title: Prospective, observational study of pain and analgesic prescribing in medical oncology outpatients with breast, colorectal, lung, or prostate cancer.
abstract: OBJECTIVE
  Pain is prevalent among patients with cancer, yet pain management patterns in outpatient oncology are poorly understood.
  
  
  METHODS
  A total of 3,123 ambulatory patients with invasive cancer of the breast, prostate, colon/rectum, or lung were enrolled onto this prospective study regardless of phase of care or stage of disease. At initial assessment and 4 to 5 weeks later, patients completed a 25-item measure of pain, functional interference, and other symptoms. Providers recorded analgesic prescribing. The pain management index was calculated to assess treatment adequacy.
  
  
  RESULTS
  Of the 3,023 patients we identified to be at risk for pain, 2,026 (67%) reported having pain or requiring analgesics at initial assessment; of these 2,026 patients, 670 (33%) were receiving inadequate analgesic prescribing. We found no difference in treatment adequacy between the initial and follow-up visits. Multivariable analysis revealed that the odds of a non-Hispanic white patient having inadequate pain treatment were approximately half those of a minority patient after adjusting for other explanatory variables (odds ratio, 0.51; 95% CI, 0.37 to 0.70; P = .002). Other significant predictors of inadequate pain treatment were having a good performance status, being treated at a minority treatment site, and having nonadvanced disease without concurrent treatment.
  
  
  CONCLUSIONS
  Most outpatients with common solid tumors must confront issues related to pain and the use of analgesics. There is significant disparity in pain treatment adequacy, with the odds of undertreatment twice as high for minority patients. These findings persist over 1 month of follow-up, highlighting the complexity of these problems.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX, USA. mfisch@mdanderson.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisch
authors.forename: Ju-Whei
authors.initials: JW
authors.lastname: Lee
authors.forename: Matthias
authors.initials: M
authors.lastname: Weiss
authors.forename: Lynne I
authors.initials: LI
authors.lastname: Wagner
authors.forename: Victor T
authors.initials: VT
authors.lastname: Chang
authors.forename: David
authors.initials: D
authors.lastname: Cella
authors.forename: Judith B
authors.initials: JB
authors.lastname: Manola
authors.forename: Lori M
authors.initials: LM
authors.lastname: Minasian
authors.forename: Worta
authors.initials: W
authors.lastname: McCaskill-Stevens
authors.forename: Tito R
authors.initials: TR
authors.lastname: Mendoza
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D008913:Minority Groups; D010045:Outpatients; D059408:Pain Management / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy*
chemical_list: D000700:Analgesics