An increasing number of cancer patients live longer, and palliative care has become an important part of their treatment. Symptoms are often inadequately assessed and managed. A significant challenge in clinical trials is to control for the variability of the samples being studied. To overcome this problem, classification systems have been developed in order to characterise and stratify patients by grouping them according to major common characteristics. The lack of agreed methods for the assessment and classification of cancer pain has been clearly indicated in clinical trials and in clinical practice and may be one possible explanation for the inadequate treatment of cancer pain. This was the background to an international expert meeting arranged in September 2009 in Milan, Italy. The primary aims were to produce recommendations on how to assess and classify cancer pain and to recommend a strategy for the further development, validation and implementation of an international cancer pain classification and assessment system. The recommendations consisted of two basic working proposals, nine specific working proposals and seven recommendations for the further development of a cancer pain classification system. Examples of specific working proposals were to include pain intensity, pain mechanism, breakthrough pain and psychological distress as the core domains in this classification of cancer pain and to measure pain intensity with a 0–10 numerical rating scale with ‘no pain’ and ‘pain as bad as you can imagine’ as anchors. The proposed name for this international standard is Cancer Pain Assessment and Classification System (CPACS).
- Accepted 19 September 2011.
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Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
The Consensus Panel on Cancer Pain Assessment and Classification 2009 Steering committee Stein Kaasa, Giovanni Apolone, Oscar Corli, Augusto Caraceni
Experts Henry McQuay, Mark P Jensen, John Farrar, Robin Fainsinger
International research networks Marianne J Hjermstad (European Palliative Care Research Collaborative, EPCRC), Pål Klepstad (EPCRC), Jon Håvard Loge (EPCRC), Nan E Rothrock (PROMIS, Patient-Reported Outcomes Measurement Information System)
Scientific organisations Florian Strasser (ESMO, European Society for Medical Oncology, Palliative and Supportive Care Group), Tarja Heiskanen (IASP, International Association for the Study of Pain), Massimo Costantini (SICP, Italian Association for Palliative Care), Vittorina Zagonel (AIOM, Italian Association of Medical Oncology Palliative Care Study Group), Mogens Groenvold (EORTC, European Organisation for Research and Treatment of Cancer), James Cleary (ASCO, American Society of Medical Oncology)
Regulatory health care authorities Cecilia Sepulveda (WHO), Catherine Deguines (Afssasp, Agence Française de Sécurité Sanitaire des Produits de Santé; appointed by EMA, European Medicines Agency)
Observers and rapporteurs Cinzia Brunelli (Italy), Alessandra Pigni (Italy), Franco De Conno (Italy), Anne Kari Knudsen (Norway), Furio Zucco (Italy), Silvia De Andrea (Italy), Mauro Montanari (Italy), Maria Teresa Greco (Italy).
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