The Prevalence and Treatment of ADHD in Spain: A Retrospective Cohort Analysis.

OBJECTIVE: Estimate the prevalence and incidence of Attention Deficit Hyperactivity Disorder (ADHD) and analyze variations in its treatment across Spain. METHOD: Analyses were performed using IQVIA's clinical practice RealWorld Database, the electronic medical records of some 1 million patients from 2013 to 2018. MPH treatment was assessed using the Defined Daily Dose (DDD), MPH sales were extracted from IQVIA's Sell-Out database and the number of active psychiatrists from IQVIA's OneKey Database. RESULTS: Significantly higher ADHD prevalence and incidence (1) in children than in adults and (2) in males compared to females. 91% of patients take MPH. Regional variations in MPH consumption range from 247 Daily Dose per Inhabitant (DDI) per 100,000 inhabitants to 414. CONCLUSION: ADHD continues to be underdiagnosed and undertreated, particularly in adults, and more so in females. The lack of diagnostic tools for adults and the variations in treatment across the country need to be addressed.

Epidemiologic and economic burden of HPV diseases in Spain: implication of additional 5 types from the 9-valent vaccine.

BACKGROUND: A new nonavalent human papillomavirus (HPV) vaccine that includes genotypes 6/11/16/18/31/33/45/52/58 has been recently approved in Spain. A previous study has shown that attributable fraction of HPV related diseases in Spain is consistent with that reported in European and global studies. The aim of the present study was to estimate the annual direct costs associated to the following HPV-related diseases: genital warts, high grade precancerous lesions and cancer of cervix, vulva, vagina, anus and penis and head and neck cancer, caused by genotypes included in the nonavalent (9vHPV) and quadrivalent vaccines (4vHPV), in Spanish men and women. METHODS: Cancer registries and epidemiological studies were used to estimate the number of new annual cases of genital warts, anogenital precancerous lesions and cancer of cervix, vulva, vagina, anus, penis and head and neck, as well as the fraction attributable to HPV infection and to genotypes targeted by both vaccines in Spain. Costs per patient for each disease were obtained from the literature. In addition, 142 specialists were surveyed to estimate cost per patient of vulvar, vaginal, anal and penile precancerous lesions. The annual burden of diseases attributable to types targeted by both vaccines was estimated and compared. All results were validated by a panel of experts. RESULTS: In 2016, new genital warts, precancerous lesions and cancers attributable to types targeted by the 9vHPV were estimated at 49,251, 29,405 and 3381, respectively. Among them, 12,597 new precancerous lesions and 530 new cancers were related to the 5 additional types covered by the 9vHPV. Annual cost of new cases of these diseases associated to types targeted by the 4vHPV and 9vHPV were estimated at 116.7 and 150.9 million € for the Spanish National Health Service (NHS), respectively (2017 €). CONCLUSIONS: HPV-related diseases represent a major burden for the Spanish NHS. Annual new cases and costs related to the 5 additional types from the 9vHPV represent a significant burden compared with that associated to types included in the 4vHPV.

One year quality of life measured with SEC-QoL in levonorgestrel 52 mg IUS users.

OBJECTIVES: The present study aims to prospectively evaluate quality of life (QoL) of women using 52-mg levonorgestrel intrauterine system (LNG-IUS) for contraception determined through the Sociedad Española de Contracepción (Spanish contraception Society) (SEC)-QoL, a questionnaire specifically designed to assess the impact of contraceptive methods on QoL of fertile women. STUDY DESIGN: We conducted a prospective observational multicenter study of 201 reproductive age women who initiated the LNG-IUS for contraception. Sociodemographic and clinical data were collected at baseline and 12 months afterwards. Participants filled in the SEC-QoL questionnaire at both visits. SEQ-QoL scores range from 0 (worst QoL) to 100 (best QoL). RESULTS: Participants claimed an increased QoL 12 months after insertion in all five dimensions of SEC-QoL due to its high contraceptive efficacy and its capability to reduce other menstrual symptoms (e.g., heavy menstrual bleeding or dysmenorrhoea), overall exerting a positive impact on user's satisfaction. SEC-QoL general overall score went from a mean (S.D.) score of 46.3 (17.3) at baseline to 72.2 (14.8) 12 months afterwards (p<.001). Overall, 94.6% of women claimed having found additional benefits other than contraception. No pregnancies were reported during the 12 months of study duration, and only 14 women discontinued use of LNG-IUS (only two of them due to an adverse event), representing a continuation rate of 93%. CONCLUSIONS: Women using LNG-IUS for contraception have an increased QoL after 12 months of use, demonstrated by the increased score in all dimensions of the SEC-QoL questionnaire. IMPLICATIONS: The present study prospectively evaluated QoL of women using LNG-IUS for contraception through the SEC-QoL questionnaire. Participants claimed increased QoL 12 months afterwards, implying that women using LNG-IUS for contraception in usual clinical practise also benefit from the reduction of period-related symptoms, overall leading to very low discontinuation rates.

