Association of a standardized painless ward model with cancer pain control and hospitalization outcomes: a retrospective cohort study.

objectiveCancer-related pain remains a major challenge in inpatient oncology care, affecting a large proportion of patients with advanced malignancies. This retrospective cohort study was aimed at evaluating whether implementation of a standardized painless ward model was associated with improved cancer pain control and hospitalization outcomes compared with conventional ward-based care.

methodsThis single-center retrospective cohort study included 848 hospitalized patients with pathologically confirmed malignancies and cancer-related pain. Patients admitted before painless ward implementation (general ward, January 2021-December 2022; n = 422) were compared with those admitted after implementation (painless ward, January 2023-December 2024; n = 426). Baseline pain intensity was assessed at admission using the Numerical Rating Scale (NRS). Pain reassessment was performed by trained oncology nursing staff at least once daily and every 4 h when NRS > 4, with physician reassessment when clinically indicated. Pain outcomes at discharge, change in pain intensity during hospitalization (ΔNRS), length of stay (LOS), and prolonged hospitalization (LOS > 10 days) were evaluated. Multivariable linear regression analyses were performed to adjust for baseline pain and demographic factors.

resultsPatients managed in the painless ward experienced a greater reduction in pain intensity during hospitalization compared with those in the general ward, with a lower prevalence of severe pain (NRS ≥ 7: 15.5% vs. 24.4%) and a lower mean NRS score (3.70 ± 2.27 vs. 4.35 ± 2.62; P < 0.01). Gender- and age-related differences in pain severity observed under conventional care were not observed following painless ward implementation. The painless ward was also associated with a shorter mean LOS (10.15 ± 7.53 vs. 11.72 ± 7.49 days) and a lower proportion of prolonged hospitalization (36.6% vs. 48.1%). Baseline pain severity at admission was higher in the painless ward group (mean NRS 7.39 ± 1.86) than in the general ward group (6.11 ± 2.33; P < 0.001). Despite this, patients managed in the painless ward experienced a greater reduction in pain intensity during hospitalization (mean ΔNRS -3.69 ± 1.30 vs. -1.76 ± 0.68; P < 0.001). After adjustment for baseline NRS, age, and gender, admission to the painless ward remained independently associated with greater pain reduction (β =  -2.00, 95% CI -2.14 to -1.85; P < 0.001). The painless ward was also associated with a shorter mean LOS and a lower proportion of prolonged hospitalization.

conclusionThis real-world study suggests that implementation of a standardized painless ward model is associated with better inpatient cancer pain control, shorter hospitalization duration, and attenuation of demographic differences in pain severity. These findings should be interpreted as associative and warrant confirmation in prospective studies.