EAPC - ipac

416 EAPC Abstracts
achieve this, several factors that may influence the pain experience and
prognosis as well as the effect of treatment will have to be taken into account.
Firstly, there are factors related to the pain per se, e.g. the occurrence of
breakthrough pain, and the location and mechanisms of pain. Secondly, there
are factors related to the patient, e.g. former use of analgesics and/or other
drugs, the patient’s age and his/her emotional status, and thirdly there are disease
related factors e.g. cancer diagnosis and metastatic pattern. Although the
impact on pain experience, prognosis and treatment of some of these factors
is well described, the influence and importance of others are more poorly
understood. Hence, to decide which factors to include in the classification
system, further exploration and testing is necessary. Within the frames of the
EPCRC, this will be done through multinational patient and expert evaluation,
and by means of an international clinical study. The hypothesis is that
all three categories of factors, i.e pain-, patient-, and disease related, will have
to be included. A first proposal will be presented.
56 Invited Lecture
EPCRC, IASP and WHO: A step forward in Cancer Pain diagnosis
and treatment
Pain assessment – a standardised computer based tool in the
near future
Authors: Marianne Hjermstad Department of Oncology Ulleval University
Hospital NORWAY
repesenting the EPCRC
Background: Many patients experience suboptimal pain control, due to
inadequate pain assessment. The lack of agreement on how to assess and
classify pain demonstrates the need for inter-disciplinary collaboratives like
the EPCRC to reach consensus on pain and symptom assessment in
advanced cancer. Objectives: To develop a consensus based symptom
assessment tool for use in practice and research. Methods: The development
process largely follows the Delphi technique, an iterative multistage
process to reach group consensus, consisting of 9 steps: 1). Constructing an
item pool from literature reviews and expert reviews on pain
dimensions/items, 2). Clinical computerized study testing the item pool,
3). Data analyses/publications, 4). 2nd expert review, 5). Patient interviews,
pilot studies, 6.) Defining items/dimensions and the computerized analysis
model, 7.) 2nd data collection, international, 8). Data analyses/publications,
9). First version of the assessment tool. Results: As of April 2008, we have
completed the first 5 steps with publications in progress. Patients, clinicians
and researchers have contributed at all stages. Three main categories for
classification of pain are identified: pain factors, patient variables, disease
factors. The clinical study yielded 732 pain assessments. Analyses showed
that the included pain interference items generally performed less well than
the pain intensity items, and that numerical rating scales (NRS) may be
superior to verbal rating scales for raring pain intensity. Few patients scored
above 5. Assessment by computers was well accepted by patients. Software
programming for the multicenter study (12 centers) is ongoing. Advanced
programming makes possible comprehensive pain assessment and rapid
pain screening at the same time, for use in different clinical situations.
Conclusion: With all users; patients, clinicians, researchers involved in the
development process, it should be possible to develop a first version of a
consensus based assessment tool.
57 Invited Lecture
EPCRC, IASP and WHO: A step forward in Cancer Pain diagnosis
and treatment
Cancer pain guidelines in the EPCRC project
Authors: Augusto Caraceni National Cancer Institute Rehabilitation and
Pallliative Care Unit ITALY
Stein Kaasa Palliative Medicine Unit Trondheim NORWAY
Geoffrey Hanks Bristol Hematology and Oncology Centre Bristol UNITED
KINGDOM
Jane Gibbins Bristol Hematology and Oncology Centre Bristol UNITED
KINGDOM
Cinzia Brunelli National Cancer Institute Milan ITALY
Alessandra Pigni National Cancer Institute Milan ITALY
repesenting the EPCRC
Background: Aim: In order to revise and update the EAPC recommendations
on opioid administration, published in 2001, we conducted a literature
search of available chronic cancer pain guidelines. Methods: This was done
through an internet search from various websites (Google, Pubmed and
Cochrane library). A list of 18 guidelines on pain treatment published after
2000, was found. Seventeen available in English and one in French only; in
particular 9 U.S. guidelines, 7 from European countries, one Asiatic and one
Australian. The content of national and international guidelines were compared
with the 20 EAPC recommendations. Not all the 20 recommendations
were considered by each guideline, and in some cases the strenght of recommendations
was completely different from EAPC. The structure, the methods
and the content of all guidelines have been reviewed and compared with
EAPC guidelines. Results: Most guidelines include additional subjects not
covered by EAPC recommendations; e.g. indications about when to use
adjuvant drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), bisphosphonates,
radionuclides and radiotherapy. The comparison of all guidelines
lead to the formulation of 37 key points to be potentially included in the new
EAPC guideline. Conclusions: An international expert group of 27 members
has been appointed to participate in the guideline development process.
58 Invited Lecture
EPCRC, IASP and WHO: A step forward in Cancer Pain diagnosis
and treatment
Cancer pain and the WHO analgesic ladder: time for reappraisal
Authors: Geoffrey Hanks Department of Palliative Medicine Bristol
Haematology and Oncology Centre UNITED KINGDOM
The ‘WHO ladder’ has been the guiding concept in the management of cancer
pain worldwide for more than 20 years.This has been one of the most
influential and enduring guidelines in modern clinical practice. How effective
is the WHO method The prospective observational validation studies
demonstrated that roughly 80% of patients achieve good pain control (1).
The validity of this figure has been questioned (2) and there is no evidence
from RCTs to support it. There is evidence that many patients still suffer
unrelieved pain (3,4) and recent data from Bristol suggest that many
patients may suffer troublesome pain in spite of treatment according to current
best practice. The WHO guidelines need to be updated. What will
change The utility of Step 2 has long been questioned and specifically
whether the inclusion of Step 2 delays achievement of optimum pain control
for some patients. Recent data suggest that a two step approach may be
a safe and better alternative to the conventional ladder in these patients but
more robust evidence is required. Various aspects of the use of Step 3 opioids
(drug of first choice, role of active metabolites, opioid-poorly responsive
pain, opioid switching, management of breakthrough pain) continue to
excite debate. These topics will be considered in the updating of the EAPC
opioid guidelines, part of the EPCRC programme. Cancer pain continues to
be a major public health problem worldwide, affecting many millions of
patients. Several international initiatives have recently been launched
involving the WHO, IASP (International Association for the Study of Pain),
and the EPCRC all of which are aimed at improving our management of
cancer pain. The topic is very much on the scientific and political agendas.
59 Oral Presentation
Education and Epidemiology
Assessing the Effectiveness of International Palliative Care
Education Interventions using Standardized Competence and
Knowledge Evaluations
Authors: Frank Ferris Center for Palliative Studies San Diego Hospice &
Palliative Care U. STATES
Mary Wheeler Capital Hospice Fairfax, VA U. STATES
Kathleen Foley Open Society Institute New York U. STATES