Development and validation of the SEC-QOL questionnaire in women using contraceptive methods.

OBJECTIVES: Develop and validate a Spanish society of contraception quality-of-life (SEC-QOL) questionnaire to assess the impact of contraceptive methods on the health-related quality of life (HRQOL) of women. METHODS: SEC-QOL was developed following a standardized procedure including review of the literature, interviews with contraception users, and the administration of a pilot questionnaire to 187 women. SEC-QOL consists of 19 items and includes five dimensions. To validate the questionnaire, a multicenter, observational, prospective study was conducted in Spain. The following three study groups were defined: group A (n = 129) comprised women using effective contraceptive methods; group B (n = 251), comprised women about to start using an effective method; and group C (n = 73) comprised women using no or poorly effective contraception. All women attended baseline and final visits (4 ± 1 months). Participants completed the SEC-QOL, psychological well-being index, EuroQol five-dimensional questionnaire, and perceived health state questionnaires. RESULTS: At baseline, women from group A had a better HRQOL in all SEC-QOL dimensions, except for breast symptoms. Heavier menstrual bleeding, more androgenic and breast symptoms, menstrual pain, and not using hormonal contraceptive methods were associated with lower HRQOL. SEC-QOL scores showed moderate correlations to psychological well-being index and slightly lower correlation to EuroQol five-dimensional questionnaire scores. At follow-up, HRQOL had improved in all groups; most markedly in group B, which obtained an average effect size of 0.59. The minimum important difference was established as a 3.4-point change in the global SEC-QOL score. SEC-QOL obtained a Cronbach's α of 0.88 and an intraclass correlation coefficient of 0.82. CONCLUSIONS: SEC-QOL is a valid, reliable, and sensitive to change questionnaire for use in daily clinical practice and future research projects on contraception.

[Development and validation of a new questionnaire to assess health care satisfaction and the device in stomized patients: espejo questionnaire]. / Cuestionario espejo. Valorar la satisfacción de pacientes ostomizados con la atención sanitaria y el dispositivo.

OBJECTIVES: To develop a questionnaire to measure the satisfaction of stomatised patients with healthcare professionals and with the stomal device. METHODS: An initial review of the literature was performed and in meetings with experts, the most relevant items were selected. In a pilot study with patients that had been recently stomatised (three months from intervention), the comprehensibility and discriminatory ability of each item was tested. Items were eliminated on the grounds of frequent "no response" or low correlation with others on the provisional scale (determined by means of Cronbach's alpha). RESULTS: Following meetings with experts, 12 items were eliminated by reason of irrelevance or low frequency of use. Subsequently by means of administration of the questionnaire to a sample of 72 patients, five more items were selected for elimination. An analysis of the 13 items that remained confirmed an acceptable level of reliability (Cronbach's alpha of 0.917) and also the significant differences in the global scores between the patients who have had stoma for more than three months (higher satisfaction) and patients who had been recently stomatised. The items in the questionnaire referred to aspects of easy and comfort of use of the stoma, as well as satisfaction with information received and interaction with healthcare professionals from the point of view of the patient. CONCLUSIONS: This is the first questionnaire to measure satisfaction with healthcare professionals and the stomal device from the perspective of the stomatised patient. In a subsequent study the other properties of the measurement tool (validity responsiveness and longitudinal validation) will be evaluated.

Validation of the AF-QoL, a disease-specific quality of life questionnaire for patients with atrial fibrillation.

