Wikipedia:Featured article candidates/Cancer pain/archive1

The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was not promoted by GrahamColm 07:54, 12 August 2012 [1].

---

Cancer pain

Cancer pain (edit | talk | history | protect | delete | links | watch | logs | views)

• Featured article candidates/Cancer pain/archive1

Nominator(s): Anthonyhcole (talk) 07:19, 7 August 2012 (UTC)

I am nominating this for featured article because it has recently been promoted to GA, and I've read the FA criteria and it seems to pass those. I based the article on four textbooks on cancer pain, and have included the relevant subtopics common to all or most of those. Most of the general data is derived from textbooks. Current data - epidemiology etc. - is based on reviews. Some sources are old or primary: the old sources are all (I think) historical milestones or referred to in the main source cited at the end of the sentence or paragraph; primary sources are all referred to in the main source at the end of the sentence or paragraph. I've hotlinked to images within the text. I realise this is odd, but also think it does no harm and is helpful so would appreciate rationales beyond "that's unusual" if reviewers object to it (but will, of course, go along with consensus). This is my first FA candidate. I've notified the six editors who've made more than one edit to the article in the last year. --Anthonyhcole (talk) 07:19, 7 August 2012 (UTC)

• I'm not well-versed enough to comment on whether this article meets FA criteria, but I'd be happy to help the nominator address any concerns that come up during the process. MastCell ^Talk 18:38, 7 August 2012 (UTC)

• Thank you! --Anthonyhcole (talk) 02:52, 8 August 2012 (UTC)

I have some expertise in the area and, similar to MastCell, would be glad to help fix or tweak things if you need a hand. Nice job!!! Best regards: Cliff (a/k/a "Uploadvirus") (talk) 18:48, 8 August 2012 (UTC)

That's excellent. Thank you, Cliff. Is your expertise in pain, cancer or the FA process? --Anthonyhcole (talk) 19:47, 8 August 2012 (UTC)

My pleasure, Anthonyhcole - I've seen you around here a lot, and I greatly respect your work. to your question - while I have considerable expertise in both cancer and pain, I will flee in abject screaming terror when confronted with the intricacies of the FA process :-O LOL!

Just as a suggestion, if you want to, why don't you just feel free to give me specific tasks you'd like me to complete, or to assist with. I'll then put my results, suggestions, etc. on the article Talk Page ASAP. Whatever you like, copy and paste or tweak it to fit your needs and/or tastes. What you DON'T like, you can just leave it to rot harmlessly in situ. When you are completely finished with all editing and changes, let me know and I will give it one "final" copyedit, section by section. When I finish THAT, I'll let you know - you can then go over that "final" copyedit and re-revert whatever you don't like as you please.

Of course, if you have another strategy or want to proceed differently I will happily defer to your plan, my friend - just let me know.

Best regards: Cliff (a/k/a "Uploadvirus") (talk) 20:25, 8 August 2012 (UTC)

Wonderful. Thanks for the kind words. As for the article, I think it's pretty well perfect :). That is, all the issues I was aware of were sorted after suggestions from Allen, James, WhatamIdoing and others in the GA process. I emailed fifteen of the authors I cited, asking them to let me know if I've misrepresented them, and the seven that responded were complimentary (though I don't know if any read more than the section on their topic), so I'm fairly confident about the accuracy. But I would appreciate another critical reading, just pointing out anything that catches your eye, seems wrong, doesn't make sense, is prolix, repetitive, missing, etc. --Anthonyhcole (talk) 20:50, 8 August 2012 (UTC)

Support - this is an important article, easy to read and understand, written in plain English, and nicely presented. I'm happy to support it. Two tiny nitpicks that don't affect my support:

• There's an inconsistent use of percent vs % which should be fixed.
• Is there a way to integrate some of the single paragraph sentences? This is one that jumped out at me: "If a patient's pain cannot be well controlled, they should be referred to a palliative care or pain management specialist or clinic." > although it's an important sentence and I wouldn't object if left as a stand-alone
• I'm not sufficiently familiar with sourcing conventions for medical articles so I can't comment in that regard, but the caliber of the sources looks excellent.

