title: Assessing the prognostic features of a pain classification system in advanced cancer patients.
abstract: The Edmonton Classification System for Cancer Pain (ECS-CP) has been shown to predict pain management complexity based on five features: pain mechanism, incident pain, psychological distress, addictive behavior, and cognitive function. The main objective of our study was to explore the association between ECS-CP features and pain treatment outcomes among outpatients managed by a palliative care specialist-led interdisciplinary team.
  
  
  
  Initial and follow-up clinical information of 386 eligible supportive care outpatients were retrospectively reviewed and analyzed.
  
  
  
  Between the initial consultation and the first follow-up visit, the median ESAS pain intensity improved from 6 to 4.5 (p < 0.0001) and the median total symptom distress score (0-100) improved from 38 to 31 (p < 0.0001). At baseline, patients with neuropathic pain (p < 0.001) and those with at least one ECS-CP feature (p = 0.006) used a higher number of adjuvant medications. At follow-up, patients with neuropathic pain were less likely to achieve their personalized pain goal (PPG) (29 vs 72%, p = 0.015). No statistically significant association was found between increasing sum of ECS-CP features and any of the pain treatment outcomes at follow-up.
  
  
  
  Neuropathy was found to be a poor prognostic feature in advanced cancer pain management. Increasing sum of ECS-CP features was not predictive of pain management complexity at the follow-up visit when pain was managed by a palliative medicine specialist. Further research is needed to further explore these observations.
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA. jaarthur@mdanderson.org.
authors.forename: Joseph
authors.identifier: 0000-0002-9185-6108
authors.initials: J
authors.lastname: Arthur
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
authors.forename: Kimberson
authors.initials: K
authors.lastname: Tanco
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Haider
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Maligi
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, TX, USA.
authors.forename: Minjeong
authors.initials: M
authors.lastname: Park
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, TX, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Palliative Care & Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000523:psychology; D010146:Pain / Q000145:classification*; D059408:Pain Management / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cancer; Edmonton classification system for cancer pain; Neuropathic; Pain