Comparison of Three Pain Assessment Tools in Oncological Patients during Palliative Chemotherapy-Implications for Clinical Practice

Abstract

Purpose: The present methodological observation aimed to compare assessment of pain and of pain related disability when using different tools in Viennese outpatients suffering from advanced cancer during palliative chemotherapy.

Materials and Methods: A total of 100 consecutive patients with a median age of 59 years (range 27.0–72.0 years) were included in this cross-sectional observation. All participants were suffering from metastatic cancer and, receiving palliative chemotherapy as outpatients at the Department of Oncology in the General Hospital of Vienna. Pain was registered on Visual analogue scale (VAS) and by using the SF-36 Health Survey subscale “Bodily pain”. The Pain Disability Index (PDI) was used to measure the degree of interference with normal role functioning caused by chronic pain. Associations between various outcome variables were quantified using Spearman's correlation coefficient. P-values ≤0.05 were considered to be statistically significant.

Results: “Bodily pain” showed a Spearman correlation coefficient of −0.87 (p<0.001) and −0.86 (p<0.001) with VAS and PDI, respectively. PDI and VAS gave a Spearman correlation of 0.94 (p<0.001). The various subscales of PDI showed moderate to high correlations with scores on “Bodily pain” (Spearman coefficients ranging from −0.55 for the subscale Life support activity to −0.84 for the subscale recreation, all p<0.001) as well as with scores on VAS (Spearman coefficients ranging from 0.64 for the subscale Life support activity to 0.91 for the subscale recreation, all p<0.001).

Conclusions: The findings of the present investigation in Viennese outpatients suffering from advanced cancer during palliative chemotherapy indicate high correlations between pain measured by VAS or by SF-36 subscale “Bodily pain”, with disability related to pain and its impact on QOL measured using PDI. All instruments seem to be adequate for pain assessment in this patient group. For clinical practice of pain assessment in patients with different advanced cancer we recommend the usage of VAS for simple assessing intensity of pain. SF-36 should be used, if assessment of QOL including “Bodily pain” is required. Assessment by PDI should be recommended as long as no ICF (International Classification of Functioning, Disability and Health) Core-sets are available, or to accomplish established Core sets for assessing disability related to pain in advanced cancer.

Zusammenfassung

Fragestellung: Ziel der vorliegenden Studie war die Untersuchung der Vergleichbarkeit von Schmerzangaben Wiener onkologischer Patienten mit infauster Prognose (unter palliativer Chemotherapie) bei Anwendung unterschiedlicher Instrumente (Visuelle Analog Skala=VAS, Pain Disability Index=PDI, Schmerzdomäne des SF-36 Health Survey=„Bodily pain”) zur „Schmerz-Erfassung”.

Material und Methode: In die vorliegende Untersuchung wurden 100 onkologische Patienten (m:f=62:38, 59a, r: 27–72) mit infauster Prognose (und unter palliativer Chemotherapie) eingeschlossen. Die Erfassung des Symptoms „Körperlicher Schmerz” erfolgte unter Einsatz 1) einer VAS, 2) der Domäne Bodily pain“ des SF-36 Health Survey und 3) des PDI. Zum Vergleich zwischen den einzelnen Variablen wurde der sog. Spearmankorrelationskoeffizient herangezogen. Das Signifikanzniveau wurde mit p<0,05 angesetzt.

Resultate: Die Variable „Bodily pain” zeigte einen Spearmankorrelationskoeffizienten von 0,87 (p<0,001) bzw. −0,86 (p<0,001) verglichen mit VAS bzw. PDI. Der Vergleich zwischen PDI und VAS ergab einen Spearmankorrelationskoeffizienten von 0,94 (p<0,001). Die verschiedenen Subskalen des PDI wiesen moderate bis starke Korrelationen mit der SF-36-Subskala “Bodily pain“ (der Rahmen der Spearmankorrelationskoeffizienten reichte von −0,55 für die Subskala „lebensnotwendige Tätigkeiten” bis −0,84 für die Subskala „Erholung”, alle p<0,001). Zusätzlich zeigten alle Subskalen des PDI signifikante Korrelationen mit der VAS (das Ausmaß der Spearmankorrelationskoeffizienten reichte von 0,64 für die Subskala „lebensnotwendige Tätigkeiten” bis −0,91 für die Subskala „Erholung”, alle p<0,001).

Schlussfolgerungen: Im Rahmen der vorliegenden Studie konnten an Wiener onkologischen Patienten mit infauster Prognose (unter palliativer Chemotherapie) bei Anwendung der VAS verglichen mit der SF-36 Subskala „Bodily pain” starke Korrelationen gezeigt werden. Zusätzlich zeigten sich starke Korrelationen zwischen dem Parameter „körperlicher Schmerz” (gemessen an der VAS und an der SF-36 Subskala „Bodily pain”) und schmerzassozierter Einschränkung der Lebensqualität (gemessen anhand des PDI). Alle drei Instrumente scheinen adäquat Schmerz in dieser Patientengruppe zu „messen”. Für die Anwendung bei Patienten mit verschiedenen Entitäten eines fortgeschrittenen Krebses im klinischen Alltag lässt sich daraus schließen, dass die VAS zur simplen Einschätzung der Schmerzintensität geeignet erscheint. Der SF-36 Health Survey sollte dann verwendet werden, wenn die Lebensqualität (QOL) einschließlich der Domäne „Bodily pain” abgeschätzt wird. Eine Beurteilung mittels des PDI sollte dann zur Anwendung kommen, solange keine Subskalen des ICF (international Classification of Functioning, Disability and Health) zum „Assessment” einer schmerzassozierten „Disability” vorliegen oder zur Ergänzung derer.

Key words

pain - disability - quality of life - cancer - assessment

Schlüsselwörter

fortgeschrittene Krebserkrankung - Schmerzbeurteilung - Lebensqualität - „Disability”

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