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Report: Many cancer patients lack pain care

WASHINGTON (CNN) -- U.S. doctors and hospitals are not prepared to handle the suffering of dying cancer patients, according to a report released Tuesday.

The report, "Improving Palliative Care for Cancer: Summary and Recommendations," was released by the National Cancer Policy Board of the National Research Council and the Institute of Medicine. It says that federal research and training efforts have focused largely on treatment and finding cures, while little has been done to advance palliative care. Palliative care focuses on relieving the symptoms and pain that cancer patients experience, particularly when they are near death. The report suggests much of patient suffering could be alleviated if symptom control measures currently available were more widely used.

The National Comprehensive Cancer Network recently released new guidelines for treating cancer pain  

  • Read the guidelines  

    Palliative care can include hospice care, the system currently in place that's designed to help patients cope with the dying process. For most patients, hospice is paid for by Medicare. The services are predominantly home-based, but Medicare limits enrollment to patients with a prognosis of less than six months. And the hospice benefit does not cover curative or life-prolonging procedures. The report found that one of the major barriers to adequate palliative care has been the focus on either active therapy or palliative/hospice care rather than a combination of the two approaches.

    National Cancer Policy Board  

    "Palliative care is meant to help persons even (those) who are still pursuing aggressive care or life-prolonging care and need attention to symptom management and all of the psycho-social and spiritual issues that arise when somebody is a seriously ill," said Dr. Cheryl Arenella, medical director of Hospice of Northern Virginia.

    "We know a lot about how to address the suffering of patients who are at this phase in their illness and yet we know that a lot of that knowledge is not applied. There is a lot of under-treatment of pain, for instance, and other symptoms and certainly a lot of the psycho-social and spiritual issues for very many people, perhaps a majority of people who are dying, go unmet."

    According to the report, other barriers to access include:

    • in care, even when available, for African Americans and other ethnic and socioeconomic segments of the population.

    • inadequate training of health-care personnel in symptom management and other palliative care skills.

    • lack of accountability for providing excellent end-of-life care within the health care system.

    • the separation of palliative and hospice care from potentially life-prolonging treatment within the health care system.

    • low level of public-sector investment in palliative and end-of-life care research and training.

    Saying that research on palliative care has been a low priority at the National Cancer Institute, the board recommends that the NCI designate specific cancer centers as research, training and treatment facilities that would develop programs that can be adopted by other cancer centers and hospitals. These centers would be recognized as "comprehensive cancer centers."

    In a related development -- but one not cited in the report -- a civil jury in California last week found a doctor liable for recklessness and abuse for not prescribing enough pain medication to a patient who later died of cancer.

    • American Pain Society
    • The National Hospice and Palliative Care Organization

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