Supportive Care in Cancer

, Volume 20, Issue 10, pp 2491–2500 | Cite as

Interviews with patients with advanced cancer—another step towards an international cancer pain classification system

  • Anne Kari KnudsenEmail author
  • Nina Aass
  • Ellen Heitzer
  • Pål Klepstad
  • Marianne Jensen Hjermstad
  • Walter Schippinger
  • Elisabeth Brenne
  • Stein Kaasa
  • Elisabet Wasteson
  • On behalf of the European Palliative Care Research Collaborative (EPCRC)
Original Article



Patients’ involvement in the development of assessment tools is recommended, and the European Palliative Care Research Collaborative has adhered to this when developing a shared language for cancer pain, an international assessment and classification system. Study objectives were to investigate how patients ranked the relevance of several previously identified pain domains, to investigate patients’ perception of the pain experience and to disclose additional, relevant pain domains for cancer pain classification to those identified in the literature.


Semistructured interviews with advanced cancer patients treated with opioids were performed and analysed verbatim. Patients scored the relevance of predefined pain domains on an 11-point Numerical Rating Scale.


Thirty-three Norwegian and Austrian patients were included (16 females and 17 males); the mean age was 63 years, and the mean Karnofsky performance score was 65. The ranking of domains was as follows etiology (mean Numerical Rating Scale score, 8.5), duration (8.0), intensity (7.4), coping (7.1), physical (5.9) and psychological functioning (5.8). Sleep was identified as a new candidate domain to include in the system. The patients emphasised consequences of having pain, for example, poor physical functioning and psychological distress.


Previously identified pain domains were confirmed to be relevant to the patients; however, the ranking differed from the experts’ ranking. Sleep disturbances may be added as a domain in a future classification system.


Cancer Classification Pain Palliative care Qualitative method PROs 



We would like to thank all the patients for their kind and generous sharing of thoughts and experiences.

Thanks to Bente Moldaunet for conscientious transcribing of the interviews and to Hanne Paltiel for proofreading the translated quotations.


This study was supported by the EU’s 6th framework, contract no. 037777, PI Stein Kaasa, and funding from Trondheim University Hospital, Norway. Anne Kari Knudsen received a grant from the Central Norway Regional Health Authority.

Conflict of interest

None of the authors have a relationship with any entities that have a financial interest in this topic.

The authors have full control of all primary data; the journal is allowed to review the data upon request.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Anne Kari Knudsen
    • 1
    • 7
    Email author
  • Nina Aass
    • 2
    • 3
  • Ellen Heitzer
    • 4
  • Pål Klepstad
    • 5
    • 6
  • Marianne Jensen Hjermstad
    • 1
    • 3
  • Walter Schippinger
    • 4
  • Elisabeth Brenne
    • 1
    • 7
  • Stein Kaasa
    • 1
    • 7
  • Elisabet Wasteson
    • 1
    • 8
  • On behalf of the European Palliative Care Research Collaborative (EPCRC)
  1. 1.European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, 3.etg. BevegelseTrondheim University HospitalTrondheimNorway
  2. 2.Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Regional Center for Excellence in Palliative CareOslo University HospitalOsloNorway
  4. 4.Division of Palliative Medicine, Department of Internal MedicineMedical University of GrazGrazAustria
  5. 5.Department of Circulation and Medical ImagingFaculty of MedicineTrondheimNorway
  6. 6.Department of Anesthesiology and Emergency Medicine, Intensive Care UnitTrondheim University HospitalTrondheimNorway
  7. 7.Department of OncologyTrondheim University HospitalTrondheimNorway
  8. 8.Division of Psychology, Department of Social SciencesMid Sweden UniversityÖstersundSweden

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