Treatment of terminal cancer pain in Finland: a second look

A questionnaire concerning the treatment of cancer pain was sent to 10% and 5% random samples of Finnish physicians in 1985 and in 1990, respectively. The physicians were asked about their current practice in the treatment of pain in their cancer patients, and about their main clinical problems when treating pain. Three simulated patient cases were presented, and the adequacy of the suggestions for therapy was evaluated. The results indicated that Finnish physicians had adopted a more rational and effective analgesic therapy during the 5-year period. Treatment suggestions for the simulated patient cases had improved both in terms of daily doses of analgesics and of dose intervals, but the doses of opioids were still below those commonly used in chronic cancer pain. The clinical difficulties experienced by the physicians had changed: instead of being frustrated by the inefficacy of their treatment as in 1985, physicians were now working on the problem of finding a suitable preparation and dosage. The results suggest that the voluntary activity of patient organizations, a few pain clinics, and a few clinicians interested in pain treatment have been able to improve the practising physicians' theoretical knowledge in 5 years. In contrast to the improvement in the knowledge and skills, changing attitudes takes much longer. As many as 39% of physicians who see cancer patients at least occasionally, reported that they still had not acquired the prescription sheets necessary to prescribe opioids to outpatients.