Pain among older adults diagnosed with gastrointestinal (GI) malignancies: Results from the cancer and aging resilience evaluation (CARE) registry.

Abstract

82 Background: The impact of pain on functional status and neuropsychological disorders among older adults with cancer is relevant, yet poorly understood. We sought to identify the prevalence of pain at diagnosis in older adults with GI malignancies and evaluate the association between pain and functional status limitations, cognition, and mental health issues. Methods: This study included patients diagnosed with cancer at age ≥60 years and enrolled in the CARE Registry at the University of Alabama at Birmingham (UAB). Patients completed a patient-reported geriatric assessment at their initial visit with a medical oncologist. Patients rated pain on a numeric scale from 0-10. We employed the literature-based cut off for moderate-severe pain of ≥4. Logistic regression modeling was used to determine the association between moderate/severe pain and functional status, falls, cognition, and depression/anxiety. We adjusted the models for sex, race, education, race/ethnicity, marital status, cancer type, and cancer stage. Results: Our cohort included 714 older adults. Median age at diagnosis was 70y (range 60-96) and 59% were male. Median time between diagnosis and study participation was 37 days. Most prevalent diagnoses included colorectal (27.9%), pancreatic (18%), hepatobiliary (11.5%) and gastroesophageal (6.4%) cancers. Overall, 53.1% of the participants reported none/mild (0-3) pain, 25.6% reported moderate (4-7) pain, and 21.4% reported severe (8-10) pain. In univariate analyses, Black patients, lower education, disabled employment, and pancreatic cancer was associated with moderate/severe pain. After multivariate adjusting for covariates, participants with moderate/severe pain were more likely to report limitations in instrumental activities of daily living (adjusted Odds Ratio [aOR] 4.3, 95% confidence interval [CI] 3.1-6.1, p <.001), limitations in activities of daily living (aOR 3.2, 95% CI 2.0-5.1, p <.001), falls (aOR 2.4, 95% CI 1.6-3.6, p <.001), cognitive complaints (aOR 2.9, 95% CI 1.4-6.0, p <.004), anxiety (aOR 2.2, 95% CI 1.4-3.4, p < 0.01), and depression (aOR 3.7, 95% CI 2.2-6.5, p <.001). Conclusions: Pain is common amongst older adults with GI cancers and is associated with functional status limitations, falls, cognitive complaints, and depression/anxiety. Strategies to reduce pain and/or minimize its potential impact on function and mental health warrant future research.