The Prevalence And Management Of Pain In Gynaecological Malignancy Within The Outpatient Setting

Abstract

Objectives: Despite pain being a common symptom in gynaecological malignancies there is limited literature on accurate rates of prevalence or current management. Our aim was to investigate these issues to establish integrated pain pathways with our oncology colleagues. This information would also be considered in future research for the development of cancer specific pain pathways.Method: We recorded pain scores from those attending gynaecology outpatient clinics in our tertiary cancer referral hospital. The characteristics of the pain and its management were assessed using the Brief Pain Inventory, the self-assessed Leeds Assessment of Neuropathic Symptoms and Signs pain scale and the Pain Management Index. We also investigated associated risk factors (age, tumor site, cancer treatment types) in presence and severity of pain.Results: Of all patients investigated, 38% were in pain from any cause with 80% of these patients scoring their pain as moderate to severe. Background pain lasted for more than three months in 75% of patients with pain whilst 42% complained of breakthrough pains of similar duration. Just under half of patients in pain suffered from neuropathic involvement. A negative PMI signifying under-treatment was seen in 63% of patients with pain. Surprisingly the most common cause of pain was from non-cancer causes. Over half of patients in pain accepted post-study assistance when offered. We could not identify any associated risk factors.Conclusions: Patients with gynaecological malignancies in the outpatient setting commonly experience pain which is chronic and undertreated. Many also have complicating neuropathies which would benefit from specialist input. We recommend that all patients attending gynaecological cancer outpatient clinics should be routinely assessed for pain to improve cancer management. This information is to be incorporated in future cancer specific pain pathways. Grant: The Royal Marsden Hospital NHS Foundation Trust