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Background Systematic pain registration and assessment with a visual analog scale ( VAS) or numeric rating scale ( NRS) at each visit are key recommendations in one of the most recent guidelines on cancer pain management. It is unclear whether this recommendation is applied. Objectives The aim was to explore registration of pain in medical records of patients visiting the medical oncology outpatient clinic. Methods In a multicenter study in six Dutch hospitals, data were extracted from medical records of 380 outpatients with cancer. Data of the first three visits at the outpatient clinic were studied. Descriptive statistics were conducted. Results In 23% of all 987 visits at the outpatient clinic, pain or absence of pain was registered, and in an additional 15%, a nonspecific symptom description was given. Regarding all other visits, (62%) pain or absence of pain was not documented at all. Pain measurement using a VAS or NRS was documented in only one visit. Pain was more often registered in medical records of patients with metastasis, as well as in those of patients with urogenital tumors. Conclusion Pain in medical oncology outpatients is not systematically registered in their medical records. With one exception, pain was not registered with a VAS or NRS. Yet, registration and assessment of pain to monitor pain are essential to evaluate and adapt pain treatment over time. Pain registration has not improved since 2001 and therefore implementing the recommendations regarding systematic monitoring of pain is needed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: In this study among patients with cancer in the palliative phase, we analysed whether assessing the symptom, which is causing the most trouble in the patient''s every day life (‘most troublesome’ symptom) had added value apart from the presence and severity of symptoms, which are most commonly assessed in clinical practice. Methods: Patients with cancer (lung, gastro-intestinal, breast cancer) in the palliative phase from two non-academic hospitals were included in the study. Using the Symptom Monitor tool, 10 physical symptoms were assessed with regard to presence and severity. The Symptom Monitor has an extra added item indicating as the ‘most troublesome’ symptom. This item was monitored to determine whether it had added value apart from the presence of symptoms and ‘most severe’ symptom. The severity score on the indicated ‘most troublesome’ symptom was subtracted from the severity score of the ‘most severe’ symptom. The generated delta score of 0 indicated no added value, whereas a score of one or more indicated that the ‘most troublesome’ symptom would have been missed if not specifically asked for by the physician, because its severity was lower that the ‘most severe’ symptom. Results: One hundred and forty-six patients reported 590 symptoms to be present. In total, 227 symptoms were reported as ‘most severe’ symptom (n =138 patients). Among these, fatigue (n =52) and pain (n =24) were reported most frequently as ‘most severe’ symptom. In total, 134 patients indicated a symptom as ‘most troublesome’. Fatigue (n =33; 25%) and pain (n =22; 16%) were also indicated by most of these patients as the ‘most troublesome’ symptom. One hundred and fifty-two comparisons could be made between the ‘most severe’ and the ‘most troublesome’ symptom. In 102 (67%) of the comparisons assessing the ‘most troublesome’ symptom had no added value: the score for ‘most severe’ symptom did not differ from the score for the ‘most troublesome’ symptom revealing a delta score of 0. In 23 times (15%) of the 152 comparisons made, the delta score was 1 and in 27 (18%) of the comparisons the delta score was 2 or more indicating that assessing the ‘most troublesome’ symptom substantially had added value. Conclusion: In patients in the palliative phase of their disease, extra attention for the ‘most troublesome’ symptom is needed. In our study, in almost 1/3 of the cases, this symptom would have been missed the physicians attention if not specifically asked for. Practice implications: We recommend not only to assess the presence and severity of symptoms, but furthermore to assess the patient''s ‘most troublesome’ symptom in addition. [Copyright &y& Elsevier]