Nice job and thanks for doing this! Truthkeeper (talk) 02:36, 9 August 2012 (UTC)

Thank you Truthkeeper88. I've converted all the %s to percents, and merged some single sentence paragraphs. I'd prefer to leave the others single, as they are quite distinct ideas from those described in the surrounding text, but won't oppose merging if others feel strongly about it. --Anthonyhcole (talk) 06:06, 9 August 2012 (UTC)

Yes, I tend to agree. Although usually I'm not crazy about single sentence paras, I think it works well for this article. Also, I meant to mention that the liver issues in regards to paracetemol \ acetaminophen should be more prominent, so I'm happy to see that pulled out into a separate para. Good luck and nice job here. Truthkeeper (talk) 16:58, 9 August 2012 (UTC)

Thanks again, Truthkeeper. --Anthonyhcole (talk) 03:16, 10 August 2012 (UTC)

From the lead section, paragraph 1: "Approximately half of all cancer patients have pain, and about a third of cancer patients with pain experience moderate or severe pain that diminishes their enjoyment of life and interferes with sleep and daily activities including work and social interactions." This is a long sentence. Perhaps delete the last part: "including work and social interactions", which doesn't seem to add anything. Axl ¤ [Talk] 19:17, 10 August 2012 (UTC)

Done. I deleted "including work and social interactions". --Anthonyhcole (talk) 00:43, 11 August 2012 (UTC)

From the lead section, paragraph 2: "Acute (transitory) cancer pain is usually caused by treatment." This is also stated in the section "Pain", paragraph 2, with Oxford Textbook of Palliative Medicine 3rd edition as the reference. However the reference describes two sub-groups of causes of acute pain: cases associated with the diagnosis of cancer, and cases associated with treatment. The reference does not imply that treatment is the usual cause of acute pain. Axl ¤ [Talk] 21:13, 10 August 2012 (UTC)

Thanks for picking that up. It was Portenoy who said that, somewhere. I don't know why I'm citing Foley, and I can't access Foley on Google any more. I'll look for the Portenoy source when I'm back online. For now, I've amended the text. Does that match what Foley (Oxford Textbook) says now? [2] --Anthonyhcole (talk) 00:43, 11 August 2012 (UTC)

OK. I've found the Portenoy quote:

Cancer pain syndromes can be either acute or chronic. Diagnostic and therapeutic interventions are primarily responsible for the acute pain syndromes. Portenoy RK; Conn M (23 June 2003). "Cancer pain syndromes". In Bruera ED & Portenoy RK (ed.). Cancer Pain: Assessment and Management. Cambridge University Press. p. 8. ISBN 978-0-521-77332-4.

I read that as saying diagnostic and therapeutic interventions are responsible for most, but I see now that's only one reading, and the authors may have been saying only what kind of pain those interventions mostly cause, not what kind of thing causes most acute pain. Bugger. I think the new wording reflects Portenoy and your description of Foley now.

I'm going to spend the next couple of days double-checking my sources. I haven't actually done that since I wrote this thing. Can I suggest you, Axl, and others, hold off on further reviewing until I've done that? I'm building a table at Talk:Cancer pain/Sources comparing the article's claims with the source text. I'll have that revision deleted once this review is over. --Anthonyhcole (talk) 08:35, 11 August 2012 (UTC)

One more comment: I haven't checked all of the references, but it seems to me that the article places undue weight on the contribution of treatments to pain. The lead section mentions that treatment can cause both acute and chronic pain, but doesn't mention that cancer itself can cause acute pain. The lead also describes radiotherapy and chemotherapy as causes of long-term pain. However I believe that these cases are rare. Oxford Textbook of Palliative Medicine gives lists of cancer-related acute and chronic pain syndromes. Four syndromes of chemotherapy-related chronic pain are given, none of which are expanded upon in the book's text. The commonest of these is probably peripheral neuropathy, which you have given its own subsection later in the article. Regarding RT, the book's text states "Pain occurring as a complication of radiation therapy is less common than post-chemotherapy and metastatic pain syndromes." Surely surgery is a more common cause of treatment-related chronic pain than chemotherapy or RT? Axl ¤ [Talk] 09:33, 11 August 2012 (UTC)

I don't think there's too much emphasis on treatment-related chronic pain; I'm thinking there's not enough on treatment/diagnosis-related acute pain; tumor-related acute pain is absent; and there are gaps in tumor-related chronic pain. I can't access the Oxford textbook via Google at the moment and it's not in my local med library; can you tell me what four chemotherapy-related chronic pain syndromes it lists? I'll continue comparing the present article text with source text on Talk:Cancer_pain/Sources, and when that's done I'll see what I can find in other textbooks. Feel free to add/remove stuff at will, or take a break from this and I'll let you know when I think I'm there. I really appreciate your efforts. --Anthonyhcole (talk) 11:40, 11 August 2012 (UTC)

