Nursing homes undertreat cancer pain Blacks, oldest especially neglected, study finds


WASHINGTON -- 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, is all the more troubling, experts say, because as hospital stays grow shorter and the population ages, more and more old people with cancer spend the ends of their lives in nursing homes.

The research involved 13,625 cancer patients in New York, Kansas, Maine, Mississippi and South Dakota. It found that patients older than 85 were about half as likely to be treated for pain as those ages 65 to 74, and 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 today's Journal of the American Medical Association. "There is no acceptable excuse for not treating pain appropriately in terminally ill patients."

Tom Burke, a spokesman for the American Nursing Home Association, which represents 11,000 nursing homes across the country, said the study raises "legitimate issues that bear close scrutiny."

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.

Pub Date: 6/17/98

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