PSYCHO-ONCOLOGY Psycho-Oncology 12: 153–160 (2003) Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.627 PATIENT BARRIERS TO OPTIMAL CANCER PAIN CONTROL VICTORIA T. POTTER, C. ELKE WISEMAN, STEWART M. DUNN* ,y and FRANCES M. BOYLE Department of Psychological Medicine, University of Sydney, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia SUMMARY Poorly controlled pain is a significant problem for cancer patients. Contributing factors may include concerns about analgesics and fears about the implications of pain, which may hinder open communication. We surveyed the prevalence of these concerns in Australian oncology patients and investigated associations with inadequate pain control. Ninety-three adult patients with cancer, undergoing treatment at a teaching hospital, completed the patient barriers questionnaire (BQ) and a self-report questionnaire to determine pain severity, interference with daily activities, use of analgesics and alternative therapies, and hesitation to report pain. Overall, there was a high prevalence of agreement with the BQ scales assessing concerns about communication and analgesic use. One-third of patients had clinically significant pain, which interfered with daily activities, despite use of analgesics. They were more likely to use alternative therapies for pain control, to hesitate to discuss their pain, and had significantly greater concerns about side effects of analgesics and injections. Our study confirms that patient barriers exist in this Australian population and are associated with inadequate pain control. Oncology staff need to actively screen for pain, particularly targeting patients using alternative therapies and experiencing side effects, develop communication and prescribing skills, and diversify pain management approaches beyond analgesics. Copyright # 2003 John Wiley & Sons, Ltd. INTRODUCTION Up to 80% of patients with cancer experience significant pain as a result of their disease and/or its treatment (Bonica, 1990; Stjernward, 1988). Pain is not a trivial symptom of cancer. It can interfere with all aspects of a patient’s life}their sleep, work, leisure and relationships. Relief of pain is, therefore, a vitally important component in the management of the oncology patient. There is evidence that cancer pain is frequently under-treated (Boyle and Grossman, 1999; Gross- man, 1993). Several prominent bodies have devel- oped protocols to aid health professionals treating cancer patients with pain. These include the Australian National Health and Medical Research Council (NHMRC, 1999), the US National Comprehensive Cancer Network (NCCN) (Gross- man et al., 1999), US Agency for Health Care Policy and Research (AHCPR) (Jacox et al., 1994) and the World Health Organization (WHO) (Stjernsward, 1988). Despite this, there is evidence to suggest that a significant proportion of physi- cians has an inadequate understanding about the management of cancer pain. Particular issues highlighted include insufficient knowledge and training, misconceptions about medications and their side effects and a lack of formal procedures to assess pain (Pargeon et al., 1999). In addition, there is increasing evidence that patient-related barriers may significantly interfere with the implementation of these guidelines (Pargeon et al., 1999; Riddell et al., 1997). For example, many patients have misconceptions about opioids and other analgesics. They may be reluctant to comply with treatments because they fear side effects and addiction, or believe that pain in cancer is inevitable (Weiss et al., 2001). Poor communication with health-care providers has been identified as another important issue. Patients may not report pain because they are concerned Copyright # 2003 John Wiley & Sons, Ltd. Received 1 December 2000 Accepted 19 February 2002 *Correspondence to: Department of Psychological Medicine, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia. E-mail: stewd@med.usyd.edu.au