Women May Be at Greater Risk for Undertreatment of Cancer Pain

PONTE VEDRA BEACH, Fla—A descriptive study drawing cancer patients from seven outpatient clinics has found that female patients with bone metastases were prescribed half the pain medication as male patients with the same pain intensity scores. The disparity was significant whether the researchers counted all of the analgesics prescribed to each patient or only the opioid analgesics.

Christine Miaskowski, RN, PhD, chair, Department of Physiological Nursing, University of California, San Francisco, presented preliminary results at the Oncology Nursing Society’s Sixth National Conference on Cancer Nursing Research. She said the findings suggest that women with cancer-related pain are at significant risk for undertreatment.

The study showed that the women were prescribed 148.5 mg/d of opioid analgesics on average, compared with 297.9 mg/d prescribed for the men. Controlling for weight did not eliminate the disparity, according to Dr. Miaskowski. "It’s hard to know why at this point, but it certainly is a red flag, and people need to be aware of it," she told ONI in a post-conference interview.

The researchers recorded the medications that had already been prescribed to 46 men and 88 women at the point when they entered a large randomized trial of a nursing intervention for pain management in patients with bone metastases. The intervention had not yet begun when the data were collected.

Most (72%) of the women were breast cancer patients. Nearly half (43.5%) of the men had prostate cancer. The women were younger than the men (average age, 56.9 vs. 65.3 years). They also were better educated, with 15 years of schooling vs 13.7 years for the men.

The results showed no gender differences in pain intensity measures, such as average, least, or worst pain; hours per day or number of days in pain; or length of pain episodes.

Likewise, men and women gave similar reports of how pain interfered with normal activities such as walking and sleep. The one exception was effect on sexual activity, with men rating pain interference at 6.9 on a 0-to-10 scale, and women reporting 5.2.

A tool called the Medication Quantification Scale (MQS) was used to compare the full range of medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and antidepressants, prescribed to help patients cope with pain.

"This scale allows us to account for all the analgesics the patients were taking," Dr. Miaskowski said, "because the MQS units represent an overall estimate of analgesic prescriptions. If you look at these medications overall, the men got significantly more than the women."

Dr. Miaskowski speculated that prejudice might be a factor, but she cautioned that relatively little research has been done into gender differences in feeling, expressing, and treating pain. "We’ve ignored the differences between the sexes, and now its time to take a better look," she said.