Predictors of Pain Among Patients With Head and Neck Cancer

Shuman, Andrew G.; Terrell, Jeffrey E.; Light, Emily; Wolf, Gregory T.; Bradford, Carol R.; Chepeha, Douglas B.; Jiang, Yunyun; McLean, Scott A.; Ghanem, Tamer; Duffy, Sonia A.

doi:10.1001/jamaoto.2013.853

Cited by 49 publications

(50 citation statements)

References 61 publications

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“…While positive associations were found between depressive symptoms and worst pain, 6,45,47 in this study, higher levels of depressive symptoms were associated with higher pain relief scores. One potential explanation is that our patients with depressive symptoms received antidepressants with analgesic effects.…”

Section: Predictors Of Each Pain Characteristiccontrasting

confidence: 59%

“…A list of proposed predictors was developed based on a review of the literature on pain in patients with HNC (Table 1). 6,11,15,27,29,35,43,45,47,56 To improve estimation efficiency and to construct parsimonious models, exploratory analyses were performed in which each potential predictor was assessed to determine whether it would result in a better fitting model if it alone was added as a level 2 predictor. Predictors with a t value of ,2, which indicates a lack of significant effect, were dropped from subsequent model testing.…”

Section: Discussionmentioning

confidence: 99%

“…Similar associations were found in other studies of oncology patients. 20,47 Pain is one of the primary factors that precipitate sleep disturbance in patients with cancer. 51 In addition, sleep disturbance increases one's sensitivity to pain.…”

Section: Predictors Of Each Pain Characteristicmentioning

confidence: 99%

“…Findings on the association between pain intensity and the receipt of chemoradiotherapy were not consistent. 11,15,27,35 Among 3 crosssectional 29,43,56 and 3 longitudinal 6,45,47 studies that evaluated pain after HNC treatment, higher pain intensity scores were associated with younger age, 43,45 older age, 6 less education, 47 smoking, 29 surgery combined with RT, 56 neck dissection, 47 higher RT doses, 6 feeding tube, 47 xerostomia, 47 difficulty with speech or swallowing, 6 pretreatment pain, 47 use of pain medication, 47 worse physical and mental health, 45 less activity, 47 sleep problems, 47 and depressive symptoms. 6,45,47 None of these studies evaluated all of these characteristics in the same sample or whether they predicted changes in pain scores across the treatment trajectory.…”

Section: Introductionmentioning

confidence: 99%

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Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy

Astrup

Rustøen

Miaskowski

et al. 2015

Pain

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Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (e.g., rrence of surgery), other predictors (e.g., symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC.

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Section: Predictors Of Each Pain Characteristiccontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Predictors Of Each Pain Characteristicmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy

Astrup

Rustøen

Miaskowski

et al. 2015

Pain

View full text Add to dashboard Cite

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“…[3][4][5] A systematic relationship between fatigue, sleep, and decreased quality of life exists in cancer patients, and previous data from our institution have shown that poor sleep quality is also associated with increased patient-reported bodily pain. [6][7][8][9] Sleep is frequently impaired in cancer patients, with prevalence rates of 30% to 50% in newly diagnosed patients and remaining significant at 23% to 44% by 2 to 5 years after treatment. 10,11 Specifically, HNCa patients show increased problems with sleep during and after chemoradiation, including difficulty falling asleep, awakening during sleep, awakening feeling short of breath, and trouble staying awake during the day.…”

mentioning

confidence: 99%

Obstructive Sleep Apnea and Fatigue in Head and Neck Cancer Patients

Zhou

Jolly

2015

American Journal of Clinical Oncology

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There is a systematic relationship between fatigue, sleep, and decreased quality of life in cancer patients, with notably poor sleep quality among many head and neck cancer patients during and after treatment. An often overlooked cause of sleep disturbance in this patient population is obstructive sleep apnea (OSA). This review explores the current literature on the prevalence and clinical correlates of OSA, management outcomes, and data on cytokine-mediated fatigue in OSA. OSA appears to be prevalent in head and neck cancer patients, both at baseline and after treatment, especially with multimodality therapy including radiation therapy. Predictors of developing OSA include larger tumor size and hypopharynx or larynx primary site. There is evidence that the level of fatigue seen in these patients is not necessarily correlated with the severity of their OSA. Current research highlights the role of proinflammatory cytokines, which can also be synergistically activated by radiation therapy, as mediators of fatigue. Primary management of OSA consists of continuous positive airway pressure. Although continuous positive airway pressure has been shown to improve clinical symptoms, compliance with its use remains a problem and will be an area of future research.

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