Reply to H. Charalambous et al

We agree with Charalambous and Silbermann that action needs to be taken to improve the skills of oncologists to manage chronic cancer pain. Their suggestion for clinical training programs at first seems logical; they cite findings that classroom training did not improve residents’ knowledge, a finding consistent with ours, that is, that continuing medical education in cancer pain management seemed to be ineffective. They also cite a study showing that clinically based training in palliative care is effective. In that study, however, there was only a 10% improvement, with statistically significant improvement in only six of 25 questions. In addition, the program was optional, which might suggest that those who took it were more motivated than most, making the generalizability of these findings questionable. Thus, although we agree that change is critically needed, the way to accomplish that change remains elusive. We continue to study this issue and hope that a more complete characterization of this problem will inform the development of more effective programs to support best practices in pain management and palliative care for the broad oncology community. Brenda Breuer, Ricardo A. Cruciani, and Russell K. Portenoy Beth Israel Medical Center, New York, NY