oncologist. 2015;20(2):202. Epub 2015 Jan 12.
BACKGROUND: Cancer pain is usually managed by oncologists, occasionally with input from specialists in hospice and palliative medicine (PLM) or pain medicine (PMD). We evaluated the knowledge of cancer pain management in these three specialty groups.
METHODS: Eight vignettes depicting challenging scenarios of patients with poorly controlled pain were developed; each had five or six treatment choices. Respondents indicated choices likely to be safe and efficacious as "true" and choices likely to be unsafe or inefficacious as "false." Two questionnaires were created, each with four vignettes. Three anonymous mailings targeted geographically representative U.S. samples of 570 oncologists, 266 PMD specialists, and 280 PLM specialists, each randomly assigned one version of the questionnaire. Vignette scores were normalized to a 0-100 numeric rating scale (NRS); a score of 50 indicates that the number of correct choices equals the number of incorrect choices (consistent with guessing).
RESULTS: Overall response rate was 49% (oncologists, 39%; PMD specialists, 48%; and PLM specialists, 70%). Average vignette score ranges were 53.2-66.5, 45.6-65.6, and 50.8-72.0 for oncologists, PMD specialists, and PLM specialists, respectively. Oncologists scored lower than PLM specialists on both questionnaires and lower than PMD specialists on one. On a 0-10 NRS, oncologists rated their ability to manage pain highly (median 7, with an interquartile range [IQR]of 5-8). Lower ratings were assigned to pain-related training in medical school (median 3, with an IQR of 2-5) and residency/fellowship (median 5, with an IQR of 4-7). Oncologists older than 46-47 years rated their training lower than younger oncologists.
CONCLUSION: These data suggest that oncologists and other medical specialists who manage cancer pain have knowledge deficiencies in cancer pain management. These gaps help clarify the need for pain management education.
MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Section of Hematology/Oncology, Virginia New Jersey Health Care System, East Orange, New Jersey, USA; Rutgers New Jersey Medical School, Newark, New Jersey, USA; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Hospice and Palliative Care, OhioHealth, Columbus, Ohio, USA; Division of Palliative Care, Department of Medicine, The Ohio State Medical Center, Columbus, Ohio, USA; Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Pain Medicine and Palliative Care, Mount Sinai Beth Israel, New York, New York, USA; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA bbreuer@mjhs.o