Older survivors of HSCT more likely to report pain than siblings
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Older hematopoietic stem cell transplant survivors appeared 2.6 times more likely to report severe, nonminor or life-threatening pain than cancer-free siblings, according to results of a prospective study published in Cancer.
Overall, nearly 40% of older HSCT survivors followed for a median 5 years reported having pain, researchers noted.
“We chose to focus on the older adult population given their potential increased vulnerability to pain and its potential implications regarding increasing frailty, worsening physical performance and polypharmacy,” Grant R. Williams, MD, assistant professor at The Institute for Cancer Outcomes and Survivorship at University of Alabama at Birmingham School of Medicine, told Healio. “Although pain is frequently assessed as part of routine clinic triage, how pain is addressed is highly variable. Often the oncology team takes a primary role in managing pain, particularly during active cancer treatment, and refers the more complicated cases to a palliative care expert, but in the survivorship phase, it is less clear who is actively managing pain symptoms.”
Williams and colleagues analyzed predictors and prevalence of pain and its association with frailty and physical performance — as well as use of prescription pain medications, including opioids — among 736 patients with hematologic malignancies who underwent allogeneic (n = 240) or autologous (n = 496) HSCT at age 60 years or older and survived 2 or more years after transplantation. The researchers also evaluated a comparison group of 183 cancer-free siblings.
HSCT survivors, compared with siblings, tended to be older (median age at enrollment, 70.7 years vs. 68.9 years) and men (60.3% vs. 37.8%) and appeared less likely to be non-Hispanic white (82.6% vs. 92.9%).
Researchers used survey responses to questions on general pain, prolonged pain, bodily pain and pain interference to develop a composite measure of pain. This composite variable included the presence of at least one of the four types of reported pain.
Among all survivors, 601 completed the full survey.
Median follow-up was 5 years (range, 2-18) after transplantation.
Results showed that, compared with siblings, HSCT survivors reported a higher incidence of general pain (31.3% vs. 25.1%; P = .05), bodily pain (23.4% vs. 15.9%; P = .007), pain interference (19.4% vs. 12%; P = .002), prolonged pain (18.6% vs. 8.7%; P = .002) and the composite pain measure (39.4% vs. 20.8%; P < .001).
Further, HSCT survivors had higher odds of reporting pain (OR = 2.6; 95% CI, 1.7-4.1), general pain (OR = 1.5; 95% CI, 1-2.2), bodily pain (OR = 2.3; 95% CI, 1.4-3.6), pain interference (OR = 2.3; 95% CI, 1.4-3.9) and prolonged pain (OR = 2.5; 95% CI, 1.4-4.4).
Survivors of autologous vs. allogeneic transplants appeared more likely to report overall pain (43% vs. 32.5%; P = .01), as did those with less education, lower annual household income and active chronic graft-versus-host disease.
Results of multivariable analyses showed HSCT survivors with pain had a greater likelihood of impaired physical performance (OR for allogeneic HSCT = 2.7; 95% CI, 1.2-6; OR for autologous HSCT = 3; 95% CI, 1.9-4.9) and of meeting criteria for frailty based on survey responses (OR for allogeneic HSCT = 8.2; 95% CI, 2.4-27.6; OR for autologous HSCT = 7.5; 95% CI, 3.3-16.8).
Additionally, HSCT survivors had higher reported use of prescription pain medication (17.8% vs. 9.3%) and opioids (6.5% vs. 2.2%) than siblings.
“Years after the resolution of a hematologic malignancy and treatment with [HSCT], older survivors still experience a significant burden of pain, especially in comparison with a similar older, noncancer sibling control population,” Williams and colleagues wrote. “We have found that pain experienced by older [HSCT] survivors is associated with impaired physical performance, frailty, and greater use of prescription pain medications and opioid pain medications in comparison with siblings.” – by John DeRosier
For more information:
Grant R. Williams, MD, can be reached at grwilliams@uabmc.edu.
Disclosures: Williams reports personal fees from Carevive Systems outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.
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