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Comparisons of Patient and Physician Assessment of Pain-Related Domains in Cancer Pain Classification: Results From a Large International Multicenter Study

  • Cinzia Brunelli
    Correspondence
    Address reprint requests to Cinzia Brunelli, MSc, Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milano, Italy.
    Affiliations
    Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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  • Stein Kaasa
    Affiliations
    European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Cancer Clinic, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
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  • Anne Kari Knudsen
    Affiliations
    European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Cancer Clinic, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
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  • Marianne Jensen Hjermstad
    Affiliations
    European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Regional Centre for Excellence in Palliative Care, Department of Oncology, Oslo University Hospital, Ulleval, Oslo, Norway.
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  • Alessandra Pigni
    Affiliations
    Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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  • Augusto Caraceni
    Affiliations
    Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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      Abstract

      The aim of the present study is to compare physician clinical assessment with patient-rated evaluations in the classification of cancer pain patients into groups with different pain levels, according to the presence of incident/breakthrough pain, neuropathic pain, and psychological distress. Average pain in the previous 24 hours was used as the dependent variable in multivariate linear regression models, and incident/breakthrough pain, neuropathic pain, and psychological distress were tested as regressors; in the assessment of regressors, physicians used the Edmonton Classification System for Cancer Pain, whereas patients used structured self-assessment questionnaires. The amount of variability in pain intensity scores explained by the 2 sets of regressors, physician and patient rated, was compared using R2 values. When tested in 2 separate models, patient ratings explained 20.3% of variability (95% confidence interval [CI] = 15.2–25.3%), whereas physician ratings explained 6.1% (95% CI = 2.2–9.8%). The higher discriminative capability of patient ratings was still maintained when both regressor sets were introduced in the same model, with R2 indices of 17.6% (95% CI = 13.0–22.2%) for patient ratings vs 3.4% (95% CI = .9–5.9%) for physician ratings. Patients' self-assessment of subjective symptoms should be integrated in future cancer pain classification systems.

      Perspective

      Our results indicate that patient-structured assessment of incident/breakthrough pain, neuropathic pain, and psychological distress significantly contributes to the discrimination of cancer patients with different pain levels. The integration of patient self-assessment tools with more objective clinician assessments can improve the classification of cancer pain.

      Key words

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