The National Comprehensive Cancer Network (NCCN), an organization of 19 of the world's leading cancer centers, developed and communicated a cancer pain treatment guideline. NCCN seeks to implement guidelines through performance measurement using a NCCN Oncology Outcomes Database. This is a preliminary report from the NCCN Cancer Pain Management Database Project. The primary objective of this NCCN Cancer Pain Management Database Project study is to evaluate the frequency, methods, and extent of documentation of cancer pain assessment and managementat NCCN institutions. A pain data dictionary and related data collection forms were first developed. The records of 209 breast cancer patients with bone metastases were then studied. The frequency of pain mentions, type of pain assessment tool used, pain characteristics, type of clinician documenting pain, location in the medical record, and pain treatment characteristics were noted. The majority of clinical encounters included pain mentions, although considerable variability was found in pain documentation between providers and between inpatient and outpatient settings. Nurses more frequently recorded pain, usually as a numeric pain intensity score. Pain specialists were more likely to record a complete description of pain. A significant minority of patients experienced moderate to severe pain. In a small subgroup of patients with moderate to severe pain, pain treatment was not recorded. The undertreatment of cancer pain has been a focus of investigation and review for the past two decades. Quality improvement efforts to raise the standard of pain management have been underway. The results of this study highlight the need for standardization of pain documentation in comprehensive cancer centers as a prerequisite for the proper assessment of cancer pain and the improvement of clinical outcomes of pain management.
Sharon M. Weinstein, Dorothy Romanus, Eva M. Lepisto, Cielito Reyes-Gibby, Charles Cleeland, Rex Greene, Cameron Muir and Joyce Niland
Jennifer L. Lyle, Jonathan L. Vandergrift, Jennifer M. Hinkel, Eva M. Lepisto, Kristie A. Cortazzo, Stephen Sherman and F. Marc Stewart
Insight into factors important to fellows' decision-making about their career paths is critical to successfully developing program curricula, making capacity projections, and recruiting oncology physicians. This study was performed to determine the factors associated with post-fellowship career decision-making. Program evaluation surveys were administered to oncology fellows who attended the Fellows Recognition Program at the 2009 NCCN Annual Conference. A total of 125 (75%) fellows completed the initial survey. Overall, 73% of fellows reported participating in clinical research and 58% received formal training as part of their fellowship program. Receipt of formal training was correlated with greater program satisfaction (rs = 0.20; P = .03), feeling more prepared for a post-fellowship career (rs = 0.30; P < .001), and greater interest in clinical research post fellowship (rs = 0.32; P < .001). Interest in post-fellowship clinical research (rs = 0.49; P < .001) and importance of protected academic time (rs = 0.57; P < .001) were strongly correlated with interest in practicing in an academic environment, whereas institutional reputation (rs = 0.18; P = .04) and a multidisciplinary practice environment (rs = 0.22; P = .02) were moderately associated with interest. Location, salary, multidisciplinary environment, and flexible scheduling were the most important controllable lifestyle (CL) factors. These results suggest that fellowship programs may be able to foster a desire to participate in research and subsequent interest in practicing in an academic institution through providing opportunities for formal training in clinical research skills. However, even in an academic setting, CL factors are important to attracting and retaining faculty.