Factors influencing pain in head and neck cancer patients clarified

Nov 22 2012

By Sarah Guy, medwireNews Reporter

Individuals with head and neck cancer frequently report pain 1 year after diagnosis, despite being treated with analgesics, show US study results.

The findings highlight that physical and psychologic factors including pain from neck dissection, xerostomia, and depressive symptoms were more predictive of pain at this time point than demographic factors such as age, gender, and marital status.

"While effective pain treatments exist, identifying those most at risk for pain could facilitate targeted assessment and intervention," suggest Sonia Duffy (University of Michigan, Ann Arbor) and co-investigators.

"An understanding of the complex relationships among cancer treatment, health behaviors, and pain is instructive to clinicians faced with preventing, anticipating, counseling, and treating bothersome symptoms in a challenging patient population," they write in the Archives of Otolaryngology - Head and Neck Surgery.

A group of 374 patients, aged a mean of 58 years with carcinoma of the upper aerodigestive tract, were surveyed before and 1 year after first treatment to include the 36-item Short-Form Instrument (SF-36) body pain score. The population norm for 58-year-olds is a score of 75 (out of 100, where lower scores indicate worse pain), explain Duffy et al.

Mean SF-36 pain scores were significantly lower before treatment than at one year, at 61 versus 65, with both scores under the national average, report the researchers.

This finding is "intuitive" given the pain inherent to an untreated tumor burden at time of diagnosis, the team contends. Furthermore, almost half of the cohort (46%) reported taking analgesics sometimes, frequently, or always.

Multivariate analysis showed that pretreatment pain, being less educated (high school vs some college or more), presence of a feeding tube, xerostomia, depressive symptoms (Geriatric Depressive Scale Short Form score ≥4), taking pain medication frequently (vs rarely or never), and having poor sleep quality (measured on the Medical Outcomes Study sleep measure), were all significantly associated with worse pain at 1-year postdiagnosis.

Conversely, smoking (22% of patients were current smokers) and problem drinking (a score of 8 or higher on the Alcohol Use Disorders Identification Test), were not significantly associated with pain, although the researchers note a trend in that direction.

"Patients with head and neck cancer are at risk for cancer recurrence and for second primaries; pain is a frequent harbinger of such phenomena, and clinicians must remain ever vigilant during continued oncologic surveillance," conclude Duffy and colleagues.

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