Multi-Institutional Evaluation of Pain Assessment and Management within the National Comprehensive Cancer Network (NCCN)

Principal Investigator: Cielito Reyes-Gibby, Dr.P.H.

Pain affects approximately two thirds of patients with metastatic breast cancer. Patients with bone metastases are especially susceptible to the development of this symptom. Unrelieved pain may interfere with activities of daily living and affect the quality of life. Patients and health care professionals both agree that pain is often poorly managed.

In an effort to guide the pain management process, a number of initiatives have been undertaken, including the development of guidelines and standards. The National Comprehensive Cancer Network (NCCN) first published its Cancer Pain Practice Guidelines in February 1999. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced the addition of new pain management standards into its accreditation manuals for facilities, such as ambulatory care centers and hospitals, which will be scored for compliance starting in 2001. Both initiatives address the need for appropriate assessment and management of pain. They concur with screening for the presence of pain, determination of pain intensity, and regular pain reassessment as a key component of the standard of care. The NCCN guidelines further expand upon the complex management of cancer pain by including an algorithm that bases therapeutic decisions on the numerical pain rating. The NCCN Pain Panel envisioned that cancer pain could be well controlled in most patients if the NCCN Guidelines are properly adhered to.

Specific Goals

  • To ascertain the frequency, extent and methods of pain assessment and documentation of pain intensity values at NCCN institutions
  • To assess the extent of documentation of pain management at NCCN institutions and to generate baseline data on the use and types of interventions, with particular emphasis on pharmacologic analgesic therapy
  • To evaluate the feasibility of extracting data elements derived from the Cancer Pain NCCN Practice Guidelines from medical records in NCCN institutions


Pain assessment and management data will be collected retrospectively through a chart review in a cohort of eligible breast cancer patients with bone metastases. The data will be collected retrospectively through medical chart review at study initiation, and at three, six, nine and 12 months thereafter.

For more information

Contact Cielito Reyes-Gibby, Dr.P.H., at