The chemotherapy-related chronic pain syndromes listed in Oxford Textbook of Palliative Medicine are:-

1. Chronic painful peripheral neuropathy
2. Avascular necrosis of femoral or humeral head
3. Plexopathy associated with intra-arterial infusion
4. Gynaecomastia with hormonal therapy for prostate cancer

However none of these are expanded upon in the book's text. I take this to be an implicit indication of the author's lack of weighting of these syndromes as part of cancer pain as a whole. The book lists and describes many tumour-related syndromes that aren't mentioned in this article. Axl ¤ [Talk] 21:04, 11 August 2012 (UTC)

You're a rock. I've found an NCI page that gives the prevalence of chemo-induced peripheral neuropathy as 30 to 40 percent of patients on chemotherapy, so that's fairly significant. I've put it in the article for now, but will keep my eye out for a review or meta-analysis.

I would be very grateful if you could jot down for me any tumor-related causes covered in the Oxford book that you notice missing from here. I've seen some in other textbooks over the last couple of days too.

I've seen so much that needs fixing in this article (I'm still proud of it but realise it could be much more useful) over the last few days that I've decided to withdraw the nomination. Thanks again for your thoughts and help. --Anthonyhcole (talk) 07:06, 12 August 2012 (UTC)

The 30–40% prevalence of CIPN is probably true (here is a better reference), but this does not distinguish between painful and non-painful CIPN. This reference quotes 20% painful CIPN for standard regimens and "nearly all" for high-dose regimens. Axl ¤ [Talk] 10:52, 12 August 2012 (UTC)

• Comments: I'm not sure if I'll be able to do a full review, but this is a very impressive work you've put together here. A few small comments at a glance:
• There are a lot of short sections/paragraphs, I know some of that is unavoidable, but if there's a way to cut down on that I'd suggest doing so.
• "In Canada, for instance, veterinarians get five times more training in pain than people doctors" "people doctors" sounds a bit odd to me, is there a better way to say this?
• PMID 19262386 looks interesting, is there enough sourcing to include this subject in the article? Mark Arsten (talk) 20:56, 10 August 2012 (UTC)

Thank you. I've changed "people doctors" to "physicians"[3]. The use of cannabinoids in cancer pain management is not yet, as far as I can tell, part of clinical practice (though I believe some are using marijuana to treat nausea) and that meta-analysis you point to is very tentative, so I'd prefer not to bring it into the article yet. I'll have another look at the short paragraph situation. --Anthonyhcole (talk) 01:09, 11 August 2012 (UTC)

Ok, I guess you're probably right about the lack of cannabinoid evidence, I did another search and the first source I came to said there is "very little experimental work" on the topic. Mark Arsten (talk) 02:51, 11 August 2012 (UTC)

Oppose: I have two concerns with this article. The first is the massive overuse of section headers. I suggest previewing the article with {{TOC limit}} removed and asking yourself: is this what the organization scheme of an encyclopedia article should look like? I think the answer is "no", and I think the solution is not to limit the TOC depth, but instead to reduce the number of distinct sections. This issue is compounded by the fact that so many of the sections aren't even complete paragraphs; they're merely one or two sentences long. See Mucositis and Hypophysectomy for examples.

My second concern is the Legal and ethical considerations section. While it certainly seems reasonable for such a section to exist in this article, the current version of it is completely unacceptable in nearly every way that it is possible for a section to be unacceptable. It doesn't contain any content which is specific to cancer pain; the word "cancer" appears in it only once! Five of the six paragraphs are written from a single source, which is not nearly enough variety for a topic as complex as this. Those five paragraphs are also severely underlinked. Furthermore, much of the material is written in a tone that is inappropriate for an encyclopedia article: "The doctor should not insist on treatment the patient rejects..." This is an opinion being presented as a fact. This entire section will need to be rewritten from scratch in order for this article to pass FAC. --Cryptic C62 · Talk 01:40, 12 August 2012 (UTC)

Thank you for your thoughtful critique. I don't know what to do about the section headings situation. I'll give it some thought. As for the ethics content, there are other sources out there, but the source I used covered everything they did. I'm not sure what underlinked means, or why it's a problem.

I want to go through my sources once again, as Axl found an error and I think I've just found another, and Axl has pointed out some missing content that I agree the article needs. Thank you everybody for your advice and help. I'm withdrawing this nomination. --Anthonyhcole (talk) 06:36, 12 August 2012 (UTC)

The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.