17 June 1998

Shameful Neglect Of Elderly And Minority Cancer Patients

Unacceptable numbers of elderly and minority cancer patients in American nursing homes are being forced to live out their final days in agony, without even an aspirin to ease the pain. That is the shocking finding of a Brown University study into cancer pain management, published in today's Journal of the American Medical Association.

"We're not pointing fingers, but we know that nursing homes and many clinical settings do not do a good job in this area, and here's more proof," says Giovanni Gambassi, visiting professor in the Centre for Gerontology and Health Care Research at Brown University and one of the study's authors. "At some point, nursing home staff and in-house doctors may give up on patients who they know are going to die. The results of our study are particularly alarming since there are ways to treat patients to greatly relieve their conditions. There is no acceptable excuse for not treating pain appropriately in terminally ill patients."

Equally alarming is the extent of the neglect. Gambassi and his colleagues scrutinized data collected on 13 625 cancer patients aged 65 or older from 1992 to 1995 in five different states. What they discovered is nothing short of scandalous.

One in four patients who reported daily pain received no analgesics at all - not even an aspirin or acetaminophen tablet. The older and frailer they became, the less likely they were to get relief. Incredibly, patients older than 85 years were 50 per cent less likely to receive any analgesic than those aged 65 to 74. On top of that, African Americans were 50 per cent less likely than whites to receive analgesics. A similar, if less pronounced, trend was discovered for Hispanics, Asians and Native Americans.

"We must tear down the cultural, social and intellectual barriers to do a better job of attending to those who are terminally ill," says Gambassi, calling for greater education for individual clinicians and patients.

Attempting to explain the neglect, the authors speculate that older patients may be less likely to complain about pain, while the presence of multiple medical problems, increased likelihood of cognitive and sensory damage, and the presence of depression might also contribute to an under-reporting of discomfort. For minority patients, language barriers and cultural backgrounds could play a role. Yet none of these explanations, say the authors, is an adequate excuse.