Skip to main content
Top
Published in: Supportive Care in Cancer 7/2014

01-07-2014 | Original Article

A cross-sectional study on prevalence of pain and breakthrough pain among an unselected group of outpatients in a tertiary cancer clinic

Authors: Sunil X. Raj, Morten Thronaes, Cinzia Brunelli, Marianne J. Hjermstad, Pål Klepstad, Stein Kaasa

Published in: Supportive Care in Cancer | Issue 7/2014

Login to get access

Abstract

Purpose

Systematic knowledge about the prevalence and the treatment effects of cancer pain in patients attending a general oncology outpatient department is limited. The purpose of this study was to investigate the prevalence of pain in a large representative cohort of patients attending a general oncology outpatient department in order to guide further screening, classification, and treatment of pain.

Material and methods

A cross-sectional study among patients visiting the outpatient clinic with histologically verified cancer, age ≥18 years, adequate cognitive function, and no surgical procedures last 24 h were included. Pain was assessed by the Brief Pain Inventory and the Alberta Breakthrough Pain Assessment Tool.

Results

Three hundred five patients were included. The mean age was 60 years, 94 % had a WHO performance status of 0–1 and 59 % received oncological treatment with a curative intent. The mean score for average pain last 24 h (numerical rating scale, 0–10) and current pain was 1.84 and 1.08, respectively. Twenty-two percent reported pain score of ≥4 as their average pain in the previous 24 h. Twenty-one percent reported breakthrough pain (BTP). In multivariate analyses, sleep, BTP, age, treatment intent, and comorbidity was significantly associated with mean average pain in the previous 24 h and explained 29 % of the variability of average pain in the previous 24 h.

