An exploratory, large-scale study of pain and quality of life outcomes in cancer patients with moderate or severe pain, and variables predicting improvement

Abstract

BackgroundThere have been few large-scale, real world studies in Spain to assess change in pain and quality of life (QOL) outcomes in cancer patients with moderate to severe pain. This study aimed to assess changes on both outcomes after 3 months of usual care and to investigate factors associated with change in QoL.Patients and methodsLarge, multi-centre, observational study in patients with lung, head and neck, colorectal or breast cancer experiencing a first episode of moderate to severe pain while attending one of the participating centres. QoL was assessed using the EuroQol-5D questionnaire and pain using the Brief Pain Inventory (BPI). Instruments were administered at baseline and after 3 months of follow up. Multivariate analyses were used to assess the impact of treatment factors, demographic and clinical variables, pain and other symptoms on QoL scores.Results1711 patients were included for analysis. After 3 months of usual care, a significant improvement was observed in pain and QoL in all four cancer groups (p<0.001). Effect sizes were medium to large on the BPI and EQ-5D Index and Visual Analogue Scale (VAS). Improvements were seen on the majority of EQ-5D dimensions in all patient groups, though breast cancer patients showed the largest gains. Poorer baseline performance status (ECOG) and the presence of anxiety/depression were associated with significantly poorer QOL outcomes. Improvements in BPI pain scores were associated with improved QoL.ConclusionIn the four cancer types studied, pain and QoL outcomes improved considerably after 3 months of usual care. Improvements in pain made a substantial contribution to QoL gains whilst the presence of anxiety and depression and poor baseline performance status significantly constrained improvement.

High symptom burden is associated with impaired quality of life in colorectal cancer patients during chemotherapy:A prospective longitudinal study

“…Chemotherapy might be associated with poorer QoL in CRC patients. [175] However, a significant association was observed in this cohort only in patients receiving oxaliplatin, who also reported more severe numbness/tingling. Patients' experience of numbness/tingling was associated with impaired physical QoL.…”

“…[ The MSAS includes the symptoms worrying and sadness, but not depression, [174] which affects QoL. [94,175] To assess depression, the SCQ-19, which contains the question "Are you depressed?" and information regarding medical treatment for depression, was used in the thesis research.…”

“…Previous research has shown that poorer performance status results in poorer QoL outcomes, [175] greater psychological distress, anxious preoccupation and hopelessness. [211] When previous findings and those of this thesis are summed up, they suggest that attention should be given to patients with reduced performance status to help to control their symptoms and improve their QoL.…”

Systematic Review and Meta-Analysis of Community- and Choice-Based Health State Utility Values for Lung Cancer

“…These two studies were analysed separately because the time since diagnosis could not be derived. The other four studies with repeated measures all reported loss to follow-up at each evaluated time point [40,46,50,52].…”

Health-related quality of life in patients with prostate cancer and their spouses: Results from a longitudinal study

“…Correspondingly, most men experience initial declines in HRQoL in the 2 years following their treatment; there is little change in years 3-10, and most differences between treatments attenuated over time (Punnen et al, 2015). On the other hand, a Spanish study in patients with lung, head, neck, colorectal, or breast cancer reported that after 3 months of usual care, there was a significant improvement in pain and the quality of life (Maximiano et al, 2018). Our findings show that clinically significant changes in HRQoL were not found in this study.…”