Achievement of personalized pain goal (PPG) in cancer patients referred to a supportive care clinic.

Abstract

9060 Background: Cancer pain quality improvement initiatives recommend tailoring pain treatments to patient’s (pt’s) individual goals for comfort/functioning. The pt’s PPG for pain relief (0-10 pain-intensity that pt considers to be comfortable, in physical, functional, and psychosocial domains) is a simple measure of such goals. Pain and PPG are routinely assessed at our institution. Study was conducted to determine the proportion of cancer pts treated for pain, who achieve a pain response, as determined by their PPG, and identify factors associated with its non-achievement. Methods: Records of consecutive cancer pts seen in the Supportive-Care Clinic in consultation, who had follow-up visits within 1-5 weeks (n=348) were reviewed. All pts were treated by palliative-medicine specialists. Pain-response was defined as (1) Clinical-response (30% or ≥2 point pain reduction), and (2) PPG-response (if pain ≤ PPG). Logistic-regression model was used to estimate the effect of various factors on PPG-response. Results: Males 51%, median age 58 years, and survival 188 (IQR 92-412) days. At baseline, 239 pts (69%) had pain ≥4. Median pain was 7 (IQR 5-8) and PPG 3 (2-3). At follow-up (median 14-days), pain significantly decreased (7 vs 5, p < 0.001), while PPG remained stable (p=0.9). Initial PPG remained the same (51%) or changed by <2-points (31%) in 195 pts (82%). 122 pts (51%) achieved a clinical-response, but only 66 (28%) achieved their PPG (Table). Using PPG as gold-standard, sensitivity of clinical-response was 89%, and specificity 65%. Baseline factors associated with non-achievement of PPG were higher Memorial Delirium Assessment Scale scores (odds-ratio 1.43 per point, p= 0.002), positive alcoholism screening (CAGE ≥ 2) (2.79, 0.04) and insomnia (1.13, 0.04). Conclusions: PPG is a simple pt reported outcome for pain goals. Our preliminary findings suggest that PPG is stable over time, and that traditional definitions of clinical-response have a large percentage of false-positives. Predictors of lack of PPG-response include delirium, alcoholism history, and insomnia. Clinical-response by PPG-response. Achieved PPG Yes No Total Clinical Response Yes 59 60 119 No 7 111 118 Total 66 171 237 2 pts missing