Severe undertreatment of cancer pain: A 3-year survey of the German situation

Abstract

The aim of this survey was to determine the prescribing patterns of German physicians in the treatment of cancer pain. The computerized patient records of 330 practices, which treated a total number of 1,104,435 patients over a 3-year period, were analyzed. "Strong" opioids, widely accepted in the management of severe cancer pain, were prescribed to just 322 of 16,630 cancer patients (1.9%). Only 99 (0.6%) patients received more than three prescriptions during more than 3 weeks of treatment. Additionally, many prescriptions mandated inadequate time intervals for the dosing, and 12% of the prescriptions were given "as required." From these data, it can be concluded that the majority of cancer patients in Germany are not treated for pain at all, and that those patients who receive treatment are treated inadequately. Germany is still a developing country in terms of pain therapy. This situation is symptomatic of many countries and reflects the continuing prejudice against opioids.

Symptom burden and medication use in adult sarcoma patients

“…In addition to the identification of symptoms that commonly present in patients with sarcoma, it is also crucial to ensure that these symptoms are well controlled. Similarly to other studies, a significant proportion of these patients did not receive adequate management of pain and dyspnea [7,[23][24][25]. In addition, a substantial number were still suffering from clinically significant pain and shortness of breath.…”

“…In addition, a substantial number were still suffering from clinically significant pain and shortness of breath. Possible explanations provided in literature include patients' underreporting of symptoms to clinicians, underutilization of medications, and a lack of evidence-based guidelines for the treatment of dyspnea [23,24]. There are also several studies in the literature that highlight the undertreatment of insomnia in cancer patients, which may negatively affect HRQoL [26][27][28].…”

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

“…Despite the existence of published and well-known guidelines for cancer pain management recommended by the World Health Organization (World Health Organization, 1996), undertreatment of pain remains an outstanding problem for the correct treatment of cancer patients, as already emerged from several studies conducted in different countries (Cleeland et al, 1994;Larue et al, 1995;Zenz et al, 1995;Wang et al, 1999). This is disappointing because, with a correct use of WHO analgesic ladder, up to 88% of patients is reported to obtain satisfactory relief from pain (Ventafridda et al, 1987;Zech et al, 1995).…”

Langzeitanwendung von Opioiden bei chronischen nicht tumorbedingten Schmerzen (LONTS 2)

“…Selbst Tumorpatienten waren noch 10 Jahre spä-ter stark unterversorgt [21]. Die erste Publikation zu Opioiden bei Nichttumorschmerz erschien 1982 [17], es folgte der vielzitierte Artikel von Portenoy und Foley [11], in dem über insgesamt 38 Patienten unter einer erfolgreichen Opioidtherapie als "humane Alternative zu operativen Optionen oder keiner Therapie" berichtet wurde.…”