AIMS: To assess the performance of AF-QoL, a quality of life questionnaire for patients with atrial fibrillation (AF). METHODS AND RESULTS: Observational, prospective, multicentre study in 29 Spanish centres. Three patients' groups were identified at baseline visit: AF patients receiving a new therapeutic intervention according to physician criteria (intervention group); AF clinically stable patients according to physician evaluation (clinically stable group); and patients in a stable condition for more than 1 year after a myocardial infarction (control group). All patients were > or = 18 years. Follow-up visit was at 1 month (clinically stable group) and 3 +/- 1 months (intervention group). Sociodemographic and clinical information was gathered. AF-QoL, SF-36, and patient self-perception of general health status were administered. A total of 417 patients was included. Mean (SD) age was 61.2 (12.4), 31.4% women. AF-QoL mean overall score in AF patients (43.6) was lower (worse health-related quality of life, HRQoL) than in the control group (51.7) (P < 0.05). At baseline, patients with higher frequency of symptoms (P < 0.05) and worse NYHA functional class (P < 0.01) reported lower AF-QoL scores. AF-QoL and SF-36 correlated in all of their domains (r = 0.14-0.8, P < 0.01). AF-QoL showed good internal consistency (0.92) and test-retest reliability (0.86). CONCLUSION: AF-QoL is a valid and reliable HRQoL measure. Further investigation is recommended before using it in clinical practice.

Epidemiologic study to assess patient involvement in choice of adjuvant chemotherapy for breast cancer (PROSA Study).

INTRODUCTION: The objective of the current study was to assess patient involvement in adjuvant chemotherapy choice, reasons for treatment choice and satisfaction with the chosen treatment, given that improvement in breast cancer survival has been accompanied by a greater demand for disease information from patients. MATERIAL AND METHODS: An epidemiologic, prospective, multicentre study was conducted with patients aged over 18 diagnosed with breast cancer stages I, II and III. The study, which was conducted prior to these patients initiating adjuvant chemotherapy, was based on a baseline visit and a follow-up visit. Data on sociodemographic and clinical variables were collected and a survey was administered to assess both the reasons for choosing particular treatments and ultimate satisfaction with the chosen treatment. Statistical procedures included a descriptive analysis, bivariate tests and logistic regression. RESULTS: A total of 613 patients were recruited with a mean (SD) age of 53.3 (10.8) years. Most patients had stage II breast cancer (53.9%) and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 (82.8%). Of these patients, 58.3% were treated with taxanes (48.2% docetaxel, doxorubicin and cyclophosphamide) and 41.7% without (43.5% 5-fluorouracil, epirubicin and cyclophosphamide). At the baseline visit and final visit, 73.8% and 72.6% of patients, respectively, were aware of their diagnosis and prognosis. A total of 77.1% patients (64.7% who had followed their physician's advice) were involved in treatment choice and this involvement was directly related to improved ECOG performance status and information. A total of 78.7% of patients were very satisfied or satisfied with their treatment and 5.4% of patients refused to continue treatment (with 39.3% giving toxicity as the reason). CONCLUSIONS: Although a high proportion of patients were involved in choosing their treatment, this involvement was not related to greater treatment satisfaction. Further research in routine clinical settings is needed in order to assess other factors related to choice of adjuvant chemotherapy, treatment satisfaction and long-term effectiveness (3-5 years).

Validation of the Spanish version of the Asthma Control Questionnaire.

BACKGROUND: The Asthma Control Questionnaire (ACQ) has not been validated in the Spanish population, and the fact that it requires spirometry poses an important limitation on its widespread use in the primary care setting in Spain. OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the Spanish version of the ACQ. METHODS: In this multicenter, prospective study, consecutive adult patients with persistent asthma were recruited at 62 respiratory and allergy units across Spain. Patients were assessed at baseline and at weeks 2 and 6. The following clinical variables were recorded: lung function (forced expiratory volume in 1 second [FEV(1)]), symptoms, exacerbations, concomitant diseases, asthma severity according to the Global Initiative for Asthma international guideline, and asthma control as perceived by patients and physicians through direct ad hoc questions. The latter measures were derived specifically for this study. Patients self-completed the ACQ at all visits before the rest of the study variables were recorded. The ACQ's feasibility, validity, reliability, and sensitivity to change were assessed. Cross-sectional and longitudinal validity was assessed using the relationship between ACQ score and clinical parameters. Sensitivity to change was assessed by estimating the global effect size and the minimal important difference (MID). Reliability was assessed using estimation of the Cronbach alpha coefficient (CCalpha) and intraclass correlation coefficient (ICC). RESULTS: A total of 607 patients were included. The mean (SD) age was 45.6 (17.1) years and 61.4% of the patients were women. Of these 607, 235 (39%) had mild asthma; 246 (41%), moderate; and 126 (21%), severe. Mean (SD) time to complete the ACQ was 3.9 (4.4) minutes. The Pearson correlation coefficient in the relationship between ACQ and FEV(1) (% predicted value) was -0.23. ACQ was found to be significantly related to asthma severity and intensity and frequency of symptoms (coughing, wheezing, and dyspnea) (both, P < 0.001). Change in ACQ was significantly related to changes in FEV(1), intensity and frequency of symptoms, and number of exacerbations (all, P < 0.001). The global effect size of ACQ was 0.46 and the MID was 0.47 point of a maximum of 6. CCalpha was 0.90 and ICC was 0.86. CONCLUSION: In these adults with asthma in Spain, the Spanish version of the ACQ was found to be a reliable and valid questionnaire, suggesting that it can be used in this population as a discriminative and evaluative instrument.

