Advanced-stage cancer patients experience significant pain variations

Issue: September 25, 2012

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

Perspective from Biren Saraiya, MD

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.

Perspective

Biren Saraiya, MD

In this exploratory and interesting study, researchers used the data from electronic medical records and routine pain questions for each patient to understand longitudinal pain scores and variability for patients with stage IV cancer and pain. This is an interesting approach to understand pain. With implementation of electronic medical records in our health care systems, we will be able to look at data such as this for various purposes, including for quality assurance, quality improvement and research. Given that asking for pain severity is a well-accepted method, the data are valid. Future use, though, remains an open question. Given multiple variables for pain — including cancer factors (bone or specific others sites of metastasis), patient factors (demographics and comorbidities), and treatment factors (cancer-directed therapy and pain-directed therapy) — detailed evaluation is needed. To use these data for quality of care may be the most valuable use, using mandated interventions for those with either high-intensity or high-variable pain.

Biren Saraiya, MD

HemOnc Today Editorial Board member

Disclosures: Dr. Saraiya reports no relevant financial disclosures.