Skip to main content

Advertisement

SpringerLink
Log in

Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Cancer pain (CP) management is challenging. In recent years, efforts were undertaken to achieve better CP management, e.g. clinical research, new treatment modalities, development of guidelines, education and focus on implementation. The aim of the present study was to compare the prevalence and characteristics of pain and breakthrough pain (BTP) between cross-sectional studies conducted in 2008 and 2014. It was hypothesized that an improvement in pain control would be observed the years in between.

Methods

Two cross-sectional studies were conducted where adult cancer patients answered questions from Brief Pain Inventory and the Alberta Breakthrough Pain Assessment Tool for cancer patients. Physicians reported socio-demographic and medical data. Regression models were applied for analysis.

Results

In total, 168 inpatients, 92 in 2008 and 76 in 2014, and 675 outpatients, 301 in 2008 and 374 in 2014, were included. The patient characteristics of the samples were comparable. Prevalence of CP among inpatients was 55 % in 2008 and 53 % in 2014, and among outpatients, 39 and 35 %, respectively. Inpatients reported average pain intensity (0–10 numerical rating scale, NRS) of 3.60 (standard deviation, SD 1.84) (2008) and 4.08 (SD 2.11) (2014); prevalence of BTP was 52 % (2008) and 41 % (2014). For outpatients, average pain intensity was 3.60 (SD 2.04) (2008) and 3.86 (SD 2.20) (2014); prevalence of BTP was 43 % (2008) and 37 % (2014). None of the differences were statistically significant.

Conclusion

Unexpectedly, no improvement in pain control was observed. Efforts are still needed to improve cancer pain management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Donaldson N, Joranson D, Sbanotto A, Teoh N, Twycross R, Ventafridda V. Cancer pain relief. Cancer pain relief. second edition ed. Genova: World Health Organisation (WHO); 1996. p. 1–36.

  2. Stjernsward J (1988) WHO cancer pain relief programme. Cancer Surv 7(1):195–208

    CAS  PubMed  Google Scholar 

  3. Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA (1995) Validation of World Health Organization guidelines for cancer pain relief: a 10-year prospective study. Pain 63(1):65–76

    Article  CAS  PubMed  Google Scholar 

  4. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–49

    Article  Google Scholar 

  5. Porter LS, Keefe FJ (2011) Psychosocial issues in cancer pain. Curr Pain Headache Rep 15(4):263–70

    Article  PubMed  Google Scholar 

  6. Knudsen AK, Brunelli C, Klepstad P, Aass N, Apolone G, Corli O et al (2012) Which domains should be included in a cancer pain classification system? Analyses of longitudinal data. Pain 153(3):696–703

    Article  PubMed  Google Scholar 

  7. Fainsinger RL, Nekolaichuk C, Lawlor P, Hagen N, Bercovitch M, Fisch M et al (2010) An international multicentre validation study of a pain classification system for cancer patients. Eur J Cancer 46(16):2896–904

    Article  PubMed  Google Scholar 

  8. Cleeland CS, Ryan KM (1994) Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 23(2):129–38

    CAS  PubMed  Google Scholar 

  9. Bennett M (2001) The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92(1–2):147–57

    Article  CAS  PubMed  Google Scholar 

  10. Gilbody S, Richards D, Brealey S, Hewitt C (2007) Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med 22(11):1596–602

    Article  PubMed  PubMed Central  Google Scholar 

  11. Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 282(18):1737–44

    Article  CAS  PubMed  Google Scholar 

  12. Watanabe SM, Nekolaichuk C, Beaumont C, Johnson L, Myers J, Strasser F (2011) A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J Pain Symptom Manage 41(2):456–68

    Article  PubMed  Google Scholar 

  13. Sigurdardottir KR, Kaasa S, Rosland JH, Bausewein C, Radbruch L, Haugen DF et al (2014) The European Association for Palliative Care basic dataset to describe a palliative care cancer population: results from an international Delphi process. Palliat Med 28(6):463–73

    Article  PubMed  Google Scholar 

  14. Deandrea S, Corli O, Consonni D, Villani W, Greco MT, Apolone G (2013) Prevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature. J Pain Symptom Manage

