title: Is it possible to detect an improvement in cancer pain management? A comparison of two Norwegian cross-sectional studies conducted 5 years apart.
abstract: Cancer pain (CP) management is challenging. In recent years, efforts were undertaken to achieve better CP management, e.g. clinical research, new treatment modalities, development of guidelines, education and focus on implementation. The aim of the present study was to compare the prevalence and characteristics of pain and breakthrough pain (BTP) between cross-sectional studies conducted in 2008 and 2014. It was hypothesized that an improvement in pain control would be observed the years in between.
  
  
  
  Two cross-sectional studies were conducted where adult cancer patients answered questions from Brief Pain Inventory and the Alberta Breakthrough Pain Assessment Tool for cancer patients. Physicians reported socio-demographic and medical data. Regression models were applied for analysis.
  
  
  
  In total, 168 inpatients, 92 in 2008 and 76 in 2014, and 675 outpatients, 301 in 2008 and 374 in 2014, were included. The patient characteristics of the samples were comparable. Prevalence of CP among inpatients was 55 % in 2008 and 53 % in 2014, and among outpatients, 39 and 35 %, respectively. Inpatients reported average pain intensity (0-10 numerical rating scale, NRS) of 3.60 (standard deviation, SD 1.84) (2008) and 4.08 (SD 2.11) (2014); prevalence of BTP was 52 % (2008) and 41 % (2014). For outpatients, average pain intensity was 3.60 (SD 2.04) (2008) and 3.86 (SD 2.20) (2014); prevalence of BTP was 43 % (2008) and 37 % (2014). None of the differences were statistically significant.
  
  
  
  Unexpectedly, no improvement in pain control was observed. Efforts are still needed to improve cancer pain management.
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491. morten.thrones@ntnu.no.|Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006. morten.thrones@ntnu.no.
authors.forename: Morten
authors.initials: M
authors.lastname: Thronæs
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.|Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006.
authors.forename: Sunil X
authors.initials: SX
authors.lastname: Raj
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.|Palliative Care, Pain therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Brunelli
authors.affiliation: Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006.
authors.forename: Sigrun Saur
authors.initials: SS
authors.lastname: Almberg
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.|Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006.
authors.forename: Ola Magne
authors.initials: OM
authors.lastname: Vagnildhaug
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.
authors.forename: Susanna
authors.initials: S
authors.lastname: Bruheim
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.
authors.forename: Birgit
authors.initials: B
authors.lastname: Helgheim
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.|Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006.
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.affiliation: European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, NO 7491.|Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Kunnskapssenteret 4.Floor, St. Olavs Hospital, Trondheim, Norway, NO 7006.
authors.forename: Anne Kari
authors.initials: AK
authors.lastname: Knudsen
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059390:Breakthrough Pain / Q000188:drug therapy; D000072716:Cancer Pain / Q000175:diagnosis* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009664:Norway; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D015995:Prevalence
chemical_list: D000701:Analgesics, Opioid
keywords: BTP; Breakthrough pain; Cancer; Cross-sectional study; Implementation; Pain management; Prevalence