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Expert conference on cancer pain assessment and classification—the need for international consensus: working proposals on international standards
  1. Stein Kaasa1,2,
  2. Giovanni Apolone3,
  3. Pål Klepstad1,4,
  4. Jon Håvard Loge1,5,
  5. Marianne Jensen Hjermstad1,6,
  6. Oscar Corli3,
  7. Florian Strasser7,
  8. Tarja Heiskanen8,
  9. Massimo Costantini9,
  10. Vittorina Zagonel10,
  11. Mogens Groenvold11,12,
  12. Robin Fainsinger13,
  13. Mark P Jensen14,
  14. John T Farrar15,
  15. Henry McQuay16,
  16. Nan E Rothrock17,
  17. James Cleary18,
  18. Catherine Deguines19,20 and
  19. Augusto Caraceni1,21 European Palliative Care Research Collaborative (EPCRC) and the European Association for Palliative Care Research Network (EAPCRN)
  1. 1European Palliative Care Research Centre (PRC), Faculty of Medicine, NTNU, Trondheim, Norway
  2. 2Department of Oncology, Trondheim University Hospital, Trondheim, Norway
  3. 3Center for the Research and Evaluation of Pain, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
  4. 4Department of Intensive Care Medicine, Trondheim University Hospital, Trondheim, Norway
  5. 5National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
  6. 6Regional Center for Excellence in Palliative Care, Oslo University Hospital Ulleval, Oslo, Norway
  7. 7Oncological Palliative Medicine, Division of Oncology/Hematology, Department of Internal Medicine and Palliative Care Center, Cantonal Hospital, St. Gallen, Switzerland
  8. 8Pain Clinic, Helsinki University Central Hospital, Helsinki, Finland
  9. 9S.C. Coordinamento Regionale Cure Palliative, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
  10. 10Medical Oncology Unit 1, Istituto Oncologica Veneto, IRCCS, Padua, Italy
  11. 11The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
  12. 12Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
  13. 13Division of Palliative Care Medicine, University of Alberta, Edmonton, Canada
  14. 14Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  15. 15Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  16. 16Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford, UK
  17. 17Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
  18. 18Pain and Policy Studies Group, UW Carbone Cancer Center, Madison, Wisconsin, USA
  19. 19European Medicines Agency, London, UK
  20. 20Agence Française de Sécurité Sanitaire des Produits de Santé, Saint-Denis, France
  21. 21Palliative Care Pain Therapy and Rehabilitation, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
  1. Correspondence to Stein Kaasa, European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology, 3 etg. Bevegelsessenteret, 7006 Trondheim, Norway; stein.kaasa{at}


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).

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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).