Pain in Head and Neck Cancer Survivors: Prevalence,Predictors,and Quality-of-Life Impact

Abstract

Objectives

Pain is common among patients with cancer, stemming from both malignancy and side effects of treatment. The extent to which pain persists after treatment has received little attention. We examined the prevalence, predictors, and impact on quality of life (QOL) caused by pain among survivors of head and neck cancer.

Study Design

Cohort study.

Setting

Tertiary head and neck cancer survivorship clinic.

Subjects and Methods

We identified survivors of head and neck cancer ≥1 year after diagnosis and examined the prevalence and risk factors for development of pain. Pain and QOL were assessed with multiple QOL instruments. Ordinal regression modeling examined predictors of pain in survivors.

Results

We identified 175 patients at a median of 6.6 years after diagnosis. Among survivors, 45.1% reported pain, and 11.5% reported severe pain. Among patients with current pain, 46% reported low overall QOL versus only 12% of those without pain (P < .001). On multivariable analysis after adjustment for age, sex, and stage of disease, pain was associated with trimodality treatment (odds ratio [OR], 3.55; 95% CI, 1.06-12.77). Multivariable analysis of QOL issues revealed that pain was associated with major depression (OR, 3.91; 95% CI, 1.68-9.11), anxiety (OR, 4.22; 95% CI, 2.28-7.81), poor recreation (OR, 3.31; 95% CI, 1.70-6.48), and low overall QOL (OR, 2.20; 95% CI, 1.12-4.34).

Conclusions

Years after head and neck cancer treatment, pain remains a significant problem and is associated with worse QOL. Future efforts should focus on preventing pain from treatment and comprehensive management.

Keywords

pain chronic pain analgesics opioids head and neck neoplasms quality of life survivorship

Get full access to this article

View all access options for this article.

References

Huxtable

Roberts

Somogyi

et al . Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care. 2011;39:804-823.

Levy

Chwistek

Mehta

. Management of chronic pain in cancer survivors. Cancer J. 2008;14:401-409.

Green

Hart-Johnson

Loeffler

. Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer. 2011;117:1994-2003.

Ciesielski

Iyengar

Bothra

et al . A tool to assess risk of de novo opioid abuse or dependence. Am J Med. 2016;129:699-705, e694.

Glare

Davies

Finlay

et al . Pain in cancer survivors. J Clin Oncol. 2014;32:1739-1747.

Burton

Fanciullo

Beasley

et al . Chronic pain in the cancer survivor: a new frontier. Pain Med. 2007;8:189-198.

Logan

Bartoshuk

Fillingim

et al . Metallic taste phantom predicts oral pain among 5-year survivors of head and neck cancer. Pain. 2008;140:323-331.

National Cancer Institute Office of Cancer Survivorship. Definitions. https://cancercontrol.cancer.gov/ocs/statistics/definitions.html. Published May 2014. Accessed October 2, 2017.

Hassan

Weymuller

Jr.

Assessment of quality of life in head and neck cancer patients. Head Neck. 1993;15:485-496.

10.

Rogers

Cleator

Lowe

et al . Identifying pain-related concerns in routine follow-up clinics following oral and oropharyngeal cancer. World J Clin Oncol. 2012;3:116-125.

11.

Ringash

. Survivorship and quality of life in head and neck cancer. J Clin Oncol. 2015;33:3322-3327.

12.

Chaturvedi

Engels

Pfeiffer

et al . Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29:4294-4301.

13.

Pulte

Brenner

. Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist. 2010;15:994-1001.

14.

van den Beuken-van Everdingen

. Chronic pain in cancer survivors: a growing issue. J Pain Palliat Care Pharmacother. 2012;26:385-387.

15.

Villa

Sonis

. Toxicities associated with head and neck cancer treatment and oncology-related clinical trials. Curr Probl Cancer. 2016;40:244-257.

16.

Rogers

Miller

Ali

et al . Patients’ perceived health status following primary surgery for oral and oropharyngeal cancer. Int J Oral Maxillofac Surg. 2006;35:913-919.

17.

Bianchini

Maldotti

Crema

et al . Pain in head and neck cancer: prevalence and possible predictive factors. J BUON. 2014;19:592-597.

18.

Gagliese

Melzack

. Age-related differences in the qualities but not the intensity of chronic pain. Pain. 2003;104:597-608.

19.

Shuman

Terrell

Light

et al . Predictors of pain among patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2012;138:1147-1154.

20.

Blanchard

Bollet

Dreyer

et al . Management of somatic pain induced by head and neck cancer treatment: pain following radiation therapy and chemotherapy. Guidelines of the French Otorhinolaryngology Head and Neck Surgery Society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131:253-256.

21.

Paice

Portenoy

Lacchetti

et al . Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34:3325-3345.

22.

Terrell

Welsh

Bradford

et al . Pain, quality of life, and spinal accessory nerve status after neck dissection. Laryngoscope. 2000;110:620-626.

23.

Cramer

Wisler

Gouveia

ACJ

. Opioid stewardship in otolaryngology: state of the art review. Otolaryngol Head Neck Surg. 2018;158:817-827.

24.

Dowell

Haegerich

Chou

. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315:1624-1645.