  15. Caraceni A, Martini C, Zecca E, Portenoy RK, Ashby MA, Hawson G et al (2004) Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 18(3):177–83

    Article  PubMed  Google Scholar 

  16. Zeppetella G (2011) Breakthrough pain in cancer patients. Clin Oncol (R Coll Radiol) 23(6):393–8

    Article  CAS  Google Scholar 

  17. Haugen DF, Hjermstad MJ, Hagen N, Caraceni A, Kaasa S (2010) Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain 149(3):476–82

    Article  PubMed  Google Scholar 

  18. Kwon JH (2014) Overcoming barriers in cancer pain management. J Clin Oncol 32(16):1727–33

    Article  PubMed  Google Scholar 

  19. Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N et al (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13(2):e58–e68

    Article  CAS  PubMed  Google Scholar 

  20. (2013) Directorate of Health: Nasjonalt handlingsprogram med retningslinjer for palliasjon i kreftomsorgen [Norwegian guidelines for palliative care]. IS-2101

  21. Zeppetella G, Davies AN (2013) Opioids for the management of breakthrough pain in cancer patients. Cochrane Database Syst Rev 10:CD004311

    PubMed  Google Scholar 

  22. Norwegian Ministry of Health and Care Services: the coordination reform. Report No. 47. 2008–2009.

  23. Raj SX, Thronaes M, Brunelli C, Hjermstad MJ, Klepstad P, Kaasa S (2014) A cross-sectional study on prevalence of pain and breakthrough pain among an unselected group of outpatients in a tertiary cancer clinic. Support Care Cancer 22(7):1965–71

    Article  PubMed  Google Scholar 

  24. Hagen NA, Stiles C, Nekolaichuk C, Biondo P, Carlson LE, Fisher K et al (2008) The Alberta Breakthrough Pain Assessment Tool for cancer patients: a validation study using a Delphi process and patient think-aloud interviews. J Pain Symptom Manage 35(2):136–52

    Article  PubMed  Google Scholar 

  25. Karnofsky DA, Burchenal J (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod C, editor. Evaluation of chemotherapeutic agents. Columbia Univ Press; p. 196.

  26. Buccheri G, Ferrigno D, Tamburini M (1996) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 32A(7):1135–41

    Article  CAS  PubMed  Google Scholar 

  27. Holtan A, Aass N, Nordoy T, Haugen DF, Kaasa S, Mohr W et al (2007) Prevalence of pain in hospitalised cancer patients in Norway: a national survey. Palliat Med 21(1):7–13

    Article  PubMed  Google Scholar 

  28. Te Boveldt N, Vernooij-Dassen M, Burger N, Ijsseldijk M, Vissers K, Engels Y (2013) Pain and its interference with daily activities in medical oncology outpatients. Pain Physician 16(4):379–89

    Google Scholar 

  29. Davies A, Zeppetella G, Andersen S, Damkier A, Vejlgaard T, Nauck F et al (2011) Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies. Eur J Pain 15(7):756–63

    Article  PubMed  Google Scholar 

  30. Bedard G, Hawley P, Zhang L, Slaven M, Gagnon P, Bisland S et al (2013) A survey of Canadian cancer patients’ perspectives on the characteristics and treatment of breakthrough pain. Support Care Cancer 21(9):2557–63

    Article  PubMed  Google Scholar 

  31. Bennett MI, Bagnall AM, Jose CS (2009) How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain 143(3):192–9

    Article  PubMed  Google Scholar 

  32. Lovell MR, Luckett T, Boyle FM, Phillips J, Agar M, Davidson PM (2014) Patient education, coaching, and self-management for cancer pain. J Clin Oncol 32(16):1712–20

    Article  PubMed  Google Scholar 

  33. Te Boveldt N, Vernooij-Dassen M, Besse K, Vissers K, Engels Y (2014) Adoptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study. Support Care Cancer

  34. Lovell M, Agar M, Luckett T, Davidson PM, Green A, Clayton J (2013) Australian survey of current practice and guideline use in adult cancer pain assessment and management: perspectives of palliative care physicians. J Palliat Med 16(11):1403–9