[Development of a questionnaire to evaluate the impact of hot flashes in quality of life in patients with advanced prostate cancer. The ESCAPA study]. / Desarrollo de un cuestionario sobre la repercusión de los sofocos en la calidad de vida de los pacientes con cáncer de próstata avanzado. Estudio ESCAPA.

BACKGROUND AND OBJECTIVE: Although the use of the androgen deprivation in advanced prostate cancer (APC) is extended, the impact of one of its frequent secondary effects, hot flashes, remains not deeply studied. Our aim is the design and validation of a specific questionnaire to evaluate the impact of hot flashes in APC patients with hormonal ablative treatment. PATIENTS AND METHOD: Observational, prospective, multicenter study of 496 patients with APC, who were included in one of 2 groups -A (reliability): 56 patients without expected significative state changes; and B (sensitivity): 440 patients, who were either naïve or under changes in hormonal therapy because of intolerance or disease progression-, during 9 months. Hot Flashes Questionnaire (19 items) and the Rotterdam Symptoms Checklist (RSCL) were administered. Variables as disease stage, prostate-specific antigen and Karnofsky index were collected. RESULTS: Response rate of questionnaire: 85.5%. Correlations observed between different items were high, ranging from 0.545 to 0.957. Effect size between initial visit and follow-up were 0.34, 0.41 and 0.53 at 3, 6 and 9 months. At 3 months, patients with progression showed a mean reduction (standard deviation) of hot flashes impact on daily life activities of 35.76 (37.05). Intern consistency, measured through Cronbach alpha, was of 0.98. Test-retest reliability, measured through intraclass correlation coefficient, resulted significative (0.84; 95% confidence interval, 0.69-0.91). CONCLUSIONS: Hot Flashes Questionnaire presents good results in feasibility, validity, reliability and sensitivity to change. It's the first questionnaire in evaluating hot flashes impact on APC patients, showing good measure properties that make proper its use both for clinical practice and investigation.

Desarrollo de un cuestionario sobre la repercusión de los sofocos en la calidad de vida de los pacientes con cáncer de próstata avanzado. Estudio ESCAPA / Development of a questionnaire to evaluate the impact of hot flashes in quality of life in patients with advanced prostate cancer. The ESCAPA study

Fundamento y objetivo: Aunque está extendido el uso del bloqueo androgénico en el cáncer de próstata avanzado (CPA), se ha estudiado poco la repercusión de un efecto secundario frecuente de este tratamiento: los sofocos. Se pretende diseñar y validar un cuestionario específico para evaluar el impacto de los sofocos en pacientes con CPA en tratamiento hormonal ablativo. Pacientes y método: Se ha realizado un estudio observacional, prospectivo y multicéntrico, de 9 meses de duración, de 496 pacientes con CPA, divididos en 2 grupos: A (de fiabilidad), formado por 56 pacientes en los que no se preveían cambios significativos en el estado de salud, y B (de sensibilidad), constituido por 440 pacientes que recibían por primera vez tratamiento hormonal o en los que éste se modificaba por intolerancia o progresión de la enfermedad. Se administró el Cuestionario de Sofocos (19 ítems) y el Rotterdam Symptoms Checklist (RSCL), y se recogieron variables como el estadio de la enfermedad, antígeno prostático específico e índice Karnofsky. Resultados: La tasa de respuesta al cuestionario fue del 85,5%. Las correlaciones observadas entre los distintos ítems fueron altas, oscilando entre 0,545 y 0,957. El tamaño del efecto entre la visita inicial y las de seguimiento fue de 0,34; 0,41, y 0,53 a los 3, 6, y 9 meses, respectivamente. A los 3 meses, los pacientes con progresión mostraron una reducción media (desviación estándar) del impacto de los sofocos sobre la vida diaria de 35,76 (37,05). La consistencia interna, medida por el alfa de Cronbach, fue de 0,98. La fiabilidad test-retest, determinada por el coeficiente de correlación intraclase, resultó significativa (0,84; intervalo de confianza del 95%, 0,69-0,91). Conclusiones: El Cuestionario de Sofocos muestra buenos resultados en factibilidad, validez, fiabilidad y sensibilidad al cambio. Es el primero en evaluar el impacto de los sofocos en el paciente con CPA, y sus buenas propiedades de medición lo hacen apto para su utilización tanto en la práctica clínica como en investigación

