Fengmin Zhao1, Victor T Chang, Charles Cleeland, James F Cleary, Edith P Mitchell, Lynne I Wagner, Michael J Fisch. 1. Fengmin Zhao, Dana-Farber Cancer Institute, Boston, MA; Victor T. Chang, Veterans' Affairs New Jersey Health Care System/Rutgers-New Jersey Medical School, East Orange, NJ; Charles Cleeland and Michael J. Fisch, The University of Texas MD Anderson Cancer Center, Houston, TX; James F. Cleary, University of Wisconsin, Madison, WI; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; and Lynne I. Wagner, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
PURPOSE: To understand changes in pain severity over time and to explore the factors associated with pain changes in ambulatory patients with solid tumors. PATIENTS AND METHODS: We enrolled 3,106 patients with invasive cancer of the breast, prostate, colon/rectum, or lung from multiple sites. At baseline and 4 to 5 weeks later, patients rated their pain level on a 0 to 10 numerical rating scale. A 2-point change in pain score was defined as a clinically significant change in pain. Multivariable logistic models were fitted to examine the effects of pain management and demographic and clinical factors on change in pain severity. RESULTS: We analyzed 2,761 patients for changes in pain severity. At initial assessment, 53.0% had no pain, 23.5% had mild pain, 10.3% had moderate pain, and 13.2% had severe pain. Overall, one third of patients with initial pain had pain reduction within 1 month of follow-up, and one fifth had an increase, and the improvement and worsening of pain varied by baseline pain score. Of the patients without pain at initial assessment, 28.4% had pain (8.9% moderate to severe) at the follow-up assessment. Logistic regression analysis showed that inadequate pain management was significantly associated with pain deterioration, as were lower baseline pain level, younger age, and poor health status. CONCLUSION: One third of patients have pain improvement and one fifth experience pain deterioration within 1 month after initial assessment. Inadequate pain management, baseline pain severity, and certain patient demographic and disease characteristics are associated with pain deterioration.
PURPOSE: To understand changes in pain severity over time and to explore the factors associated with pain changes in ambulatory patients with solid tumors. PATIENTS AND METHODS: We enrolled 3,106 patients with invasive cancer of the breast, prostate, colon/rectum, or lung from multiple sites. At baseline and 4 to 5 weeks later, patients rated their pain level on a 0 to 10 numerical rating scale. A 2-point change in pain score was defined as a clinically significant change in pain. Multivariable logistic models were fitted to examine the effects of pain management and demographic and clinical factors on change in pain severity. RESULTS: We analyzed 2,761 patients for changes in pain severity. At initial assessment, 53.0% had no pain, 23.5% had mild pain, 10.3% had moderate pain, and 13.2% had severe pain. Overall, one third of patients with initial pain had pain reduction within 1 month of follow-up, and one fifth had an increase, and the improvement and worsening of pain varied by baseline pain score. Of the patients without pain at initial assessment, 28.4% had pain (8.9% moderate to severe) at the follow-up assessment. Logistic regression analysis showed that inadequate pain management was significantly associated with pain deterioration, as were lower baseline pain level, younger age, and poor health status. CONCLUSION: One third of patients have pain improvement and one fifth experience pain deterioration within 1 month after initial assessment. Inadequate pain management, baseline pain severity, and certain patient demographic and disease characteristics are associated with pain deterioration.
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