Treatment of terminal cancer pain in France: a questionnaire study

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Abstract
Compared with other European countries, French laws and restrictions concerning the use of opioids are of medium severity only. Still, together with Germany, Belgium and Spain, France belongs to the group of countries with a low national consumption of morphine, calculated by the International Narcotics Control Board of United Nations. In order to elucidate the current practice of French physicians treating cancer pain, a questionnaire study was carried out, using the nationwide register of general practitioners and specialists of a pharmaceutical company. The knowledge of the principles and methods of cancer pain treatment were evaluated with 9 open and 19 multiple-choice questions. The ability of the physicians to apply their knowledge in practice was evaluated by analyzing their suggested treatment of 3 illustrative case histories. The favourite drugs in treating cancer pain were strong opioid agonists, suggested by 25% of the general practitioners and 44% of the specialists for a typical cancer pain patient. The recommended daily doses of opioids were mostly far below the level generally accepted in palliative care. The drug of choice for metastatic bone pain was a combination of paracetamol and codeine, chosen by a third of the general practitioners. Consequently, only 10% and 21% of the treatment suggestions were regarded as adequate. Ninety-two percent of the physicians experienced difficulties in the treatment of cancer pain, inefficacy of treatment being the most important problem.

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