Background and objective: Although the use of the androgen deprivation in advanced prostate cancer (APC) is extended, the impact of one of its frequent secondary effects, hot flashes, remains not deeply studied. Our aim is the design and validation of a specific questionnaire to evaluate the impact of hot flashes in APC patients with hormonal ablative treatment. Patients and method: Observational, prospective, multicenter study of 496 patients with APC, who were included in one of 2 groups ­A (reliability): 56 patients without expected significative state changes; and B (sensitivity): 440 patients, who were either naïve or under changes in hormonal therapy because of intolerance or disease progression­, during 9 months. Hot Flashes Cuestionnaire (19 items) and the Rotterdam Symptoms Checklist (RSCL) were administered. Variables as disease stage, prostate-specific antigen and Karnofsky index were collected. Results: Response rate of questionnaire: 85.5%. Correlations observed between different items were high, ranging from 0.545 to 0.957. Effect size between initial visit and follow-up were 0.34, 0.41 and 0.53 at 3, 6 and 9 months. At 3 months, patients with progression showed a mean reduction (standard deviation) of hot flashes impact on daily life activities of 35.76 (37.05). Intern consistency, measured through Cronbach alpha, was of 0.98. Test-retest reliability, measured through intraclass correlation coefficient, resulted significative (0.84; 95% confidence interval, 0.69-0.91). Conclusions: Hot Flashes Questionnaire presents good results in feasibility, validity, reliability and sensitivity to change. It's the first questionnaire in evaluating hot flashes impact on APC patients, showing good measure properties that make proper its use both for clinical practice and investigation

Desarrollo de un cuestionario de evaluación de la satisfacción con el tratamiento en paciente con acné / Developing a questionnaire to assess treatment satisfaction in patients with acne

Introducción. No se ha estudiado la satisfacción del paciente con el tratamiento para el acné de forma tipificada. El objetivo de este trabajo es desarrollar un cuestionario de satisfacción con el tratamiento en pacientes con acné que permita conocer el grado de satisfacción del paciente de forma tipificada y que a su vez discrimine entre los diferentes tratamientos. Métodos. Se utilizó un método exploratorio como el del grupo focal. Se elaboró un guión semiestructurado basado en aspectos recogidos de la literatura médica. Los participantes del grupo focal fueron 6 mujeres diagnosticadas de acné y que en algún momento habían recibido tratamiento con isotretinoína oral. Resultados. El resultado ha sido un cuestionario de 11 puntos referidos a la satisfacción con varios aspectos relacionados con el tratamiento: mejoría de los síntomas, satisfacción con la información recibida, satisfacción respecto al estado de ánimo, a la vida social, a la eficacia del tratamiento, a los efectos secundarios provocados por el tratamiento, a la forma de administración y a su posología, a las actividades diarias y al tratamiento en general. Conclusión. Se ha desarrollado un cuestionario de satisfacción con el tratamiento en pacientes con acné. Introducción. No se ha estudiado la satisfacción del paciente con el tratamiento para el acné de forma tipificada. El objetivo de este trabajo es desarrollar un cuestionario de satisfacción con el tratamiento en pacientes con acné que permita conocer el grado de satisfacción del paciente de forma tipificada y que a su vez discrimine entre los diferentes tratamientos. Métodos. Se utilizó un método exploratorio como el del grupo focal. Se elaboró un guión semiestructurado basado en aspectos recogidos de la literatura médica. Los participantes del grupo focal fueron 6 mujeres diagnosticadas de acné y que en algún momento habían recibido tratamiento con isotretinoína oral. Resultados. El resultado ha sido un cuestionario de 11 puntos referidos a la satisfacción con varios aspectos relacionados con el tratamiento: mejoría de los síntomas, satisfacción con la información recibida, satisfacción respecto al estado de ánimo, a la vida social, a la eficacia del tratamiento, a los efectos secundarios provocados por el tratamiento, a la forma de administración y a su posología, a las actividades diarias y al tratamiento en general. Conclusión. Se ha desarrollado un cuestionario de satisfacción con el tratamiento en pacientes con acné (AU)

