Assessment of knowledge about cancer pain management by physicians in training.
This survey assessed the knowledge of physicians in training about the pharmacology of opioid analgesics and the benefits of palliative radiation therapy in the management of cancer pain. Eighty-one trainees at the Washington University Medical Center completed a questionnaire that addressed the palliative care of a hypothetical patient with metastatic non-small cell lung cancer. The questions addressed were 1) opioid selection, 2) conversion of parenteral to oral morphine, 3) management of opioid toxicities, 4) opioid addiction, and 5) efficacy of radiation therapy. The results demonstrated that few physicians in training were familiar with the stepwise progression of analgesic selection outlined in the World Health Organization (WHO) guidelines. When asked to convert a parenteral dose of morphine to an equivalent dose of a controlled-release preparation, 75% calculated a dose that was less than one-third the correct dose; only four (5%) calculated the dose correctly. Trainees were familiar with the management of opioid toxicities. They were unfamiliar with the palliative benefits of radiation therapy. Although 41% recognized that complete relief of pain could be achieved in 50%-60% of patients, most (70%) predicted that maximum pain relief would be seen within the first month, and 98% predicted maximum benefit by 12 weeks. Although cancer pain management has been highlighted in the lay and medical literature, physicians in training still demonstrate deficiencies in their knowledge about the pharmacology and bioequivalency of the opioid and the benefits of radiation therapy. Published guidelines for the management of cancer pain need to be disseminated to all medical personnel caring for patients with cancer.