Trajectories of Pain in Patients Undergoing Lung Cancer Surgery: A Longitudinal Prospective Study

Abstract

Context. Lung cancer surgery is among the surgical procedures associated with the highest prevalence of pain, but prospective longitudinal studies following the pain trajectory are scarce. Objectives. We aimed to describe the pain trajectory in patients undergoing surgery for primary lung cancer and to investigate whether distinct groups of patients could be identified based on different pain trajectories. Methods. Patients (n = 264, 95% thoracotomies) provided data on the average and worst pain intensity, pain location, and comorbidities before, and at 1, 5, 9, and 12 months after surgery. Pain profiles were analyzed by latent class mixed models (LCMMs). Results. The occurrence of any pain increased from 40% before surgery to 69% after 1 month, and decreased to 56%, 57%, and 55% at 5, 9, and 12 months, respectively. LCMMs identified two classes both for average and worst pain; one class started low with high ratings after one month, then returning to a level slightly higher than baseline. The other class started higher with similar scores through the trajectory. Patients reporting no pain (8%) were placed in a separate class. Higher comorbidity score, preoperative use of pain and psychotropic medicine characterized the class with overall highest pain for average and/or worst pain. Conclusion. Pain was highly prevalent after surgery and subgroups could be identified based on different pain trajectories. Patients reported both postoperative pain and pain from chronic conditions. Knowledge about vulnerable patients and risk factors for pain is important to tailor interventions and information about pain.

Pain Prevalence During Cancer Treatment: A Systematic Review and Meta-Analysis

“…The year of publication of the included studies ranged from 2014-2020, including crosssectional studies (n= 2) (27,28), longitudinal cohort studies (n=8) (29)(30)(31)(32)(33)(34)(35)(36) and randomized controlled trials (n=2) (37,38) (see table 2). Eleven out of 12 included studies contained stage I-III cancer patients (27,28,38,(29)(30)(31)(32)(33)(34)36,37) and only one study contained stage I patients (35). This systematic review included 10 studies with breast cancer (27,28,(30)(31)(32)(33)(34)(36)(37)(38) and two studies with lung cancer patients (table 2) (29,35).…”

“…Eleven out of 12 included studies contained stage I-III cancer patients (27,28,38,(29)(30)(31)(32)(33)(34)36,37) and only one study contained stage I patients (35). This systematic review included 10 studies with breast cancer (27,28,(30)(31)(32)(33)(34)(36)(37)(38) and two studies with lung cancer patients (table 2) (29,35). There were nine pain prevalence rates reported up to three months after surgery (27,29,32,35,37,38), one during chemotherapy (28), two up to three months after chemotherapy (30,33) and five pain prevalence rates up to three months after radiotherapy (table 2) (31,34,36,38).…”

“…for Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) (27), in one study by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) early and late radiation morbidity scoring schemes (36), in one study by the MaTox questionnaire (30), in one study by the Brief Pain Inventory -Short Form (BPI-SF) (38), in three studies by the Brief Pain Inventory (BPI) (29,34,35), in three studies by the Visual Analogue Scale (VAS) (32,37), in one study by the Numeric Rating Scale (NRS) (28,33) and in one study by the Common Terminology Criteria for Adverse Events (CTCAE) (table 2) (31). In eight of the 12 studies (28,29,(32)(33)(34)(35)37,38), validated questionnaires for measuring pain within a cancer population were used (39-41). In the other four studies, it was unclear if the used questionnaire was also validated for measuring pain in particular (27,30,31,36).…”

Profiling Patient-Reported Symptom Recovery from Esophagectomy for Patients with Esophageal Squamous Cell Carcinoma: A Real World Longitudinal Study

“…Postoperative pain is the most prominent symptom that affects the quality of life of cancer patients [25][26][27]. Our results showed that the severity of pain after esophagectomy peaked on day 1 after surgery.…”

What's going on after hospital? – Exploring the transition from hospital to home and patient experiences of nurse‐led follow‐up phone calls

“…However, the patients say that they initially experience pain, fatigue and changes in their body and that this can make it difficult to meet their own and the health professionals' expectations. Oksholm et al (2015) have reported that, for example patients after lung cancer surgery may experience a high number of symptoms and also how especially pain may be highly prevalent (Gjeilo et al, 2020). Norlyk and Harder (2009, 2011) reach similar findings of the difficulty for patients to meet expectations in their studies on colon cancer patients in an ERAS programme.…”