Pain Quality by Location in Outpatients with Cancer

Risk factors for chronic postsurgical pain following thoracoscopic surgery for lung cancer

OBJECTIVE

Chronic post-surgical pain (CPSP) following thoracoscopic lung cancer surgery is a common and challenging complication. Identifying risk factors and predictive markers is essential for improving patient outcome.

METHODS

In this retrospective case-control study, the clinical data from 106 patients with non-small cell lung cancer (NSCLC) who underwent thoracoscopic radical resection between January 2021 and December 2023 were comprehensively analyzed. Patients were divided into a CPSP group (n = 41) and a non-CPSP group (n = 65) based on CPSP status. An external validation cohort of 20 patients was also assessed. Demographic data, perioperative characteristics, psychological states, and pain scores were compared between the two groups. Logistic regression analysis was used to identify predictors of CPSP, and their predictive performance was validated using receiver operating characteristic (ROC) curve analysis.

RESULTS

Age and TNM stage were significantly higher in the CPSP group (P < 0.001). Significant differences were observed in pain scores on postoperative days 1-3 and Fear of Pain Questionnaire-III (FPQ-III) scores (P = 0.003 and P < 0.001, respectively) between the two groups. Multivariate logistic regression identified age (OR, 1.230; P < 0.001), TNM staging (OR, 5.106; P < 0.001), early postoperative pain score (OR, 1.868; P = 0.012), and FPQ-III score (OR, 1.135; P < 0.001) as independent predictors of CPSP. A nomogram based on these predictors demonstrated excellent discrimination ability, with an area under the curve (AUC) of 0.891. External validation yielded an AUC of 0.956, confirming high sensitivity (1.00) and specificity (0.923).

CONCLUSION

Age, advanced TNM stage, early postoperative pain intensity, and higher fear of pain are significant predictors of chronic postoperative pain following thoracoscopic lung cancer surgery. Incorporating these factors into predictive models may improve postoperative management and reduce CPSP incidence.

Distinct Worst Pain Profiles in Oncology Outpatients Undergoing Chemotherapy

BACKGROUND

While pain is a significant problem for oncology patients, little is known about interindividual variability in pain characteristics.

OBJECTIVE

The aims of this study were to identify subgroups of patients with distinct worst pain severity profiles and evaluate for differences among these subgroups in demographic, clinical, and pain characteristics and stress and symptom scores.

METHODS

Patients (n = 934) completed questionnaires 6 times over 2 chemotherapy cycles. Worst pain intensity was assessed using a 0- to 10-point numeric rating scale. Brief Pain Inventory was used to assess various pain characteristics. Latent profile analysis was used to identify subgroups of patients with distinct pain profiles.

RESULTS

Three worst pain profiles were identified (low [17.5%], moderate [39.9%], severe [42.6%]). Compared with the other 2 classes, severe class was more likely to be single and unemployed and had a lower annual household income, a higher body mass index, a higher level of comorbidity, and a poorer functional status. Severe class was more likely to have both cancer and noncancer pain, a higher number of pain locations, higher frequency and duration of pain, worse pain quality scores, and higher pain interference scores. Compared with the other 2 classes, severe class reported lower satisfaction with pain management and higher global, disease-specific, and cumulative life stress, as well as higher anxiety, depression, fatigue, sleep disturbance, and cognitive dysfunction scores.

CONCLUSIONS

Unrelieved pain is a significant problem for more than 80% of outpatients.

IMPLICATIONS FOR PRACTICE

Clinicians need to perform comprehensive pain assessments; prescribe pharmacologic and nonpharmacologic interventions; and initiate referrals for pain management and psychological services.

Immunotherapy improved cancer related pain management in patients with advanced Hepato-Pancreatic Biliary Cancers: A propensity score-matched (PSM) analysis

Background

Hepato-pancreato-biliary (HPB) cancer is a serious form of cancer. in many HPB cancers, including cholangiocarcinoma (also known as bile duct cancer), pancreatic cancer, hepatocellular carcinoma, gallbladder cancer and ampullary cancer, although several treatment options are developed during these decades, the prognosis is still poor.

Methods

A total of 356 HPB cancers patients in advanced stage received different kinds of treatments including adjuvant chemotherapy, radiotherapy, targeted therapy and immunotherapy. Among these patients with advanced HPB cancers, 135 patients have received standard opioid treatment for pain controlling.

Results

We performed a PSM analysis to minimize differences between groups. Before PSM, 135 patients received standard opioid treatment for pain controlling were enrolled in this study and divided into 4 groups, including chemotherapy, radiotherapy, targeted therapy and immunotherapy. Relevant clinical variables that were available at the time of initial diagnosis were used for 1:1 matching between the two groups. After PSM, the cohort consisted of 18 patients in each group. Prior to PSM, patients received targeted therapy and immunotherapy exhibited shorter median OSs than their counterparts for patients received chemotherapy and radiotherapy (p&lt;0.001). there were so survival differences among all the four different treatments for these patients with HPB cancers (p&gt;0.05). We found the OMED (mg) q/day and NRS scores decreased significantly when patients received immunotherapy treatment. Fewer adverse events were showed between immunotherapy group and other three treatment groups, which was consistent with our previous reports.

