Frequency of Non–Cancer-Related Pain in Patients With Cancer
Bibliographic record
Abstract
TO THEEDITOR: In 2012, theJournal published an article of ours evaluating opioid prescriptions for elderly patients with cancer who reported pain. 1 Pain scores were captured as part of a provincial initiative to screen patients with cancer for symptoms at every visit to the cancer center. 2,3 The study found that 45% of patients with a pain severity score of 4 to 10 out of a possible 10 did not receive opioid analgesics. Possible explanations that have been raised for this observation include non– cancer-related pain and patient refusal to accept opioids. In that same year, the provincial cancer agency undertook a province-wide chart audit to evaluate the documentation at the time of the high pain score, including questions about pain etiology and interventions. Eleven cancer centers audited approximately 25 charts from each patient who reported a pain score of at least 4, for a total audit of 299 charts. Of these, 8% clearly documented that the pain was not related to cancer. An additional 5% of patients indicated that the pain was chronic, and 2% indicated that the pain was being managed in the community. It is uncertain if these 7% had cancer-related pain. The estimate would then be that 8% to 15% of the audited cohort with pain scores of 4 to 10 had non– cancer-related pain. Only two patients had documentation that they declined opioids. In the original study, 9,826 patients had pain scores of 4 to 10. Applying the observations above, 786 to 1,474 patients had pain unrelated to cancer. If none of these patients received opioids and they are removed from the denominator, then the proportion of untreated cancer-related pain improves to 35% to 40%, suggesting that pain is still undertreated in a significant proportion of patients with cancer. The observations from the audit are limited because the criteria for chart selection may not have been applied uniformly at each center, and chart abstractors were not centrally trained. There may also be ambiguity in medical charts around the possible reasons for lack of opioid treatment. However, the data resulting from the audit suggest that non– cancer-related pain does not appear to make up a significant proportion of the pain being described by patients with cancer. Additional work is required to better understand reasons for undertreatment of pain in Ontario to facilitate possible interventions to improve patient care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".