Karen O. Anderson

BACKGROUND: Minority patients with breast cancer are at risk for undertreatment of cancer‐related pain. The authors evaluated the feasibility and efficacy of an automated pain intervention for improving pain and symptom management of underserved African American and Latina women with breast cancer.METHODS: Sixty low‐income African American and Latina women with breast cancer and cancer‐related pain were enrolled in a pilot study of an automated, telephone‐based, interactive voice response (IVR) intervention. Women in the intervention group were called twice weekly by the IVR system and asked to rate the intensity of their pain and other symptoms. The patients' oncologists received e‐mail alerts if the reported symptoms were moderate to severe. The patients also reported barriers to pain management and received education regarding any reported obstacles.RESULTS: The proportion of women in both groups reporting moderate to severe pain decreased during the study, but the decrease was significantly greater for the intervention group. The IVR intervention also was associated with improvements in other cancer‐related symptoms, including sleep disturbance and drowsiness. Although patient adherence to the IVR call schedule was good, the oncologists who were treating the patients rated the intervention as only somewhat useful for improving symptom management.CONCLUSIONS: The IVR intervention reduced pain and symptom severity for underserved minority women with breast cancer. Additional research on technological approaches to symptom management is needed. Cancer 2015;121:1882–1890. © 2015 American Cancer Society.

The control of cancer pain is an essential goal in the care of patients with cancer. Inadequate pain assessment by health care providers is a major risk factor for undertreatment of pain. Repeated and accurate pain assessment is required for optimal pain management. Pain assessment tools such as simple rating scales and short pain questionnaires can facilitate routine measurement of cancer-related pain in clinical and research settings. In addition to measuring pain intensity, it is important to determine the impact of pain on patients’ function, mood, and quality of life. Developmental issues must be considered when assessing the pain of children and elderly individuals with cancer. Novel technologies may be used to improve accurate and timely pain measurement.

Patients who undergo autologous peripheral blood stem cell (PBSC) transplantation experience multiple symptoms that adversely affect quality of life. We assessed symptoms during the acute phase of autologous PBSC transplantation to determine the severity of individual symptoms and to determine overall symptom profiles in 100 patients with multiple myeloma or non-Hodgkin's lymphoma. Study subjects completed the blood and marrow transplantation module of the M. D. Anderson Symptom Inventory before hospitalization, during conditioning, on day of transplantation, at nadir (the time of lowest white blood cell count) and on day 30 post-transplantation. Additional symptom, quality-of-life and medical status measures were collected. Symptom means were mild at baseline, intensified during conditioning, peaked at nadir and decreased by day 30. At nadir, the most severe symptoms for the entire patient sample were lack of appetite, fatigue, weakness, feeling sick, disturbed sleep, nausea and diarrhea. Cancer diagnosis was a significant predictor of changes in symptoms over time. The patterns of fatigue, pain, sleep disturbance and lack of appetite were significantly different for patients with multiple myeloma as compared with patients with non-Hodgkin's lymphoma.

BACKGROUND Few studies have evaluated cognitive‐behavioral interventions as an adjunct treatment for chronic cancer‐related pain. A randomized clinical trial was performed evaluating the efficacy of 3 brief cognitive‐behavioral techniques: relaxation, distraction, and positive mood interventions. METHODS Fifty‐seven patients with chronic cancer‐related pain taking opioid medications were randomly assigned to either the relaxation, distraction, positive mood, or waiting‐list control group. The patients in the 3 intervention groups received audiotapes of the cognitive‐behavioral technique and were asked to practice regularly at home. The tapes were supplemented with written instructions and follow‐up telephone calls. RESULTS Patients in the relaxation and distraction groups reported significantly reduced pain intensity immediately after listening to the tapes. The pain reduction was not maintained, however. At the 2‐week follow‐up assessment, no significant differences in pain intensity or interference were found among the treatment groups. The groups also did not differ with regard to secondary outcome measures assessing quality of life, mood, self‐efficacy, and other symptoms. The results of qualitative interviews indicated that patients often had difficulty focusing on the audiotapes and preferred their own methods of pain reduction. CONCLUSIONS Brief relaxation and distraction audiotape interventions produced immediate pain reductions but not longer‐term pain relief. Additional research with a more individualized intervention is needed to evaluate cognitive‐behavioral interventions for cancer pain control. Cancer 2006. © 2006 American Cancer Society.

Purpose: Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients. Patients and Methods: Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments. Results: Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments. Conclusion: Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed.

BACKGROUND: Minority patients with cancer are at risk for undertreatment of cancer‐related pain. Most studies of patient‐related barriers to pain control have surveyed primarily non‐Hispanic Caucasian patients. The purpose of the current study was to explore barriers to optimal pain management among African‐American and Hispanic patients with cancer through the use of structured patient interviews. Structured interviews allowed the authors to probe for previously unidentified barriers to pain management in these populations.METHODS: Thirty‐one socioeconomically disadvantaged minority patients with cancer (14 African‐American patients and 17 Hispanic patients) who had cancer‐related pain completed structured interviews that assessed three main content areas: information and communication regarding cancer pain, treatment of cancer pain, and the meaning of cancer pain.RESULTS: The African‐American and Hispanic patients reported severe pain and many concerns about pain management. The majority of patients in both ethnic groups expressed a belief in stoicism and concerns about possible addiction to opioid medications and the development of tolerance. The patients described their physicians as the most frequent and trusted source of information about cancer pain. However, patients also reported difficulties with communication and a reluctance to complain of pain.CONCLUSIONS: The reported barriers to pain management indicate that socioeconomically disadvantaged African‐American and Hispanic patients can benefit from educational interventions on cancer pain that dispel myths about opioids and teach patients to communicate assertively about their pain with their physicians and nurses. Cancer 2002;94:2295–304. © 2002 American Cancer Society.DOI 10.1002/cncr.10414