Conclusion

In conclusion, we found that given the same survival benefit, immunotherapy reduced opioid consumption in HPB cancers patients and improved the pain management. Moreover, immunotherapy results in fewer other adverse effects.

Sociodemographic and Clinical Characteristics Associated With Worst Pain Intensity Among Cancer Patients

AIMS

Patients with cancer have pain due to their cancer, the cancer treatment and other causes, and the pain intensity varies considerably between individuals. Additional research is needed to understand the factors associated with worst pain intensity. Our study aim was to determine the association between worst pain intensity and sociodemographics and cancerspecific factors among patients with cancer.

DESIGN

A total of 1,280 patients with cancer recruited from multiple cancer centers over 25 years in the United States were asked to complete a questionnaire that collected respondents' demographic, chronic pain, and cancer-specific information.

SETTINGS

Worst, least, and current pain intensities were captured using a modified McGill Pain Questionnaire (pain intensity measured on 0-10 scale). A generalized linear regression analysis was utilized to assess the associations between significant bivariate predictors and worst pain intensity scores.Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (β = 0.6859), previous toothache pain (β = 0.0960), headache pain (β = 0.0549), and stomachache pain (β = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain.

CONCLUSIONS

Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (β = 0.6859), previous toothache pain (β = 0.0960), headache pain (β = 0.0549), and stomachache pain (β = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. Findings identified being Hispanic and having previous severe toothache, stomachache, and headache pain as significant predictors of worst pain intensity among patients with cancer. After controlling for selected covariates, we did not note statistical differences in worst pain during a 25-year period. Therefore,studies focused on improving the management of pain among patients with cancer should target interventions for those with Hispanic heritage and those with past history of severe common pain.

To Explore the Effects of Acupuncture and Medical Treatment at Different Times on the Gastrointestinal Reaction and White Blood Cell Count of Patients with Lung Cancer Chemotherapy

Objective

To explore and analyze the effects of acupuncture and medical treatment at different times on the gastrointestinal reaction and leukocyte count of patients with lung cancer undergoing chemotherapy.

Methods

Select 224 lung cancer chemotherapy patients admitted to our hospital and randomly divide them into three groups: control group (n = 76), study 1 group (n = 78), and study 2 group (n = 70). The control group was treated with tropisetron hydrochloride for 30 minutes before chemotherapy. Study 1 group was given tropisetron hydrochloride and acupuncture combination therapy 30 minutes before chemotherapy. Study 2 group was given tropisetron hydrochloride treatment 30 min before chemotherapy and acupuncture treatment 30 min after chemotherapy. Collect patients' general information and compare the three groups of white blood cell count, G-CSF, GM-CSF levels, quality of life and KPS score, platelets, neutrophils, hemoglobin levels, TCM symptom scores, and the degree of digestive tract reaction.

Results

The data of the control group and study groups 1 and 2 are comparable in gender, age, pathological type, etc. (P > 0.05). Before treatment, the white blood cell counts of the three groups were not significantly different (P > 0.05), significantly reduced after treatment, but the difference between the groups was not statistically significant (P > 0.05). The levels of G-CSF and GM-CSF in the three groups were not substantially different before treatment (P > 0.05). The levels of G-CSF and GM-CSF were considerably lowered in all three groups, although the drop in the study group was more significant (P > 0.05) when compared to that in the control group. Before treatment, the quality of life and KPS score of the three groups were not statistically different (P > 0.05). The three groups' quality of life and KPS scores fell after treatment, with the study 1 group experiencing the greatest reduction, followed by the study 2 group and the control group. The levels of platelets, neutrophils, and hemoglobin in all three groups declined dramatically, with the most noticeable reduction in the control group, followed by study 2 and study 1. The difference between the three groups was statistically significant (P < 0.05). The TCM symptom scores of the three groups showed an upward trend, but compared with those of the study 1 group and study 2 group, the TCM symptom scores of the control group increased significantly and the difference between the three groups was statistically significant (P < 0.05). The effective rates of the control group, study group 1, and study group 2 were 42.11%, 82.05%, and 62.86%, respectively; compared with that of the control group, the treatment efficiency of study groups 1 and 2 was higher and the difference between the three groups was statistically significant (P < 0.05).

Conclusion

Tropisetron hydrochloride is an effective treatment for patients with lung cancer before chemotherapy, which can effectively improve the side effects of nausea and vomiting caused by chemotherapy, reduce the white blood cell count, and improve the quality of life of patients; it plays an important role in the improvement of prognosis.