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Empirical Comparison of Commonly Used Measures to Evaluate Pain Treatment in Cancer Patients With Chronic Pain

From the Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, and Faculty of Psychology, University of Amsterdam, Amsterdam; Department of Medical Psychology and Psychotherapy, Erasmus University, Rotterdam, and Pain Expertise Center, University Hospital Rotterdam, Rotterdam; and Department of Nursing Science, University of Maastricht, Maastricht, the Netherlands.

Address reprint requests to Frits van Dam, PhD, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; email RdeWit{at}nki.nl

PURPOSE: There is limited consensus about the most appropriate measures to evaluate the adequacy of pain treatment in cancer patients. There are no known studies describing commonly used measures to simultaneously evaluate the adequacy of cancer pain treatment. The purpose of this study was to compare measures, which are frequently reported in the literature, to assess the adequacy of pain treatment in cancer patients with chronic pain. This study was part of a randomized controlled trial.

PATIENTS AND METHODS: In total, 313 cancer patients with a pain duration of at least 1 month were evaluated. After a baseline measure in the hospital, patients were followed up at 2, 4, and 8 weeks after discharge at home. Adequacy of cancer pain treatment was evaluated by means of four different types of outcome measures. The four types included three pain intensity markers based on patients' pain intensity, a pain relief scale, a patient satisfaction scale, and three pain management indexes that related patients' pain medication with pain intensity.

RESULTS: The proportion of inadequately treated pain patients varied extremely. Depending on the outcome measure used, the percentage of inadequately treated patients ranged from 16% to 91%. The choice of measure, rather than pain treatment itself, determined the proportion of inadequacy.

CONCLUSION: There is an urgent need for consensus about how to evaluate the effectiveness of pain treatment. Studies that evaluate adequacy of pain treatment should be interpreted with caution. Further research is necessary to elucidate the validity and reliability of outcome measures simultaneously.

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