Study: Pain Is Prevalent, Persists in Ambulatory Cancer Patients

Pain in ambulatory cancer patients with solid tumors is complex and dynamic, and adequate pain management requires constant monitoring and therapeutic intervention when needed.

The Eastern Cooperative Oncology Group (ECOG) conducted a multicenter study to assess pain symptoms. Outpatient oncology patients from 38 (six academic and 32 community) centers completed the MD Anderson Symptom Inventory at their initial assessment visit and again four to five weeks later at a follow-up visit.

Participants were asked to rate their pain experience over the previous 24 hours on a scale of 0 to 10. Rankings of 1 to 3 were considered mild, 4 to 5 moderate and 6 to 10 severe; changes of at least 2 points on the scale were considered clinically significant. The solid tumors represented in this study were breast (49.7%), colorectal (23.6%), prostate (10.3%) and lung (16.4%) cancers. In an article published in the Journal of Clinical Oncology (2014:32:312-319), lead author Fengmin Zhao, MS, PhD, of Boston’s Dana-Farber Cancer Institute, and co-authors compared the severity of pain at the two visits. Of 2,761 patients who completed both surveys, 1,298 (47.0%) described some pain at the initial visit. Specifically, 23.5% of patients had mild pain, 10.3% had moderate pain and 13.2% had severe pain initially. At follow-up, 32.2% of this group initially reporting pain had reduced pain, 19.6% had worse pain and 48.2% had stable pain. In patients who had no pain at the initial visit (n=1,463; 53%), 19.5% had mild

pain, 4.9% had moderate pain and 4.0% had severe pain at the follow-up assessment.

The authors found that 54.9% of patients had adequate pain management at both visits; 11.4% of patients had good pain management at enrollment but were undertreated at follow-up; 10.2% of patients were undertreated at initial visit but had adequate pain management at follow-up; and 11.7% of patients were undertreated at both visits (an additional 11.8% had missing data for one or more visits). Patients who described severe pain at the initial visit were excluded from this analysis (a pain score of 10 cannot increase by 2), as were patients who did not complete the survey.

Of the patients describing no pain at the initial visit, 28.4% had pain (8.9% either moderate or severe) at follow-up assessment. Younger age; Hispanic ethnicity; unemployment; severe constipation and other adverse effects of treatment drugs; and care received in a community center were among the factors that affected reported pain levels. Analysis revealed that inadequate pain management, lower baseline pain levels, younger age and poor health status were all significantly associated with increases in pain self-assessments. The authors concluded, “Pain is not only prevalent but also persistent and dynamic,” and recommended frequent assessments in the ambulatory setting and adjustments of pain treatment as needed.