[Validation of the Spanish version of the Brief Pain Inventory in patients with oncological pain]. / Validación española del cuestionario Brief Pain Inventory en pacientes con dolor de causa neoplásica.

BACKGROUND AND OBJECTIVE: Our goal was to validate the Spanish version of the Brief Pain Inventory (BPI) questionnaire used to measure the intensity of oncological pain and its impact on activities of daily living in patients with cancer. PATIENTS AND METHOD: Patients with oncological pain were consecutively included in the study. These patients filled up the Spanish version of the BPI questionnaire (CBD) and the Rotterdam Symptom Checklist (RCSL) during the inclusion visit and again after 3-5 days (patients with clinically stable oncological pain) or after one month (patients with unstable oncological pain). RESULTS: 126 patients were assessed; 85.1% of them had suffered some episode of irruptive pain 24 hours prior to their inclusion in the study. 86.5% of patients fully completed the questionnaire. The CBD showed mild to moderate correlations with the patients perception of pain severity and with the presence of tumor dissemination. The <> dimension of the RCSL displayed the highest correlation with the dimensions of the BPI (<> and <>). The internal consistency and the test-retest reliability between dimensions were good (0.87 and 0.89) and low to moderate (0.53 and 0.77), respectively. The CBD questionnaire was found to be a tool capable of detecting changes in pain intensity. The changes observed in the two CBD dimensions between study visits fairly reflected the patients perceived changes in pain intensity. CONCLUSIONS: The Spanish version of BPI is valid for measuring the intensity of oncological pain and its impact on activities of daily living in conditions of usual clinical practice.

Validación española del cuestionario Brief Pain Inventory en pacientes con dolor de causa neoplásica / Validation of the spanish version of the brief pain inventory in patients with oncological pain

FUNDAMENTO Y OBJETIVO: Validar la versión española del cuestionario Brief Pain Inventory (BPI) para medir la intensidad del dolor de causa neoplásica y su impacto en las actividades de la vida diaria en pacientes con cáncer. PACIENTES Y MÉTODO: Se incluyó consecutivamente a pacientes con dolor de origen neoplásico. Los pacientes cumplimentaron los cuestionarios BPI (Cuestionario Breve del Dolor o CBD en español) y el Rotterdam Symptom Checklist (RSCL) en la visita de inclusión. El CBD se repitió a los 3-5 días en los pacientes clínicamente estables de su dolor de origen neoplásico y ambos cuestionarios se repitieron al mes en los pacientes no estables de su dolor. RESULTADOS: Se evaluó a 126 pacientes, el 85,1 per cent había sufrido algún episodio de dolor irruptivo en las 24 h previas al inicio del estudio. El 86,5 per cent de los pacientes completó el CBD en su totalidad. Las puntuaciones del CBD se correlacionaron con la percepción del paciente de la intensidad máxima del dolor y con la presencia de tumor diseminado. La dimensión 'síntomas psicológicos' del RSCL fue la que presentó mayor correlación con las dimensiones del CBD ('intensidad del dolor' e 'interferencia en las actividades'). La consistencia interna de las dimensiones fue buena (0,87 y 0,89), y la fiabilidad test-retest entre baja y moderada (0,53 y 0,77). El CBD ha demostrado ser un instrumento capaz de detectar cambios en el nivel de dolor. Los cambios observados en las dos dimensiones del CBD entre las dos visitas de estudio reflejan los cambios percibidos por el propio paciente en la intensidad del dolor. CONCLUSIONES: La versión española del CBD se mostró válida para medir la intensidad del dolor de causa neoplásica y su impacto en las actividades de la vida diaria, en condiciones de práctica clínica habitual (AU)