In the light of the high prevalence and the severity of pain among patients with cancer, the assessment and treatment of cancer pain in France remain inadequate, emphasising the need for changes in patient care.

Objective: To investigate if the incidence of disorders of spermatogenesis and testicular tissue morphology have changed in middle aged Finnish men over 10 years. Design: Two necropsy series completed in 1981 and in 1991. Setting:

Background. Two representative samples of primary care physicians (N=600) and medical oncologists (N=300) in France were surveyed about their attitudes toward and knowledge about cancer pain management. Methods. The survey was conducted by telephone with a questionnaire based on a model developed by the University of Wisconsin‐Madison Pain Research Group. It was designed to assess physicians' estimates of the prevalence of pain among patients with cancer, their practice in prescribing analgesics, their training in cancer pain management, and the quality of care received by cancer patients in their own practice and in France. Results. Barriers to adequate cancer pain management are prevalent and consistently more common among primary care physicians than among medical oncologists. Although 85% of primary care physicians and 93% of medical oncologists express satisfaction with their own ability to manage cancer pain, 76% of primary care physicians and 50% of medical oncologists report being reluctant to prescribe morphine for cancer pain. Both groups cite fear of side effects as their main reason to hesitate to prescribe morphine. Concerns about the risk of tolerance (odds ratio [OR], 1.15–2.52), perceptions that other effective drugs are available (OR, 1.11–2.41), perceptions that morphine has a poor image in public opinion (OR, 0.96–2.07), and the constraints of prescription forms (OR, 1.12‐2.26) contribute significantly to physicians' infrequent prescription of morphine, as are being female (OR, 1.01‐2.03) and being an older oncologist (OR, 1.09‐2.51). Conclusions. This study (1) confirms the existence among French physicians of attitudinal barriers and knowledge deficits previously reported in other countries that can impede cancer pain management, (2) identifies new barriers to the proper prescription of morphine for cancer pain control, and (3) reveals discrepancies in physicians' attitudes and knowledge about pain control which suggest a need for the systematic evaluation of cancer patients' care. Cancer 1995; 76:2375‐82.

To assess how well physicians recognize common symptoms in HIV patients and identify factors associated with symptom recognition, a multicenter cross-sectional survey was performed in a random sample of 118 hospitalized and 172 ambulatory HIV patients, and their attending physicians. Patients' reports of 16 different symptoms were compared to physicians' reports of whether each symptom was present and/or specific treatments prescribed. Overall, fatigue, anxiety, skin problems, fever, and weight loss were more often recognized by physicians than other symptoms. Agreement between patients and physicians was poor to moderate, with Kappa statistics ranging from 0.17 (dry mouth) to 0.58 (fever). Recognition was independently more likely for ambulatory patients (adjusted odds ratio 1.69, P < 0.001) and for patients seen as sicker (adjusted odds ratio 1.88, P < 0.001). Appropriate symptom management requires improved symptom recognition. More systematic clinical examinations, including attentive patient interview, are needed.

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