Documentation of Pain in Comprehensive Cancer Centers in the United States: A Preliminary Analysis

Authors:
Sharon M. Weinstein From: Huntsman Cancer Institute, Salt Lake City, Utah; Dana-Farber Partners Cancer Care, Boston, Massachusetts; National Comprehensive Cancer Network, Jenkintown, Pennsylvania; The University of Texas M.D. Anderson Cancer Center, Houston, Texas; formerly of City of Hope National Medical Center, Duarte, CA, now from Dorothy Schneider Cancer Center, San Mateo, CA; formerly from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, currently from The Hospices of the National Capital Region, Fairfax, Virginia, and City of Hope National Medical Center, Duarte, California.

Search for other papers by Sharon M. Weinstein in
Current site
Google Scholar
PubMed
Close
 MD
,
Dorothy Romanus From: Huntsman Cancer Institute, Salt Lake City, Utah; Dana-Farber Partners Cancer Care, Boston, Massachusetts; National Comprehensive Cancer Network, Jenkintown, Pennsylvania; The University of Texas M.D. Anderson Cancer Center, Houston, Texas; formerly of City of Hope National Medical Center, Duarte, CA, now from Dorothy Schneider Cancer Center, San Mateo, CA; formerly from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, currently from The Hospices of the National Capital Region, Fairfax, Virginia, and City of Hope National Medical Center, Duarte, California.

Search for other papers by Dorothy Romanus in
Current site
Google Scholar
PubMed
Close
 MSc
,
Eva M. Lepisto From: Huntsman Cancer Institute, Salt Lake City, Utah; Dana-Farber Partners Cancer Care, Boston, Massachusetts; National Comprehensive Cancer Network, Jenkintown, Pennsylvania; The University of Texas M.D. Anderson Cancer Center, Houston, Texas; formerly of City of Hope National Medical Center, Duarte, CA, now from Dorothy Schneider Cancer Center, San Mateo, CA; formerly from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, currently from The Hospices of the National Capital Region, Fairfax, Virginia, and City of Hope National Medical Center, Duarte, California.

Search for other papers by Eva M. Lepisto in
Current site
Google Scholar
PubMed
Close
 MSc
,
Cielito Reyes-Gibby From: Huntsman Cancer Institute, Salt Lake City, Utah; Dana-Farber Partners Cancer Care, Boston, Massachusetts; National Comprehensive Cancer Network, Jenkintown, Pennsylvania; The University of Texas M.D. Anderson Cancer Center, Houston, Texas; formerly of City of Hope National Medical Center, Duarte, CA, now from Dorothy Schneider Cancer Center, San Mateo, CA; formerly from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, currently from The Hospices of the National Capital Region, Fairfax, Virginia, and City of Hope National Medical Center, Duarte, California.

Search for other papers by Cielito Reyes-Gibby in
Current site
Google Scholar
PubMed
Close
 DrPH
,
Charles Cleeland From: Huntsman Cancer Institute, Salt Lake City, Utah; Dana-Farber Partners Cancer Care, Boston, Massachusetts; National Comprehensive Cancer Network, Jenkintown, Pennsylvania; The University of Texas M.D. Anderson Cancer Center, Houston, Texas; formerly of City of Hope National Medical Center, Duarte, CA, now from Dorothy Schneider Cancer Center, San Mateo, CA; formerly from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, currently from The Hospices of the National Capital Region, Fairfax, Virginia, and City of Hope National Medical Center, Duarte, California.

Search for other papers by Charles Cleeland in
Current site
Google Scholar
PubMed
Close
 PhD
,
Rex Greene From: Huntsman Cancer Institute, Salt Lake City, Utah; Dana-Farber Partners Cancer Care, Boston, Massachusetts; National Comprehensive Cancer Network, Jenkintown, Pennsylvania; The University of Texas M.D. Anderson Cancer Center, Houston, Texas; formerly of City of Hope National Medical Center, Duarte, CA, now from Dorothy Schneider Cancer Center, San Mateo, CA; formerly from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, currently from The Hospices of the National Capital Region, Fairfax, Virginia, and City of Hope National Medical Center, Duarte, California.

Search for other papers by Rex Greene in
Current site
Google Scholar
PubMed
Close
 MD
,
Cameron Muir From: Huntsman Cancer Institute, Salt Lake City, Utah; Dana-Farber Partners Cancer Care, Boston, Massachusetts; National Comprehensive Cancer Network, Jenkintown, Pennsylvania; The University of Texas M.D. Anderson Cancer Center, Houston, Texas; formerly of City of Hope National Medical Center, Duarte, CA, now from Dorothy Schneider Cancer Center, San Mateo, CA; formerly from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, currently from The Hospices of the National Capital Region, Fairfax, Virginia, and City of Hope National Medical Center, Duarte, California.

Search for other papers by Cameron Muir in
Current site
Google Scholar
PubMed
Close
 MD
, and
Joyce Niland
Search for other papers by Joyce Niland in
Current site
Google Scholar
PubMed
Close
 PhD
Full access

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.

Correspondence: Sharon M. Weinstein, MD, Department of Anesthesiology, Neurology and Oncology, University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, Utah 84112. E-mail: sharon.weinstein@hci.utah.edu
  • Collapse
  • Expand
  • 1

    McGivney WT, Crooks GM. The care of patients with severe chronic pain in terminal illness. JAMA 1984;251:11821188.

  • 2

    Cleeland CS, Gonin R, Hatfield AK et al.. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994;330:592596.

  • 3

    NCCN Cancer Pain Clinical Practice Guidelines in Oncology. In The Complete Library of Practice Guidelines in Oncology [CD-ROM]. Rockledge, PA: National Comprehensive Cancer Network; 2001.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373383.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Agresti A. Categorical Data Analysis. XV. New York, NY: Wiley and Sons, 1990;234235.

  • 6

    Weinstein SM, Laux LF, Thornby JI et al.. Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative. South Med J 2000;93:479487.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Eddy DM. Clinical decision-making: From theory to practice: Broadening the responsibilities of practitioners. JAMA 1993;270:708709.

Metrics

All Time Past Year Past 30 Days
Abstract Views 1 0 0
Full Text Views 1067 390 95
PDF Downloads 409 69 8
EPUB Downloads 0 0 0