Conclusion

Of the patients at an oncology outpatient clinic, 22 % reported clinically significant pain. These findings indicate that all patients are candidates to be screened for pain and, if present, a more detailed pain diagnosis should be established before any interventions can be recommended.
Literature
1.
go back to reference Barbera L, Seow H, Howell D, Sutradhar R, Earle C, Liu Y, Stitt A, Husain A, Sussman J, Dudgeon D (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116:5767–5776PubMedCrossRef Barbera L, Seow H, Howell D, Sutradhar R, Earle C, Liu Y, Stitt A, Husain A, Sussman J, Dudgeon D (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116:5767–5776PubMedCrossRef
2.
go back to reference Cleeland CS (1989) Measurement of pain by subjective report. In: Chapman CR, Loeser JD (eds) Advances in pain research and therapy. Raven, New York, pp 391–403 Cleeland CS (1989) Measurement of pain by subjective report. In: Chapman CR, Loeser JD (eds) Advances in pain research and therapy. Raven, New York, pp 391–403
3.
go back to reference O’Connor M, Weir J, Butcher I, Kleiboer A, Murray G, Sharma N, Thekkumpurath P, Walker J, Fallon M, Storey DJ, Sharpe M (2011) Pain in patients attending a specialist cancer service: prevalence and association with emotional distress. J Pain Symptom Manage 43(1):29–38PubMedCrossRef O’Connor M, Weir J, Butcher I, Kleiboer A, Murray G, Sharma N, Thekkumpurath P, Walker J, Fallon M, Storey DJ, Sharpe M (2011) Pain in patients attending a specialist cancer service: prevalence and association with emotional distress. J Pain Symptom Manage 43(1):29–38PubMedCrossRef
4.
go back to reference Mercadante S, Radbruch L, Caraceni A, Cherny N, Kaasa S, Nauck F, Ripamonti C, De Conno F (2002) Episodic (breakthrough) pain: Consensus Conference of an Expert Working Group of the European Association for Palliative Care. Cancer 94:832–839PubMedCrossRef Mercadante S, Radbruch L, Caraceni A, Cherny N, Kaasa S, Nauck F, Ripamonti C, De Conno F (2002) Episodic (breakthrough) pain: Consensus Conference of an Expert Working Group of the European Association for Palliative Care. Cancer 94:832–839PubMedCrossRef
5.
go back to reference Zeppetella G, O’Doherty CA, Collins S (2000) Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. J Pain Symptom Manage 20:87–92PubMedCrossRef Zeppetella G, O’Doherty CA, Collins S (2000) Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. J Pain Symptom Manage 20:87–92PubMedCrossRef
6.
go back to reference Portenoy RK, Hagen NA (1990) Breakthrough pain: definition, prevalence and characteristics. Pain 41:273–281PubMedCrossRef Portenoy RK, Hagen NA (1990) Breakthrough pain: definition, prevalence and characteristics. Pain 41:273–281PubMedCrossRef
7.
go back to reference Payne R (2007) Recognition and diagnosis of breakthrough pain. Pain Med 8(Suppl 1):S3–S7PubMed Payne R (2007) Recognition and diagnosis of breakthrough pain. Pain Med 8(Suppl 1):S3–S7PubMed
8.
go back to reference Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA (2010) Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 1: prevalence and characteristics. J Opioid Manag 6:97–108PubMedCrossRef Portenoy RK, Bruns D, Shoemaker B, Shoemaker SA (2010) Breakthrough pain in community-dwelling patients with cancer pain and noncancer pain, part 1: prevalence and characteristics. J Opioid Manag 6:97–108PubMedCrossRef
9.
go back to reference Valeberg BT, Miaskowski C, Hanestad BR, Bjordal K, Moum T, Rustoen T (2008) Prevalence rates for and predictors of self-reported adherence of oncology outpatients with analgesic medications. Clin J Pain 24:627–636PubMedCrossRef Valeberg BT, Miaskowski C, Hanestad BR, Bjordal K, Moum T, Rustoen T (2008) Prevalence rates for and predictors of self-reported adherence of oncology outpatients with analgesic medications. Clin J Pain 24:627–636PubMedCrossRef
10.
go back to reference Fainsinger RL, Nekolaichuk C, Lawlor P, Hagen N, Bercovitch M, Fisch M, Galloway L, Kaye G, Landman W, Spruyt O, Zhukovsky D, Bruera E, Hanson J (2010) An international multicentre validation study of a pain classification system for cancer patients. Eur J Cancer 46:2896–2904PubMedCrossRef Fainsinger RL, Nekolaichuk C, Lawlor P, Hagen N, Bercovitch M, Fisch M, Galloway L, Kaye G, Landman W, Spruyt O, Zhukovsky D, Bruera E, Hanson J (2010) An international multicentre validation study of a pain classification system for cancer patients. Eur J Cancer 46:2896–2904PubMedCrossRef
11.
go back to reference Knudsen AK, Brunelli C, Kaasa S, Apolone G, Corli O, Montanari M, Fainsinger R, Aass N, Fayers P, Caraceni A, Klepstad P, European Palliative Care Research Collaborative, European Pharmacogenetic Study (2011) Which variables are associated with pain intensity and treatment response in advanced cancer patients? Implications for a future classification system for cancer pain. Eur J Pain 15:320–327PubMedCrossRef Knudsen AK, Brunelli C, Kaasa S, Apolone G, Corli O, Montanari M, Fainsinger R, Aass N, Fayers P, Caraceni A, Klepstad P, European Palliative Care Research Collaborative, European Pharmacogenetic Study (2011) Which variables are associated with pain intensity and treatment response in advanced cancer patients? Implications for a future classification system for cancer pain. Eur J Pain 15:320–327PubMedCrossRef
12.
go back to reference Cleeland CS (1991) Pain assessment in cancer. CRC Press, Boca Raton Cleeland CS (1991) Pain assessment in cancer. CRC Press, Boca Raton
13.
