The Edinburgh Pain Assessment and Management Tool (EPAT) improved pain outcomes without increasing opioid-related adverse events among patients with cancer compared with usual care (UC) alone, according to a study published in the Journal of Clinical Oncology.1

Cancer pain is one of the most commonly observed challenges faced by patients with cancer — occurring in approximately 50% of patients — yet outcomes are oftentimes poor and management guidelines have many shortcomings.

For this 2-arm, parallel group study, researchers randomly assigned 19 cancer centers to implement EPAT —  a simple clinician administered tool that considers pain a vital sign — or maintain UC. Eligible centers did not have an existing bedside pain management system in place. The primary outcome was the change in percentage of patients who had a clinically significant improvement (2 points or greater) in worst pain 3 to 5 days after admission.

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The centers enrolled 1921 patients in the study, of which 1795 (93%) patients provided evaluable data.

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Analysis showed that among centers assigned to implement EPAT, the percentage of patients who had a clinically significant improvement in worst pain increased from 47.7% to 54.1%, compared with patients who received UC, for whom the percentage decreased from 50.6% to 46.4%.

The absolute difference between centers that implemented EPAT vs continued UC was 10.7%, and this difference only became more pronounced when the 2 centers that failed to implement EPAT were excluded, increasing the difference to 15.4%.

However, no other measures including pain (percentage of patients with controlled pain, mean pain score), distress outcomes, and opioid-related adverse events were significantly different between the EPAT and UC centers.

EPAT improved both prescribing practices and pain outcomes without increasing the rate of opioid-related adverse events. The authors concluded that “the findings of this trial add to the accumulating evidence for the efficacy of more integrated and systematic approaches to symptom management in patients with cancer.”


Fallon M, Walker J, Colvin L, et al. Pain management in cancer center inpatients: a cluster randomized trial to evaluate a systematic integrated approach — the Edinburgh Pain Assessment and Management Tool [published online March 15, 2018]. J Clin Oncol. doi: 10.1200/JCO.2017.76.1825