Response to pain management among patients with active cancer, no evidence of disease, or chronic nonmalignant pain in an outpatient palliative care clinic.

Abstract

Abstract Background: Outpatient palliative care clinics may be required to manage patients not typically seen by palliative care. These include patients treated for cancer who no longer have evidence of disease (NED) and patients with chronic pain but no life-limiting illness (NLLI). Treatment response may differ among these groups. Our aim was to determine treatment response by change in pain scores and morphine equivalent daily dose (MEDD) between initial visit and first follow-up in patients with active cancer (AC), NED, and those with NLLI. A retrospective review of 143 consecutive outpatients referred to a clinic staffed by the palliative care program was conducted. Pain treatment response was defined by a ≥ 2 point difference on the Numerical Rating Scale (NRS) or ≥ 30% reduction from baseline score. Ninety-four patients had pain scores at both initial and follow-up visits after a median of 29.0 days. Fifty percent had AC, 27% NED, and 23% NLLI. Mean (standard deviation [SD]) pain scores at baseline were not significantly different among AC 6.0 (2.5), NED 5.6 (2.5), and NLLI 6.8 (2.2) patients (p=0.22), but were significant at follow-up between AC 4.2 (2.7) and NLLI 6.0 (2.6) (p=0.03) groups. The percent of responders differed significantly between AC 57.4% and NED 20% groups (p=0.002). MEDD increased by 17.2 mg in AC, 40.9 mg in NED, and 18.1mg in NLLI patients (p=0.88).Benzodiazepine use was significantly more frequent in the NLLI group than the AC (p=0.025) and NED (p=0.002) groups. Although median pain scores improved at follow-up, less than half of patients were responders. Patients with AC had a significantly better response rate than NED patients and a lower pain score than NLLI patients at follow-up.