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A “TNM” classification system for cancer pain: The Edmonton Classification System for Cancer Pain (ECS-CP)

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Abstract

Objective

The purpose of this paper is to provide an overview of the development of a “TNM“ cancer pain classification system for advanced cancer patients, the Edmonton Classification System for Cancer Pain (ECS-CP). Until we have a common international language to discuss cancer pain, understanding differences in clinical and research experience in opioid rotation and use remains problematic. The complexity of the cancer pain experience presents unique challenges for the classification of pain. To date, no universally accepted pain classification measure can accurately predict the complexity of pain management, particularly for patients with cancer pain that is difficult to treat.

Materials and methods

In response to this gap in clinical assessment, the Edmonton Staging System (ESS), a classification system for cancer pain, was developed. Difficulties in definitions and interpretation of some aspects of the ESS restricted acceptance and widespread use.

Result

Construct, inter-rater reliability, and predictive validity evidence have contributed to the development of the ECS-CP. The five features of the ECS-CP—Pain Mechanism, Incident Pain, Psychological Distress, Addictive Behavior and Cognitive Function—have demonstrated value in predicting pain management complexity.

Conclusion

The development of a standardized classification system that is comprehensive, prognostic and simple to use could provide a common language for clinical management and research of cancer pain. An international study to assess the inter-rater reliability and predictive value of the ECS-CP is currently in progress.

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Acknowledgments

Robin Fainsinger and Cheryl Nekolaichuk are supported by the Canadian Institutes of Health Research through grant support for the CIHR New Emerging Team in Difficult Pain Problems (CIHR PET69772) and an international multicenter validation study of a pain classification system for advanced cancer patients.

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Authors and Affiliations

  1. Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada

    Robin L. Fainsinger & Cheryl L. Nekolaichuk

  2. Tertiary Palliative Care, Grey Nuns Hospital, 217 - Health Services Centre, 1090 Youville Drive West, Room Edmonton, Edmonton, AB, Canada, T6L 5X8

    Robin L. Fainsinger

Authors
  1. Robin L. Fainsinger
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  2. Cheryl L. Nekolaichuk
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Corresponding author

Correspondence to Robin L. Fainsinger.

Additional information

Presented as an invited lecture at the MASCC/ISOO 20th Anniversary International Symposium Supportive Care in Cancer in St. Gallen, June 2007.

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Fainsinger, R.L., Nekolaichuk, C.L. A “TNM” classification system for cancer pain: The Edmonton Classification System for Cancer Pain (ECS-CP). Support Care Cancer 16, 547–555 (2008). https://doi.org/10.1007/s00520-008-0423-3

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  • DOI: https://doi.org/10.1007/s00520-008-0423-3

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