Evaluating the prognostic effect of a pain classification system in patients with advanced cancer.

95 Background: 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 increasing sum of negative ECS-CP features and achievement of good pain control at first follow up visit at an outpatient palliative care clinic.

METHODS: Initial and follow up clinical information of 409 eligible supportive care outpatients such as patient demographics, ECS-CP assessment, morphine equivalent daily dose (MEDD), opioid rotation, Edmonton Symptom Assessment Score (ESAS), and personalized pain goal (PPG) were retrospectively reviewed and analyzed.

RESULTS: Between the initial consultation and the first follow up visit, the median MEDD requirement increased from 30mg/day to 45mg/day (p < 0.0001) and median pain intensity improved from 6 to 4 (p < 0.0001). Increasing sum of negative ECS-CP features was associated with higher MEDD at consultation, with an increase from 30mg/day with no negative features to 40mg/day with ≥2 negative features (p = 0.046). There was no significant association between increasing sum of negative ECS-CP features and achievement of pain control at follow up visit (0.991, 95% CI: 0.747 - 1.304, p = 0.948).

CONCLUSIONS: Increasing sum of negative ECS-CP features was associated with higher MEDD at referral but was not predictive of pain control at the follow up visit when pain was managed by a palliative medicine specialist. Further research is needed to further explore these observations.