September 17, 2012
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Advanced-stage cancer patients experience significant pain variations

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Patients with advanced-stage cancer may experience significance variation in pain intensity throughout the course of their disease, according to study results.

Nonwhites, as well as patients with a new diagnosis, were more likely to experience high pain variability, the results showed.

Unlike many prior pain studies, which measured pain intensity at one point in time, this study was designed to examine pain at multiple time points. Studies that measured pain only at one time point “could mask important variability” given the “fluctuating nature of cancer-related pain,” the researchers wrote.

The study included 949 patients from Dana-Farber Cancer Institute who were enrolled between 2004 and 2006. Patients submitted pain scores at the beginning of each appointment as part of the vital sign examination. Pain was rated on a scale from 0 (no pain) to 10 (worst pain). All patients had solid tumors and had submitted pain scores at least 3 different months within 24 months of their stage IV cancer diagnosis.

About half of the patient population had a high level of pain variability. Although breast cancer patients had the most consistent pain variability, those patients with head and neck cancers had the greatest median variability.

Upon examining the data for factors associated with pain variability, the researchers found that nonwhites were more likely to have high pain variability compared with whites (OR=2.15; 95% CI, 1.32-3.51). In addition, patients with moderate or severe pain at baseline had increased likelihood for pain variability (OR=7.7; 95% CI, 4.05-14.60). In contrast, those patients who had received  their cancer diagnosis between 4 and 12 months prior were less likely to report high pain variability (OR=0.64; 95% CI, 0.44-0.95).

Those patients who reported a high pain variability and showed a trend toward increasing pain intensity were most likely to have poor survival, with an unadjusted 1-year survival probability of 39.1% (95% CI, 27.7-50.4).

“Our data highlight the volatile nature of pain among many patients with advanced cancer and underscore the need for careful, ongoing assessment and management,” the researchers wrote.

Reference:
  • Zhu J. Cancer. 2012;doi:10.1002/cncr.27673.