Abstract A020: Patients with pancreatic cancer reporting prediagnosis pain have greater pain intensity scores, symptom burden, and ER visits: need for improved, ongoing management in pancreatic pain and associated symptoms
Authors: McNearney Terry A. , Digbeu Biai D.E. , Ladnier Dennis , Abdilleh Kawther , Doss Sudheer , Matrisian Lynn M. , Baillargeon Jacques G. 
Published: November 2022

Abstract
Objective: This study assessed the pancreatic cancer (PC) patient-reported burdens of PC pain from 2016-2020 in an online patient-reported outcomes (PRO) survey supported by the Pancreatic Cancer Action Network (PanCAN). Assessments of PC symptoms, PC pain intensity, physical and mental functioning, associated symptom management and resource utilization were analyzed between PC patients reporting prediagnosis PC pain vs those who did not. Methods: Through years 2016 - 2020, PC patient volunteers filled out an online PRO survey composed of independent surveys and standalone items in this cross-sectional study. PC patient responses to Patient Information, PC Experience, General Health Assessment and Pain Management surveys were collected to assess PC pain and related factors in activities and associated symptoms. Comparisons between PC patient group responses to two survey items were assessed: 1) presence or absence of prediagnosis PC pain; 2) pain intensity, scored by an 11-point numeric rating scale (NRS). Patient groups: NRS=0-3 (none to mild pain) and NRS=5-8 (moderate to severe pain). Descriptive statistics were used for numbers and frequencies and all bivariate analyses were performed using Chi-square or Fisher’s Exact tests. Results: Survey responses to 108 items ranging from 5-100% participation were collected and analyzed from 1978 PC patient volunteers. Significant differences were noted in postdiagnosis average pain intensities based on presence or absence of prediagnosis pain: NRS 2.64+2.54 vs NRS 1.56+2.01, respectively, p=0.0039. The presence of PC pain (abdominal and/or back pain) was the most frequent prediagnosis symptom reported (62%, N=1222) followed by digestive problems (55.32%, p=0.0001), weight loss and/or loss of appetite (54.88%, p=0.0001) and fatigue (46.54%, p=0001). Significantly greater impairment of those with prediagnostic pain was noted in 45% of 20 health assessment statements, including pain interference&gt;physical functioning &gt;anxiety &gt;depression &gt;fatigue, and increased resource utilization for PC pain management was noted (ER visits N=42 vs N=8 respectively, p=0.018 and/or hospitalizations, N=30 vs N=4, respectively, p=NS). Patient responses to pain ranged from NRS 0-8 (N=155), and group NRS 5-8 scores reported had significantly greater impairment in 85% of 20 health assessment statements. No improvements in average pain intensity scores were noted between yrs 2018-2020 vs yrs prior to 2018. Conclusions: PC pain is the most frequent prediagnostic PC symptom and is associated with an increase in postdiagnosis average pain intensity, greater impairment in physical function, and an increase in ER visits compared to those who do not report prediagnostic pain. The results suggest that PC pain is not adequately managed early in the course of the disease. There is a need to better assess symptoms, QOL, and therapeutic interventional outcomes to determine the contribution of improvements in tumor reduction and survival with patient symptom reduction and better physical and mental functioning.
Citation Format: Terry A. McNearney, Biai D.E. Digbeu, Dennis Ladnier, Kawther Abdilleh, Sudheer Doss, Lynn M. Matrisian, Jacques G. Baillargeon. Patients with pancreatic cancer reporting prediagnosis pain have greater pain intensity scores, symptom burden, and ER visits: need for improved, ongoing management in pancreatic pain and associated symptoms [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A020.