Using a mathematical model that describes the interplay of clinical decisions and economics, the researchers found that guideline-based cancer pain management offered effective pain relief in 80 percent of patients compared to 30 percent effectiveness for the "as needed" pain management by non-specialty providers. Pain management by oncologists was slightly more effective, but still managed the pain of only 55 percent of patients.

Guideline-based pain management is a targeted approach to addressing pain using a pre-determined treatment plan for patients. In contrast, an "as needed" approach by non-specialty providers is less methodical and its effectiveness varies depending on provider knowledge of pain and treatment intervention as well as patient willingness to report pain and ask for assistance.

The study appears in the November 2003 issue of the American Journal of Managed Care.

"Pain is one of the most commonly feared symptoms of cancer," said David Matchar, M.D., director of the Duke Center for Clinical Health Policy Research and senior author of the paper. "Not all health care providers are equally trained to assess and manage cancer pain. Guidelines can create a level playing field for everyone and it only costs a few pennies more a month to follow these guidelines, but the reduction in pain is significant for patients."

Costs were calculated based on medication cost and all associated fees for anesthesiology and surgical procedures, radiotherapy and physical therapy. After analysis, the guideline-based therapy cost an estimated $1.18 per member of a health-care organization per month; oncology-based care was 95 cents per member per month, and the non-specialty "u
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Contact: Amy Austell
amy.austell@duke.edu
919-684-4148
Duke University Medical Center
15-Oct-2003