Abstract
Palliative care is seeing cancer patients earlier in the disease trajectory with a multitude of chronic issues. Chronic non-malignant pain (CNMP) in cancer patients is under-studied. In this prospective study, we examined the prevalence and management of CNMP in cancer patients seen at our supportive care clinic for consultation. We systematically characterized each pain type with the Brief Pain Inventory (BPI) and documented current treatments. The attending physician made the pain diagnoses according to the International Association for the Study of Pain (IASP) task force classification. Among 200 patients (mean age 60 years, 69% metastatic disease, 1-year survival of 77%), the median number of pain diagnosis was 2 (IQR 1–2); 67 (34%, 95% CI 28–41%) had a diagnosis of CNMP; 133 (67%) had cancer-related pain; and 52 (26%) had treatment-related pain. In total, 12/31 (39%) patients with only CNMP and 21/36 (58%) patients with CNMP and other pain diagnoses were on opioids. There was a total of 94 CNMP diagnoses among 67 patients, including 37 (39%) osteoarthritis and 20 (21%) lower back pain; 30 (32%) were treated with opioids. In summary, CNMP was common in the timely palliative care setting and many patients were on opioids. Our findings highlight the need to develop clinical guidelines for CNMP in cancer patients to standardize its management.
Highlights
Pain is one of the most common and distressing symptoms in cancer patients, occurring in 50% to90% of patients with advanced malignancies [1,2]
We examined the prevalence and management of chronic non-malignant pain in cancer patients referred to the supportive care clinic at our comprehensive cancer center
We found that one in three cancer patients seen at the supportive care clinic for timely palliative care consultation had a diagnosis of chronic non-malignant pain
Summary
Pain is one of the most common and distressing symptoms in cancer patients, occurring in 50% to90% of patients with advanced malignancies [1,2]. Controlled pain can have a significant impact on patients’ mobility, sleep, mood, function, and overall quality of life [3]. Specialist palliative care teams have significant expertise in pain and symptom management, providing impeccable assessment and diagnosis of pain syndromes, personalized treatment recommendations, and careful monitoring [4]. At MD Anderson Cancer Center, the median survival from the time of outpatient referral to death was greater than 1 year [6]. In these patients, chronic illnesses, such as chronic pain syndromes, can have a major impact on quality of life
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