go back to reference Daut RL, Cleeland CS, Flanery RC (1983) Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 17:197–210PubMedCrossRef Daut RL, Cleeland CS, Flanery RC (1983) Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 17:197–210PubMedCrossRef
14.
go back to reference Hagen N, Stiles C, Nekolaichuk C, Biondo P, Carlson L, Fisher K, Fainsinger R (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 17:136–152CrossRef Hagen N, Stiles C, Nekolaichuk C, Biondo P, Carlson L, Fisher K, Fainsinger R (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 17:136–152CrossRef
15.
go back to reference Klepstad P, Loge JH, Borchgrevink PC, Mendoza TR, Cleeland CS, Kaasa S (2002) The Norwegian Brief Pain Inventory Questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manage 24:517–525PubMedCrossRef Klepstad P, Loge JH, Borchgrevink PC, Mendoza TR, Cleeland CS, Kaasa S (2002) The Norwegian Brief Pain Inventory Questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manage 24:517–525PubMedCrossRef
16.
go back to reference Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330:592–596PubMedCrossRef Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330:592–596PubMedCrossRef
17.
go back to reference Shvartzman P, Friger M, Shani A, Barak F, Yoram C, Singer Y (2003) Pain control in ambulatory cancer patients—can we do better? J Pain Symptom Manage 26:716–722PubMedCrossRef Shvartzman P, Friger M, Shani A, Barak F, Yoram C, Singer Y (2003) Pain control in ambulatory cancer patients—can we do better? J Pain Symptom Manage 26:716–722PubMedCrossRef
18.
go back to reference Davies A, Zeppetella G, Andersen S, Damkier A, Vejlgaard T, Nauck F, Radbruch L, Sjolund KF, Stenberg M, Buchanan A (2011) Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies. Eur J Pain 15:756–763PubMedCrossRef Davies A, Zeppetella G, Andersen S, Damkier A, Vejlgaard T, Nauck F, Radbruch L, Sjolund KF, Stenberg M, Buchanan A (2011) Multi-centre European study of breakthrough cancer pain: pain characteristics and patient perceptions of current and potential management strategies. Eur J Pain 15:756–763PubMedCrossRef
19.
go back to reference Portenoy RK, Payne D, Jacobsen P (1999) Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 81:129–134PubMedCrossRef Portenoy RK, Payne D, Jacobsen P (1999) Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 81:129–134PubMedCrossRef
20.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef
21.
go back to reference Groll DL, To T, Bombardier C, Wright JG (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602PubMedCrossRef Groll DL, To T, Bombardier C, Wright JG (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602PubMedCrossRef
22.
go back to reference Klepstad P, Fladvad T, Skorpen F, Bjordal K, Caraceni A, Dale O, Davies A, Kloke M, Lundstrom S, Maltoni M, Radbruch L, Sabatowski R, Sigurdardottir V, Strasser F, Fayers PM, Kaasa S (2011) Influence from genetic variability on opioid use for cancer pain: a European genetic association study of 2294 cancer pain patients. Pain 152:1139–1145PubMedCrossRef Klepstad P, Fladvad T, Skorpen F, Bjordal K, Caraceni A, Dale O, Davies A, Kloke M, Lundstrom S, Maltoni M, Radbruch L, Sabatowski R, Sigurdardottir V, Strasser F, Fayers PM, Kaasa S (2011) Influence from genetic variability on opioid use for cancer pain: a European genetic association study of 2294 cancer pain patients. Pain 152:1139–1145PubMedCrossRef
23.
go back to reference Hjermstad MJ, Lie HC, Caraceni A, Currow DC, Fainsinger RL, Gundersen OE, Haugen DF, Heitzer E, Radbruch L, Stone PC, Strasser F, Kaasa S, Loge JH (2012) Computer-based symptom assessment is feasible in patients with advanced cancer: results from an international multicenter study, the EPCRC-CSA. J Pain Symptom Manage 44:639–654PubMedCrossRef Hjermstad MJ, Lie HC, Caraceni A, Currow DC, Fainsinger RL, Gundersen OE, Haugen DF, Heitzer E, Radbruch L, Stone PC, Strasser F, Kaasa S, Loge JH (2012) Computer-based symptom assessment is feasible in patients with advanced cancer: results from an international multicenter study, the EPCRC-CSA. J Pain Symptom Manage 44:639–654PubMedCrossRef
24.
go back to reference Fainsinger RL, Nekolaichuk CL (2008) A “TNM” classification system for cancer pain: the Edmonton Classification System for Cancer Pain (ECS-CP). Support Care Cancer 16:547–555PubMedCrossRef Fainsinger RL, Nekolaichuk CL (2008) A “TNM” classification system for cancer pain: the Edmonton Classification System for Cancer Pain (ECS-CP). Support Care Cancer 16:547–555PubMedCrossRef
25.
go back to reference Knudsen AK, Brunelli C, Klepstad P, Aass N, Apolone G, Corli O, Montanari M, Caraceni A, Kaasa S (2012) Which domains should be included in a cancer pain classification system? Analyses of longitudinal data. Pain 153:696–703PubMedCrossRef Knudsen AK, Brunelli C, Klepstad P, Aass N, Apolone G, Corli O, Montanari M, Caraceni A, Kaasa S (2012) Which domains should be included in a cancer pain classification system? Analyses of longitudinal data. Pain 153:696–703PubMedCrossRef
Metadata
Title
A cross-sectional study on prevalence of pain and breakthrough pain among an unselected group of outpatients in a tertiary cancer clinic
Authors
Sunil X. Raj
Morten Thronaes
Cinzia Brunelli
Marianne J. Hjermstad
Pål Klepstad
Stein Kaasa
Publication date
01-07-2014
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 7/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-014-2178-3

Other articles of this Issue 7/2014

Supportive Care in Cancer 7/2014 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine