Pain and treatment of pain in minority patients with cancer - The Eastern Cooperative Oncology Group minority outpatient pain study

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.