Post-treatment pain linked to recurrence, survival in head and neck cancer

Patients who reported a higher level of pain after treatment for head and neck cancer had higher rates of disease recurrence and lower survival rates.

Researchers from the University of Iowa prospectively examined data from 339 patients with head and neck carcinomas who were enrolled in the department of otolaryngology’s Outcomes Assessment Project between February 1998 and November 2001.

A higher level of post-treatment pain was significantly associated with younger age, worse physical and mental general health and a higher level of depressive symptoms (P<.05).

Pain was also associated with recurrence; the mean pain score reported by participants at or before recurrence within the first year (2.9) was higher than the mean pain score reported by those without recurrence (1.4; P=.006).

In multivariate analysis, pain (P=.003) and tumor site (P=.03) were independent predictors of first-year recurrence, according to researchers. Additionally, those patients reporting intermediate or high levels of pain were nearly four times more likely to experience recurrence within the first year than those with no or low pain.

The five-year survival rate was lower among those with intermediate or high pain levels (65.1%) than among those with no or low pain (81.8%; P=.04). Also, pain level, age and treatment modality were independent predictors of five-year survival.

“The prevalence of post-treatment pain within the first year after diagnosis of head and neck cancer suggests that physicians are not adequately addressing this issue, even though pain is associated with health-related quality of life and recurrent disease,” researchers said. “Appropriate monitoring can be accomplished through the routine collection of pain as a fifth vital sign.”

Scharpf J. Arch Otolaryngol Head Neck Surg. 2009;135:789-794.