Effect of Integrated Assessment and Management Tool on Pain Management in Cancer Center Inpatients

Key Points

  • Use of the EPAT tool was associated with an increase in clinically significant reduction in worst pain score.
  • No increase in opioid adverse effects was observed. 

In a UK-based study reported in the Journal of Clinical Oncology, Fallon et al found that adding a clinician-delivered bedside pain assessment and management tool (Edinburgh Pain Assessment and Management Tool [EPAT]) to usual care improved some pain outcomes in cancer center inpatients.

Study Details

EPAT is designed to change routine practice by using systematic assessment of cancer-related pain, guiding treatment using linked algorithms, and employing regular reassessment of pain to assess efficacy and adverse effects of treatment. The tool integrates pain assessment into routine care by its inclusion in the patient’s bedside chart; clinicians are prompted to assess pain using a two-step procedure with every recording of patient vital signs.

In the study, 19 cancer centers were randomized to implement EPAT (10 centers, including 506 patients before and 487 after randomization) or to continue usual care (9 centers, including 479 patients before and 449 after randomization). The primary outcome measure was change in the percentage of patients with a clinically significant (≥ 2 point) improvement in the severity of worst pain reported over the previous 24 hours, measured between admission and reassessment at 3 to 5 days after admission using the Brief Pain Inventory Short Form (BPI-SF).

Pain Outcomes

The percentage of patients with a clinically significant improvement in worst pain increased from 47.7% before randomization to 54.1% after randomization in centers assigned to EPAT and decreased from 50.6% to 46.4% in those assigned to usual care (absolute difference = 10.7%, P = .046). In an analysis excluding two centers randomized to EPAT that failed to implement the intervention, the absolute difference was 15.4% (P = .004). EPAT centers had greater improvements in prescribing practice (P = .03), based on appropriateness of medication prescribed compared with guidelines, and in the BPI-SF pain subscale score (P = .019).

No statistically significant differences between EPAT and usual-care centers were observed for the percentage of patients with controlled pain, mean pain interference score, mean total pain score, or mean severity of global distress. No differences were observed for the percentage of patients who received strong opioids (80%), mean total 24-hour oral morphine equivalent (10 mg), or opioid-related adverse effects based on mean opioid toxicity score.  

The investigators concluded, “A systematic integrated approach improves pain outcomes for inpatients in cancer centers without increasing opioid adverse effects.”

The study was supported by Cancer Research UK and others.

Marie Fallon, MD, of the Institute of Genetics and Molecular Medicine, Edinburgh Cancer Research Centre, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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