Researchers studying elderly cancer patients in nursing homes have found that many are severely undertreated for pain and more than a quarter of those who complain of pain, especially blacks and the oldest of the old, are given no pain medication, even aspirin.
The study, the largest of its kind, involved 13,625 cancer patients in five states, including New York.It found that patients older than 85 were about half as likely to be treated for pain as those between the ages of 65 and 74, and that blacks were half as likely as whites to receive pain medication.
"At some point, nursing home staff and in-house doctors may give up on patients who they know are going to die," said Dr. Giovanni Gambassi, a main author of the study in Wednesday's Journal of the American Medical Association. "There is no acceptable excuse for not treating pain appropriately in terminally ill patients."
A spokesman for the American Nursing Home Association, which represents 11,000 nursing homes across the country, said the new study raises "legitimate issues that bear close scrutiny."
But the spokesman, Tom Burke, also complained that nursing homes were being unfairly singled out, saying the problem of undertreatment of pain cuts across all areas of medicine.
Experts do not fully understand why the very old and minorities are more vulnerable to having their pain left untreated, but several theories are circulating, said Dr. Kathleen Foley, chief of the pain and palliative care service at Memorial Sloan-Kettering Cancer Center in New York City. One is that outright prejudice is at work, particularly in the case of minorities.
Another, she said, is that these patients "are used to being in pain and suffering and therefore don't complain about it."
A third is that they don't want to be impaired by the side effects of medication. In addition, experts say that nursing home workers are poorly trained to recognize pain.
Whatever the reason, Dr. Foley and other experts in end-of-life care have long complained that their colleagues underestimate and undertreat pain and that patients' quality of life could be vastly improved if doctors paid attention to this problem.