How well do medical oncologists manage chronic cancer pain? A national survey.

Background. Cancer pain is usually managed by oncologists, occasionallywith input fromspecialists in hospice and palliative medicine (PLM) or pain medicine (PMD). We evaluated the knowledge of cancer painmanagement in these three specialty groups. Methods. Eight vignettes depicting challenging scenarios of patients with poorly controlled pain were developed; each had five or six treatment choices. Respondents indicated choices likely tobesafeandefficacious as"true"andchoices likely tobe unsafe or inefficacious as "false."Two questionnaires were created, each with four vignettes. Three anonymous mailings targeted geographically representative U.S. samples of 570 oncologists, 266 PMD specialists, and 280 PLM specialists, each randomly assigned one version of the questionnaire. Vignette scores were normalized to a 0-100 numeric rating scale (NRS); a score of 50 indicates that the number ofcorrect choices equals the number of incorrect choices (consistent with guessing). Results. Overall response ratewas 49% (oncologists, 39%; PMD specialists, 48%; and PLM specialists, 70%). Average vignette score ranges were 53.2-66.5, 45.6-65.6, and 50.8-72.0 for oncologists, PMDspecialists, andPLMspecialists, respectively. Oncologists scored lower than PLM specialists on both questionnaires and lower than PMD specialists on one. On a 0-10 NRS, oncologists rated their ability to manage pain highly (median 7, with an interquartile range [IQR] of 5-8). Lower ratings wereassigned to pain-related training in medical school (median 3, withan IQR of 2-5) and residency/fellowship (median 5, with an IQR of 4-7). Oncologists older than 46-47 years rated their training lower than younger oncologists. Conclusion. These data suggest that oncologists and other medical specialists who manage cancer pain have knowledge deficiencies in cancer pain management. These gaps help clarify the need for pain management education.