Association of pain with the presence of additional supportive care (SC) needs in patients with advanced cancer.
Authors: de la O Murillo Andrea , Torres Ana Cristina , Ramos-Lopez Wendy Alicia , Covarrubias-Gómez Alfredo , Quiroz Paulina , Sánchez-Román Sofia , Alcocer Natasha , Milke Pilar , Carrillo Monica , Monroy Chargoy Javier , Morales Alfaro Andrea , Chavarri Guerra Yanin , Soto Pérez de Celis Enrique 
Published: June 2022

e24071

Background: SC includes the prevention and management of the adverse effects of cancer and its treatment. One of the main needs of patients is the mitigation of pain, which is often associated with other symptoms. We studied the presence of pain and its relationship with other symptoms among patients with metastatic cancer enrolled in a SC patient navigation program at a Mexican cancer center. Methods: This was a secondary analysis of a prospective study of adult patients with newly diagnosed metastatic solid tumors at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City. Patients' SC needs were assessed using validated questionnaires to create a personalized SC plan by a multidisciplinary team. Interventions included pain management, physical therapy, geriatric assessment, psychological support, and nutritional interventions. Descriptive statistics, X2, and Student's T tests were used to compare patients with and without pain. A multivariate model was used to determine the effect of pain and other patient-related factors on the presence of additional SC needs. Results: We included 336 patients with newly diagnosed metastatic solid tumors enrolled in the patient navigation program between 04/2018 and 10/2020 (median age 64 years, range 19-94 years). 46% reported moderate/severe pain, 74% anxiety/depression, 71% fatigue, 37% caregiver collapse, 59% sleep disturbances, 43% required advance directives, 39% had abnormal geriatric evaluation, and 74% risk of malnutrition, with a mean of 4.3 recommended interventions per patient. Patients with pain were more likely to screen positive for anxiety/depression (88 vs. 61%, p < 0.01), to need physical therapy (87 vs. 57%, p < 0.01), to report sleep disturbances (72 vs. 48%, p < 0.01), to have an abnormal geriatric screening (43 vs. 63%, p < 0.1), to require nutritional interventions (84 vs. 65%, p < 0.01), and to have a life expectancy of < 6 months (65 vs. 25%, p < 0.01). The mean number of SC needs for patients reporting pain was 5.8 (95% CI 5.5-6.1) compared to 3.1 (95% CI 2.8-3.4) in those without pain. On multivariate analysis, the presence of moderate/severe pain was associated with increased odds of screening positive for anxiety or depression (OR 3.1, CI 95% 1.62-5.75), and fatigue (OR 2.8, CI 95% 1.49-5.10), while increasing age was found to be inversely associated with the odds of reporting psychological problems (OR 0.9, 95% CI 0.95-0.99). Conclusions: Patients with metastatic solid tumors who report pain require a significantly greater number of interventions and have more additional SC needs, particularly those related to psychological support. These results highlight the importance of multidisciplinary management in patients with advanced cancer, as well as the relevance of collaboration with psychology professionals when providing pain control.