Implementing guidelines for cancer pain management: Results of a randomized controlled clinical trial

Purpose: Pain and symptom management is an integral part of the clinical pr actice of oncology. A number of guidelines have been developed to assist th e clinician in optimizing comfort care. We implemented clinical guidelines for cancer pain management in the community setting and evaluated whether t hese guidelines improved care. Patients and Methods: Eighty-one cancer patients, aged 37 to 76 years, were enrolled onto a prospective, longitudinal, randomized controlled study fro m the outpatient clinic settings of 26 western Washington-area medical onco logists. A multilevel treatment algorithm based on the Agency for Health Ca re Policy and Research Guidelines for Cancer Pain Management was compared w ith standard-practice (control) pain and symptom management therapies used by community oncologists. The primary outcome of interest was pain (Brief P ain Inventory); secondary outcomes of interest were all other symptoms (Mem orial Symptom Assessment Scale) and quality of life (Functional Assessment of Cancer Therapy Scale). Results: Patients randomized to the pain algorithm group achieved a statist ically significant reduction in usual pain intensity, measured as slope sco res, when compared with standard community practice (P < .02). Concurrent c hemotherapy and patient adherence to treatment were significant mediators o f worst pain. There were no significant differences in other symptoms or qu ality of life between the two treatment groups. Conclusion: This guideline implementation study supports the use of algorit hmic decision making in the management of cancer pain. These findings sugge st that comprehensive pain assessment and evidence-based analgesic decision -making processes do enhance usual pain outcomes. J Clin Oncol 17:361-370. (C) 1999 by American Society of Clinical Oncology.