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sanders S, Mackin ML, Reyes J, Herr K, Titler M, Fine P et al (2010) Implementing evidence-based practices: considerations for the hospice setting. Am J Hosp Palliat Care 27(6):369–76

    Article  PubMed  PubMed Central  Google Scholar 

  36. Du Pen SL, Du Pen AR, Polissar N, Hansberry J, Kraybill BM, Stillman M et al (1999) Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial. J Clin Oncol 17(1):361–70

    PubMed  Google Scholar 

  37. Du Pen AR, Du Pen S, Hansberry J, Miller-Kraybill B, Millen J, Everly R et al (2000) An educational implementation of a cancer pain algorithm for ambulatory care. Pain Manag Nurs 1(4):116–28

    Article  PubMed  Google Scholar 

  38. Vanhaecht K, De Witte K, Panella M, Sermeus W (2009) Do pathways lead to better organized care processes? J Eval Clin Pract 15(5):782–8

    Article  PubMed  Google Scholar 

  39. Vanhaecht K, Ovretveit J, Elliott MJ, Sermeus W, Ellershaw J, Panella M (2012) Have we drawn the wrong conclusions about the value of care pathways? Is a Cochrane review appropriate? Eval Health Prof 35(1):28–42

    Article  PubMed  Google Scholar 

  40. Rotter T, Kinsman L, James E, Machotta A, Willis J, Snow P et al (2012) The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs: Cochrane systematic review and meta-analysis. Eval Health Prof 35(1):3–27

    Article  PubMed  Google Scholar 

  41. omsorgsdepartementet H-o. Sammen mot kreft, Nasjonal kreftstrategi 2013–2017 [21.05 2015]. Available from: https://www.regjeringen.no/contentassets/07cd14ff763444a3997de1570b85fad1/kreftstrategien_2013.pdf.

  42. Brusamento S, Legido-Quigley H, Panteli D, Turk E, Knai C, Saliba V et al (2012) Assessing the effectiveness of strategies to implement clinical guidelines for the management of chronic diseases at primary care level in EU Member States: a systematic review. Health Policy 107(2–3):168–83

    Article  PubMed  Google Scholar 

  43. Boaz A, Baeza J, Fraser A, European Implementation Score Collaborative G (2011) Effective implementation of research into practice: an overview of systematic reviews of the health literature. BMC Res Notes 4:212

    Article  PubMed  PubMed Central  Google Scholar 

  44. Fixsen D, Scott V, Blase K, Naoom S, Wagar L (2011) When evidence is not enough: the challenge of implementing fall prevention strategies. J Saf Res 42(6):419–22

    Article  Google Scholar 

  45. Roshanov PS, Fernandes N, Wilczynski JM, Hemens BJ, You JJ, Handler SM et al (2013) Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. BMJ 346:f657

    Article  PubMed  Google Scholar 

Download references

Disclosure and acknowledgement

The research group was given a grant from the Cancer Foundation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, to conduct this study. BC received training grant from the Floriani Foundation—Milan (del.CDA 22/11/12).

Special thanks to Professor Dagny Faksvåg Haugen for support and advice during the analysis and writing of the manuscript and to Jorunn Brekke Fjeldheim for including patients at Aalesund Hospital in this study.

Author information

Authors and Affiliations

  1. European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491

    Morten Thronæs, Sunil X. Raj, Cinzia Brunelli, Ola Magne Vagnildhaug, Susanna Bruheim, Birgit Helgheim, Stein Kaasa & Anne Kari Knudsen

  2. Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006

    Morten Thronæs, Sunil X. Raj, Sigrun Saur Almberg, Ola Magne Vagnildhaug, Stein Kaasa & Anne Kari Knudsen

  3. Palliative Care, Pain therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Cinzia Brunelli

Authors
  1. Morten Thronæs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sunil X. Raj
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cinzia Brunelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sigrun Saur Almberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ola Magne Vagnildhaug
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Susanna Bruheim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Birgit Helgheim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stein Kaasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Anne Kari Knudsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Morten Thronæs.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thronæs, M., Raj, S.X., Brunelli, C. et al. Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart. Support Care Cancer 24, 2565–2574 (2016). https://doi.org/10.1007/s00520-015-3064-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-3064-3

Keywords

Search

Navigation