The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management

Abstract

Introduction: Undertreatment of cancer pain is associated with inadequate assessment and inconsistent or non-standardized classification, resulting in failure to both appreciate its multidimensional nature and appropriately target therapeutic interventions. This review examines the classification of cancer pain with a focus on the progressive development of the Edmonton Classification System for Cancer Pain (ECS-CP); the appropriateness of its constituent features, associated outcomes and its potential future development in cancer pain classification. Areas covered: A Medline search from 1989 to November 2017, using combined terms 'cancer' or 'oncology', 'Edmonton', 'pain' or 'analgesia', and 'staging' or 'classification', identified 280 records. A total of 20 studies with empirical data relating to validation studies of the ECS-CP or evaluation of either its constituent or proposed domains were selected for inclusion in the core review. Expert commentary: The ECS-CP is a tool in evolution and a valid template for further cancer pain classification development. The assessment of ECS-CP domains requires a standardized approach. The domain ratings can inform the therapeutic strategy, and are associated with pain management outcomes, particularly stable pain control. The ECS-CP enables standardized reporting, based on patients' pain and related characteristics, and thus may improve the validity of comparisons across research study samples.

Cancer-Related Pain: A Longitudinal Study of Time to Stable Pain Control and Its Clinicodemographic Predictors

“…Large multicenter cohort studies will be required to further examine the predictors of time to SPC and other outcomes such as the PPG. 19 It may be possible to use the collective data from past and future studies to develop a predictive index, a composite score that captures the mix of negative and positive predictors of time to SPC, thus guiding specialist referral and triage.…”

“…Meanwhile, the outcome, time to achieve SPC, may be regarded as an index of complexity and challenge in CP management. 16,19,24 To our knowledge, there are no published Portuguese data on time to achieve SPC in patients with CP. We conducted a prospective longitudinal study in a Portuguese cohort of patients with CP to primarily determine the time to achieve SPC and the association of baseline demographic and clinical classification features of CP with it.…”

“…15e17 The Edmonton Classification System for Cancer Pain (ECS-CP) 18 encompasses most of these items and is arguably the most studied and validated among the formal CP classification tools. 19,20 However, there are conflicting reports regarding some classification features, particularly initial pain intensity in predicting time to reach SPC. 21,22 Furthermore, the operational definitions for various classification features of CP such as psychological distress and incident pain have presented interpretive challenges.…”

“…21,22 Furthermore, the operational definitions for various classification features of CP such as psychological distress and incident pain have presented interpretive challenges. 19,23 Consequently, further evaluation and clarification of the role of previously identified classification features of CP is necessary. Meanwhile, the outcome, time to achieve SPC, may be regarded as an index of complexity and challenge in CP management.…”

Moderate to Severe Cancer Pain: Are We Taking Serious Action? The Opioid Prescribing Scenario in Portugal

“…Pain is one of the most feared and distressing symptoms associated with cancer. 1 In Portugal, the incidence of malignant tumors has been increasing regularly, according to the 2017 National Program for Oncological Diseases. 2 In 2016, cancer was the second basic cause of death in Portugal, representing 24.7% of mortality.…”