An exploratory, large-scale study of pain and quality of life outcomes in cancer patients with moderate or severe pain, and variables predicting improvement.

Constanza Maximiano,Susana Traseira,Mariano Provencio,Juan L Martí-Ciriquián,Iker López,Jorge Contreras,Michael Herdman,Luis Zugazabeitia,Cristina Martín,Miguel A Núñez

doi:10.1371/journal.pone.0193233

Abstract

BackgroundThere have been few large-scale, real world studies in Spain to assess change in pain and quality of life (QOL) outcomes in cancer patients with moderate to severe pain. This study aimed to assess changes on both outcomes after 3 months of usual care and to investigate factors associated with change in QoL.Patients and methodsLarge, multi-centre, observational study in patients with lung, head and neck, colorectal or breast cancer experiencing a first episode of moderate to severe pain while attending one of the participating centres. QoL was assessed using the EuroQol-5D questionnaire and pain using the Brief Pain Inventory (BPI). Instruments were administered at baseline and after 3 months of follow up. Multivariate analyses were used to assess the impact of treatment factors, demographic and clinical variables, pain and other symptoms on QoL scores.Results1711 patients were included for analysis. After 3 months of usual care, a significant improvement was observed in pain and QoL in all four cancer groups (p<0.001). Effect sizes were medium to large on the BPI and EQ-5D Index and Visual Analogue Scale (VAS). Improvements were seen on the majority of EQ-5D dimensions in all patient groups, though breast cancer patients showed the largest gains. Poorer baseline performance status (ECOG) and the presence of anxiety/depression were associated with significantly poorer QOL outcomes. Improvements in BPI pain scores were associated with improved QoL.ConclusionIn the four cancer types studied, pain and QoL outcomes improved considerably after 3 months of usual care. Improvements in pain made a substantial contribution to QoL gains whilst the presence of anxiety and depression and poor baseline performance status significantly constrained improvement.

Highlights

Pain is a common and burdensome symptom in cancer patients [1] with data indicating that 50%–90% will require treatment for pain during the course of their disease [2]
After 3 months of usual care, a significant improvement was observed in pain and QoL in all four cancer groups (p
Improvements were seen on the majority of EQ-5D dimensions in all patient groups, though breast cancer patients showed the largest gains

Summary

Introduction

Pain is a common and burdensome symptom in cancer patients [1] with data indicating that 50%–90% will require treatment for pain during the course of their disease [2]. There have been few large-scale studies in Spain to describe real world outcomes over time in cancer patients with moderate to severe pain. Such studies are important because they show how pain outcomes evolve in conditions of usual care, in patients who are usually much more heterogenous than those included in clinical trials and where the presence of co-morbidites, lifestyle factors, and poly-medication can all potentially impact results. There have been few large-scale, real world studies in Spain to assess change in pain and quality of life (QOL) outcomes in cancer patients with moderate to severe pain. This study aimed to assess changes on both outcomes after 3 months of usual care and to investigate factors associated with change in QoL.

Objectives

Methods

Conclusion