Pain as a predictor of outcome in patients with operable pancreatic carcinoma Journal Article

Authors: Kelsen, D. P.; Portenoy, R.; Thaler, H.; Tao, Y.; Brennan, M.
Article Title: Pain as a predictor of outcome in patients with operable pancreatic carcinoma
Abstract: Background. The purpose of our study was to evaluate the relationship between pain and resectability and survival in patients with operable pancreatic carcinoma. Methods. Pain, pain intensity, and pain location were prospectively assessed in newly diagnosed patients with operable adenocarcinoma of the pancreas. Patients were evaluated before their first operation at a large tertiary care cancer center. Pain factors were then correlated with outcomes of surgery, including resectability and survival. Results. Seventy-seven patients with operable pancreatic carcinoma were evaluated before operation. With the Memorial Pain Assessment Card and a demographic questionnaire, an analysis of analgesic use and pain prevalence and intensity were quantitated. Twenty-two (29%) of 77 patients reported no pain. Fifty-five had mild to severe pain. Moderately severe or greater pain (Memorial Pain Assessment Card Tursky scores of 5 or greater or visual analogue self-assessment pain intensity scores greater than 30) was found in 20 patients. Twenty-six (34%) patients had resectable disease. Of the 51 patients who did not have resections, 35 had metastatic disease. Locoregional unresectable disease without metastases was found in 16 patients. Resectability was correlated with the presence of pain (p = 0.04). The median survival for all patients was 6.7 months. Not surprisingly, patients undergoing resection had a significantly better median survival than did those whose disease was unresectable (5.5 versus 15.1 months). Pain before operation significantly predicted survival (median survival for those with pain, 5. 7 months; for those without pain, 15 months; p = 0.003). Even among patients who underwent resection, the presence of pain was associated with a worse survival (21.9 months versus 9.2 months; p = 0. 045). In a multivariate analysis the two significant variables were inability to undergo resection and presence of any pain. Conclusions. The presence of pain in newly diagnosed patients with potentially operable pancreatic cancer is an ominous predictor of resectability and of survival. Even if the patient can undergo resection, the presence of preoperative pain is associated with a poor prognosis. Patients with operable pancreatic cancer who present with pain, even those whose evaluation shows a likelihood of resectability, are at high risk for recurrence with an impaired survival compared with those patients without pain.
Keywords: adult; cancer survival; clinical article; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; cancer recurrence; pancreatic neoplasms; cancer staging; laparotomy; prospective studies; adenocarcinoma; disease association; metastasis; pain; prevalence; prediction; pancreas carcinoma; diagnostic value; predictive value of tests; pain measurement; humans; prognosis; human; male; female; priority journal; article
Journal Title: Surgery
Volume: 122
Issue: 1
ISSN: 0039-6060
Publisher: Elsevier Inc.  
Date Published: 1997-07-01
Start Page: 53
End Page: 59
Language: English
DOI: 10.1016/s0039-6060(97)90264-6
PUBMED: 9225915
PROVIDER: scopus
Notes: Article -- Export Date: 17 March 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Murray F Brennan
    800 Brennan
  2. David P Kelsen
    360 Kelsen
  3. Howard T Thaler
    198 Thaler
  4. Yue Tao
    17 Tao