Around 1 in 5 people diagnosed with cancer in the UK take part in a clinical trial.
A study looking at how cancer pain is assessed and treated when people go into hospital (EPAT)
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This study compared different ways to measure and treat cancer pain, to see which was best. It was supported by Cancer Research UK.
More about this trial
A team of researchers in Edinburgh developed a method of helping doctors and nurses to measure cancer pain. It is called the Edinburgh Pain Assessment Tool, or EPAT. They have also developed a training course for doctors and nurses, which aims to help them understand and treat pain.
EPAT involves keeping some extra charts and forms by the patient’s bed. This is to help make sure pain is assessed at the same time as the other regular checks people have in hospital.
In this study, the researchers measured pain levels and looked at the painkillers doctors prescribed. They compared results from hospitals using EPAT with hospitals where the staff assessed pain in the usual way.
The aim of the study was to find out if using EPAT improves the way pain is assessed and treated when people go into hospital.
Summary of results
The research team found that using the Edinburgh Pain Assessment Tool (EPAT) did help improve pain for people with cancer.
The research team recruited people between 2007 and 2013, and published the results in 2018.
This trial recruited nearly 2,000 people who were admitted to 19 different hospitals. They all had cancer and moderate or severe pain.
The research team measured people’s pain levels. They also looked at the painkillers people had, and any side effects these may cause.
In the first part of the trial, they recruited about 1,000 people who were not assessed using EPAT. This was so they could compare results once people were assessed using EPAT.
In the second part of the trial they recruited about 1,000 people who were put into 1 of 2 groups at random, and:
- half had their pain assessed using EPAT
- half had usual standard care for their pain
The research team asked everyone taking part how bad their worst pain had been in the last 24 hours, on a scale of 0 to 10. They did this when the patient was admitted to hospital and again 3 to 5 days later, to see if their pain had improved.
The results showed that the worst pain level improved more when people were assessed using EPAT.
In the 10 hospitals that assessed patients using EPAT, pain improved in:
- nearly 5 out of 10 people (48%) in the first part of the trial
- more than 5 out of 10 people (54%) assessed using EPAT in the second part of the trial
In the 9 hospitals that used standard care, pain improved in:
- just over 5 out of 10 people (51%) in the first part of the trial
- less than 5 out of 10 people (46%) assessed using standard care in the second part of the trial
The results also showed that doctors prescribed more suitable painkillers for people who were assessed using EPAT.
But there wasn’t much difference between the two groups in:
- how much people’s pain affected their day to day life or caused distress
- the number of people having opioid painkillers (such as morphine)
- the number of people having side effects from painkillers
- people’s total pain score measured using a form called the Brief Pain Inventory (BPI)
The research team concluded that using EPAT helped improved pain in people with cancer. It also helped doctors to prescribe suitable painkillers without increasing the side effects people had. They suggest it is useful to assess and treat pain in an organised way.
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (
How to join a clinical trial
Professor Marie Fallon
Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
Lothian Health Board
NIHR Clinical Research Network: Cancer
University of Edinburgh
This is Cancer Research UK trial number CRUK/07/051.